Alzheimer’s Disease

Alzheimer’s disease often begins with forgetfulness, then progresses with personality changes, leading to loss of verbal and motor skills. As the disease advances, the person may become unable to meet daily needs and therefore require care.

Alzheimer’s has three stages:

- Mild Alzheimer’s: Independence begins to decline at work and outside the home.

- Moderate Alzheimer’s: Problems begin in home life and self-care; supervision is needed in social relationships.

- Severe Alzheimer’s: With significant memory loss, the person becomes fully dependent.

What Should the Main Goals of Care Be?

The main goals in caring for a person with Alzheimer’s are: preserving the person’s functionality, reducing disability, organizing the environment and relationships to maintain stability, compensating for losses caused by the disease, and providing a therapeutic setting that protects individuality and sustains quality of life.

Common Behaviors Seen in Alzheimer’s and Their Causes

Because caregivers are the people closest to the patient, behavioral changes in Alzheimer’s patients first and most strongly affect caregivers. These changes are often frightening, and managing them can be challenging. While trying to cope, caregivers may attempt many different solutions.

Identifying Behavioral Problems

1) Observe the behavior:

- What is the behavior?

- Is it harmful?

- Did something trigger it?

- What happened immediately after the behavior?

- Could something be causing pain?

- Could it be related to medication or another illness? (To be sure, consult a physician.)

2) Explore potential solutions:

- Have the person’s needs been met?

- Could adjusting the environment help the person feel calmer?

- Can the environment be adapted for comfort?

- How can your response or approach be changed?

3) Try different responses:

- Did the new response help?

- Do other possible causes and solutions need to be explored?

- If so, what else can be done differently?

Behavioral Problems and Suggested Approaches

Aggressive Behaviors

Aggression may be verbal (shouting) or physical (hitting). It may stem from anger, fear, or frustration, or appear suddenly without a clear reason. Understanding the cause is extremely important. What can be done?

- Make sure the behavior is not caused by pain—pain can trigger aggression.

- Identify the cause urgently: consider what happened right before the behavior. If it’s due to unmet needs or not being able to get something, meeting the need may help.

- Focus on emotions behind the words/behavior. For example, a locked door may ensure safety but also cause frustration and trigger aggression.

- Be positive and reassuring.

- Approach calmly from the front so the person doesn’t feel threatened or defensive.

- Minimize distractions: review and adjust the environment to avoid similar triggers.

- Try a calming activity: music, massage, or exercise may help.

- Redirect attention to another activity; if aggression continues, try a different activity.

- Speak calmly and slowly, using a soothing tone.

- If the person is in a safe environment, step away briefly so the caregiver can take a moment.

Agitation or Anxiety

Patients may show reactions by shouting, acting stubbornly, or behaving impulsively. These signs can be frightening for caregivers. Reviewing the environment—what time it happens, what is occurring at that moment, and possible triggers such as pain, hunger, or sleepiness—can help identify the cause.

What can be done?

- Learn what triggers the agitation/anxiety.

- Provide reassurance: use calming sentences and let the person know you are there.

- Include the person in activities: encourage relaxation through art, music, or other activities.

- Change the environment: reduce excess stimuli (TV noise, clutter, distractions).

- Help them release energy: redirect to safe activities; a walk may help.

- Use lighting: to reduce nighttime restlessness, keep gentle lighting on and prevent glare from windows or mirrors.

Confusion / Mixing Things Up

A person with Alzheimer’s may not recognize familiar people or places, forget relationships, call family members by different names, or forget where home is. They may also misplace everyday objects like a pen or fork. This can be difficult for caregivers.

What can be done?

- Stay calm—even though it can be painful when the person doesn’t recognize you.

- Respond with short, simple explanations rather than long ones.

- Use photos and reminders to help recall important people and places.

- Create a predictable routine (e.g., meal and bedtime).

- Allow the person to dress themselves and hold their belongings when possible.

- Avoid frequent changes of place; use large, colorful labels at home (wardrobe, table, etc.).

- Use calendars, clocks, labels, and newspapers to orient to time.

- Don’t correct the person in an angry way.

- Don’t take it personally—Alzheimer’s causes forgetfulness; support and understanding matter.

Suspicion

Memory loss or confusion may cause suspicion toward others; the person may accuse others of stealing or wrongdoing and may misinterpret what they see or hear.

What can be done?

- Listen and try to be understanding; reassure them and acknowledge their feelings.

- Don’t argue or try to convince them; let them express their thoughts and accept their perspective.

- Give simple responses; avoid long explanations.

- Offer simple explanations for events that may trigger suspicion (e.g., “There’s an airplane flying overhead” for a loud noise).

- Keep the environment as consistent as possible; if changes are necessary, include familiar objects from the previous setting.

Hoarding

Patients may fear their belongings will be lost or stolen and begin hoarding to keep items “safe.”

What can be done?

- Pay attention to where they place items; check those places first when something is missing.

- Encourage activities that keep them occupied (e.g., organizing a drawer).

- Not recognizing the environment can contribute to hoarding—use reminders to help them feel familiar with the space.

Repetition / Repetitive Behaviors

Because they forget, a person may repeat a word or question. This can be upsetting and stressful for caregivers.

What can be done?

- Identify the reason for the repetition and focus on the underlying cause.

- Focus on the person’s feelings rather than reacting to the behavior itself.

- Turn the behavior into an activity (e.g., if they rub the table, give a cloth and ask for help dusting).

- Be calm, patient, and consistent; use a gentle tone and touch. If explanations don’t help, redirect attention (walks, favorite activities).

- Answer in one sentence; even if you repeat it, respond as if it’s the first time. Notes and reminders can help.

- Keep the person engaged; they may be bored and need distraction (walks, puzzles).

- Use memory aids such as notes, clocks, calendars, or meaningful photos.

Wandering and Getting Lost

Wandering or getting lost is common and can occur at any stage. Even at home, the person may try to “go home” or attempt to repeat an old routine (school, work). As the disease progresses, supervision becomes necessary, and being alone may not be safe.

What can be done?

- Encourage activity: staying active can reduce anxiety/restlessness and help prevent wandering or escape attempts.

- Involve the person in household tasks (cooking, laundry, preparing dinner). If going outside interests them, accompany them for walks or safe outdoor activities.

- Ensure home safety: install bolts/locks on exterior doors and limit access to potentially dangerous areas.

- Inform others: tell family, friends, and neighbors that the person has Alzheimer’s and may wander or attempt to leave.

- Have identification items available (ID bracelet, etc.).

Why Is Exercise Important in Alzheimer’s?

Withdrawing from daily activities, mood changes, loss of appetite, reduced quality of life, and triggered depression can lead to rapid musculoskeletal problems and may cause the disease stage to progress, making independent living harder (Stechmiller, 2003; Akça, 2014). Studies in the literature show that aside from exercise therapy—considered a non-pharmacological treatment—no other treatment method leads to increased muscle strength in Alzheimer’s patients. Therefore, exercise therapy is very important for all geriatric individuals and people with Alzheimer’s.

In a 3-month study at Heidelberg University in Germany, groups of up to 8 Alzheimer’s patients participated twice a week in 120-minute sessions including walking, balance training, and simple math exercises. In addition, intensive physical strength and functional training were included. As a result, positive and significant improvements were observed in patients’ motor functions and cognitive performance.

Conclusion

Recognizing the disease, knowing its stages, identifying possible behavioral problems, and finding appropriate solutions becomes much easier with good follow-up and education.