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Judson Haims: Caregiving through stages of dementia

Judson Haims
Special to The Aspen Times

There are many types of dementia — Alzheimer’s disease is just one. While it is common to hear people use Alzheimer’s as a general term for dementia, like using “Kleenex” in lieu of tissue, not all types of dementia are Alzheimer’s.

Dementia is not a specific disease. Rather, it is a group of symptoms that most often occur together. Dementia is a rather general term for the impaired ability to remember, make decisions and reason such that it interferes with a person’s daily life and activities.

There are many types and causes of dementia. While Alzheimer’s disease is the most common type, there are others. Parkinson’s disease dementia (PDD), Lewy body dementia (LBD), and vascular dementia are a few of the most common types.



Causes of Alzheimer’s dementia are often due to an abnormal buildup of two proteins called amyloid and tau. Deposits of amyloid cause clumps to build into plaque deposits between neurons and deposits of tau form “tangles” within brain cells — both proteins cause brain degeneration.

The cause of Parkinson’s disease dementia is unknown. However, scientists believe that it may be due to an abnormal clumping together of a protein called alpha synuclein. While alpha synuclein occurs normally in the brain, scientist do not yet understand what causes it to build up in large amounts. As more and more of this protein clump together, nerve cells die and affect functions such as memory and thinking.




Lewy body dementia is a type of progressive dementia very similar to Parkinson’s disease dementia. Like PDD, alpha-synuclein protein deposits are believed to greatly influence this disease. Deposits of alpha-synuclein protein affect chemicals in the brain called neurotransmitters that act as messengers between brain cells. As these neurotransmitters decrease, memory, learning, behavior, cognition, movement, motivation, sleep and mood are greatly affected.

Vascular dementia is a decline in thinking skills caused by an interruption or blockage of blood supply to the brain. When blood supply is impeded for a few seconds, the brain cannot get oxygen and cells can die, causing permanent damage to one’s memory, thinking and reasoning.

All of these dementia types will at one time cause behavioral changes.

Learning about the various behavioral changes associated with these diseases will help provide perspective, understanding and context. For the most part, people who have dementia will at some point behave in ways that may be vastly different from how they have acted in the past. Frequently, these new behavior types are expressively reactive; however, they may be passive, as well.

Reactive behaviors are behaviors that depend on external events that are outside of one’s influence or control. A good or bad day depends completely on what happens around someone. They often present when someone is agitated and protests (sometimes with violence), cries and/or laughs uncontrollably, or falsely accuses someone as a result of something said in conversation.

Passive behaviors are when a person hoards objects, keeping feelings to themselves, hide feelings from others, acts with suspicion, paces the floor, or acts paranoid. Often people with passive behaviors appear quiet and sometimes nonchalant giving up their own rights and (directly or indirectly) defer to the rights of another person.

These behavior changes frequently interfere with relationships and cause difficulties. Here are some suggestions I hope may help:

Do not take their behavior personally: What often drives someone’s difficult behavior is that they perceive an obstacle to what they want.

Separate the person from the behavior: Look beyond the behaviors and ask yourself what’s triggering that behavior. Someone’s behavior does not always define them as a person. Find out what their intentions are.

Provide an alternative behavior: “I want to listen to your concerns, but I need you to stop yelling.” Try explaining how you perceive the behavior and why a different behavior may be beneficial.

Those who care for someone with dementia should understand that they cannot change the disease and the resulting behaviors, but they can learn to cope with them. Understanding that changes in the brain are causing challenges to one’s ability to make sense of the world around them is important.

Here are two great websites I often refer people to learn more about managing changes in dementia: the National Institute on Aging’s managing Alzheimer’s changes and the Alzheimer’s Association page on stages and behaviors.

Judson Haims is the owner of Visiting Angels Home Care in Aspen, Basalt, and Carbondale. He is an advocate for our elderly and is available to answer questions. His contact information is http://www.visitingangels.com/comtns or 970-328-5526.


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