Dementia or Some Other Cause?


I had the pleasure of spending the past week with my grandchildren, ages 1 and 3 as they visited for Thanksgiving.  Having small children around the house again can be an eye-opening experience when one has not experienced this for a few years. There are moments of happiness, moments of sadness, moments of anger, moments of terror and moments of I don’t know what is happening.  The mood and behavior of little children change drastically with temperature, comfort, pain (doesn’t take much), hunger, loneliness, happiness, sadness, acceptance, rejection, and the list goes on.  When small children have these mood changes, their reaction is usually one of unpleasant cries, with no ability to communicate exactly what they need or want.  We accept these changes as part of their make-up and usually try and satisfy them with food, love and comfort.

By contrast, we respond to adults that cannot communicate their needs in an entirely different way.  We call their response to unknown stimulus “behaviors”.  This infers that what is happening is a choice and they are acting in an unacceptable way to society – to be blunt, we think they are “being bad”.  Every human being at one point in time will probably stub a toe, or at least hurt their foot by stepping on something sharp. When one does this, the reaction is usually a load scream, shirk, cry, or otherwise yell. Do we call this bad?  Do we call this a “behavior”?

I spend a great deal of my time assessing seniors for the need for care.  Most of these individuals have some level of memory loss.  From time to time, I hear individuals describe their loved-ones “behaviors,” and I shirk as I hear the word, as it is usually associated with some type of Dementia and blamed on the Dementia.  “My wife swore at me for the first time!”  “My husband struck me, and this is not who he is!”  “My mother is acting out and cannot be trusted.”  How do we know these people didn’t just stub their toe and have no ability to communicate it?

Susan Macaulay wrote an article for “My Alzheimer’s .com”  identifying over 100 causes of discomfort among people that may be the actual cause of these “so called behaviors”, instead of the Dementia diagnosis itself.  Her research began with the research of Dr. Jiska Cohen-Mansfield of the Herczeg School of Health.  Here some of those potential causes.  As you read them, think to yourself, “would any of these cause me to change my behavior, my mood, my attitude, my day?

  1. feeling tired or sleepy
  2. sitting for too long
  3. being restrained
  4. inadequate lighting

Physical discomfort (33)

  1. pain
  2. constipation
  3. incontinence
  4. forced incontinence (needing help with toileting, but no help available)
  5. being wet / soiled
  6. being assaulted
  7. being neglected and/or abused
  8. feeling hot
  9. feeling cold
  10. fatigue
  11. exhaustion
  12. hunger
  13. thirst
  14. breathing difficulties
  15. hearing problems
  16. vision problems
  17. sensory issues
  18. reaction to food (e.g. caffeine)
  19. stomach upset
  20. being restrained
  21. dry skin
  22. itchiness
  23. poor diet
  24. malnutrition
  25. ill-fitting clothes
  26. insufficient bathing
  27. lack of exercise
  28. weakness
  29. illness (e.g. various infections including UTIs)
  30. inability to verbally communicate (e.g. aphasia)
  31. being denied touch
  32. unmet sexual needs
  33. experiencing the side effects of medications (e.g. risperidonequetiapine,) and/or polypharmacy

Psychological discomfort (36)

  1. fear
  2. confusion
  3. frustration
  4. boredom
  5. loneliness
  6. shame
  7. depression
  8. despair
  9. hopelessness
  10. grief
  11. loss
  12. humiliation
  13. isolation
  14. lack of love
  15. lack of attention
  16. feeling out of control
  17. feeling incompetent
  18. feeling unheard
  19. feeling worried
  20. feeling panicky
  21. feeling powerless
  22. being a “stranger in a strange land”
  23. being restrained/denied one’s freedom of movement or voice
  24. being told what to do
  25. being neglected
  26. being abused
  27. not getting to do what one wants
  28. too much stimulation
  29. too little stimulation
  30. too much routine
  31. too little routine
  32. life changes
  33. being purposeless
  34. being denied pleasure and play
  35. anxiety (resulting from all of the above and below)
  36. feeling angry (resulting from all of the above and below)

Social discomfort (16)

  1. having strange people all around
  2. being in close quarters with others
  3. being isolated
  4. being punished
  5. being ridiculed
  6. being bullied
  7. too much social stimulation
  8. too little social stimulation
  9. forced activity
  10. forced inactivity
  11. being denied access to loved ones
  12. being patronized
  13. being infantilized
  14. being shamed
  15. being embarrassed
  16. being forced to interact with people one doesn’t like

Environmental factors (16)

  1. noise
  2. unknown sounds
  3. loud sounds
  4. radio / television
  5. too much light
  6. too little light
  7. heat
  8. cold
  9. clutter
  10. uninteresting surroundings
  11. unfamiliar surroundings
  12. change in surroundings
  13. being confined to a small space
  14. being confined indoors
  15. stale air / lack of ventilation
  16. lack of sun