Alzheimer's / Dementia Disinhibited Behaviors in Dementia 5/13/2022 | By Kari Smith Disinhibited behaviors in Alzheimer’s and other dementia patients can be common – and embarrassing. Seniors Guide looks at these impulsive behaviors and ways to respond appropriately. As Jess’s father’s dementia became more pronounced, his filters faded. This otherwise kind man would frequently note people who were overweight (not that he was the picture of slim and trim). He seemed to display racist tendencies that Jess hadn’t seen before. He once threw ice cream at an attendant in his nursing home. And his comments about the artwork as the father and daughter toured a Pablo Picasso exhibition were not complimentary – and not quiet! Others with dementia display similar behaviors. They may flirt inappropriately or make lewd comments, fondle themselves in front of others, and even take off some or all of their clothes in inappropriate settings. Such comments and actions can be alarming and embarrassing to loved ones and caregivers. We may know that the person would not have acted this way earlier in their lives. The primary fact to understand is that these behaviors do not reflect the person you have known – instead, the behaviors are manifestations of a disease. Impulsive behaviors can be a sign of neurodegenerative diseases such as Alzheimer’s and other forms of dementia. They can also happen with Parkinson’s, some forms of mental illness, and even some forms of cancer, such as liver cancer, where toxins build up in the body and affect brain function. Diseases that affect the brain have the potential to affect language, since language is controlled by both the left and right sides of the brain. As Alzheimer’s disease destroys the left side of the brain, which controls the more “formal” part of our language, patients have difficulty finding the words they search for. The right side of the brain controls a more creative or automatic way of speaking – including profanity – so fading function in this hemisphere could result in a patient more easily finding and using words that they are not normally accustomed to using. This language phenomenon could also be due to a cognitive deficit, or a loss of inhibition that can result in swearing, name-calling or using vulgar, demeaning, or inappropriate language. How to respond to disinhibited behaviors in dementia Such foul or surprising language could happen spontaneously, or it could be triggered by specific events. Common triggers can include changes in surroundings or routines, new people or places, or interpersonal communication that feels attacking or demeaning. Identify First, try to identify the trigger. Perhaps something set off the disinhibited behaviors. Did something happen right before the foul language began? Is something different in this situation from what he or she is accustomed to? Are they tired, hungry, thirsty? Could medications be causing side effects? Is the environment loud and overwhelming? There may be no clear trigger, but if you are able to figure one out, it may help to identify a common cause of onset so you can help to avoid it in the future. Ignore In some situations, ignoring the language may be the easiest fix. This may be easier said than done, especially if the language is harassing or abusive. Address If you find that addressing foul or unexpected language is helpful, go for it – gently but firmly. You will figure out quickly whether or not you are wasting your energy on a situation where you have no control. Keep in mind that speaking to a patient with neurodegenerative disease in a way that comes across as demeaning may be a trigger for more bad behavior. Instead, follow positive communication strategies for people with Alzheimer’s and other dementias. Distract or redirect Distracting or redirecting is a great way to move past the incident without giving it much attention. Do something physical such as going for a walk, playing a board game, or turning on a favorite show to divert attention to something more enjoyable. Step away from disinhibited behaviors when possible Chances are, you are extremely frustrated and embarrassed by these outbursts of disinhibited behaviors. Talk to your loved ones’ doctor about possible treatments, but also take care of yourself. If it is safe to do so, walk away. Take a break and spend some time alone, or call for another caretaker who can take over while you regain your composure, as your agitation may escalate the situation. Spread kindness and understanding Be prepared to address potentially embarrassing public situations by carrying business cards that let people know that your loved one has Alzheimer’s, dementia, or a similar disease. You can easily make them yourself, print using an online template, or purchase some online. These cards will help discreetly explain inappropriate outbursts and may help prevent any sort of confrontation. Related: Positive communication strategies for people with Alzheimer’s and other dementias Have patience Most of all – have patience. Keep in mind that when dementia or Alzheimer’s patients suffer with language deficits, this usually means that their disease progression is moderate to severe, and that this deficit severely affects their quality of life. Losing the ability to control language and express oneself is emotionally distressing and can cause frustration, depression, and a loss of community. It is hard to imagine how maddening communication disability must feel, so make the effort to show a bit of extra grace. Read More Kari Smith Kari Smith is a frequent contributor to Seniors Guide, helping to keep those in the senior industry informed and up-to-date. She's a Virginia native whose love of writing began as a songwriter recording her own music. In addition to teaching music and performing in the Richmond area, Kari also enjoys riding horses and farming. Related Resources Deep Pressure Stimulation for Seniors An increasingly popular therapy, Deep Pressure Stimulation, has spawned products promising to help a variety of issues, with easy do-it-yourself ... [Read More] 5/13/2022 | By Faith Boluwatife How the Brain Can Stay ‘Young’ Even as we get older, we can continue to remain mentally strong through a process known as neuroplasticity. Learn more ... [Read More] 5/13/2022 | By Howard LeWine, M.D.