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    Dementia Symptoms & Caregiver Strategies: Managing Irritability in Cognitively Impaired Adults

    Common changes in behavior
    Many people find the changes in behavior, such as increased irritability, caused by cognitive impairment to be challenging and distressing. Medication, environmental influences and some medical conditions also can cause symptoms or make them worse.

    Triggering situations
    Events or changes in a person's surroundings often play a role in triggering irritability in cognitively impaired individuals.

    Change can be stressful for anyone and can be especially difficult for a person with cognitive challenges. It can increase the fear and fatigue of trying to make sense out of an increasingly confusing world.

    Situations that may increase irritable behavior include:

    • Moving to a new residence
    • Changes in a familiar environment or caregiver arrangements
    • Misperceived threats
    • Admission to a hospital
    • Being asked to bathe or change clothes
    Identifying what has triggered the irritability can often help in selecting the best approach to deal with it. Non-drug approaches to managing behavior promote both physical and emotional comfort and should always be tried first.

    Steps to developing successful non-drug treatments include:
    • Recognizing that the person is not just "acting mean or ornery" but is suffering from the symptoms of cognitive challenges
    • Identifying the cause of the irritability and how the behavior may relate to what your loved one is experiencing
    • Changing the environment to resolve challenges and obstacles to increase comfort, security and ease of mind
    Possible medical causes
    Contributing medical factors for irritable behavior may include:
    • Drug side effects. Many people with cognitive impairment often take prescription medications for other health issues. Drug side effects or interactions among drugs can affect behavior.
    • Discomfort from infections or other conditions. As cognitive challenges increase, loved ones have increasing difficulty communicating with others about their experience. As a result, they may be unable to report symptoms of common illnesses. Pain from infections of the urinary tract, ear or sinuses may lead to restlessness or agitation. Discomfort from a full bladder, constipation, or feeling too hot or too cold also may be expressed through behavior.
    • Uncorrected problems with hearing or vision. These can contribute to confusion and frustration and foster a sense of isolation.
    Coping tips
    • Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature.
    • Avoid being confrontational or arguing about facts. For example, if a person expresses a wish to go visit a parent who died years ago, don't point out that the parent is dead. Instead, say, "Your mother sounds like a wonderful person. I would like to see her too."
    • Redirect the person's attention. Try to remain flexible, patient and supportive by responding to the emotion, not the behavior.
    • Create a calm environment. Avoid noise, glare, insecure space and too much background distraction, including television. Putting on soothing music in the background can also help.
    • Allow adequate rest between stimulating events.
    • Provide a security object such as a favorite blanket, rosaries, beads, or a doll.
    • Acknowledge requests, and respond to them.
    • Look for reasons behind each behavior. Consult a physician to identify any causes related to medications or illness.
    • Explore various solutions.
    • Don't take the behavior personally.
    Medications for behavioral symptoms
    If non-drug approaches fail after being applied consistently, introducing medications may be appropriate for individuals with severe symptoms or who have the potential to harm themselves or others. While prescription medications can be effective in some situations, they must be used carefully and are most effective when combined with non-drug approaches.

    Irritability is frequently a symptom of cognitive impairment. While very difficult for families and caregivers, it is important to remember that your loved one does not mean to upset you. To reduce your own stress, make sure to look after yourself and take regular breaks.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: