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When Caregivers Are Abused

How to address anger and aggression from a loved one with dementia

Diseases such as Alzheimer's and dementia can cause behavioral changes such as anger and verbal abuse that can lead to arguments. Getty Images over the past year that is . Unfortunately, she refused (until recently) to see a doctor for an evaluation. She was furious at Pierre and berated him daily anytime he pointed out problems with her memory or restricted her from driving. She would curse and scream at him, shake her fists in his face and occasionally even slap him. Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. Pierre loved his wife dearly but was at his wit's end. Only by threatening to leave her was he finally able to get her to reluctantly agree to see me in our memory center. The verbal abuse that Pierre was experiencing as a is very common and often takes a severe emotional toll. These caregivers have significantly higher rates of physical illness, depression and even mortality compared to noncaregivers, which in turn reduces their ability to provide quality care. As I reminded Pierre, it's crucial that you, the caregiver, not blame yourself for an illness that you cannot control. Talk therapy and with other caregivers in similar situations can help. You also should make time to get regular medical checkups, exercise and a break from your loved one to recharge. And if you're suffering from severe symptoms such as poor sleep, weight loss, loss of energy and interest, intense guilt and even suicidal or homicidal thinking, seek prompt psychiatric attention. But you also need to get to the root of the abuse, which can often be reversed or diminished with treatment. There are three basic steps that can turn the tide here.

1 Clarify the diagnosis

(the most prevalent form of major neurocognitive disorder) is not diagnosed until one to two years after the onset of symptoms. If you're concerned, it's important that you encourage your loved one to have a comprehensive evaluation that includes, among other tests, a physical and neurological exam, a mental status exam and a brain scan. The physician will want to rule out the than can cause a change in cognition and behavior — it's not always Alzheimer's. Entertainment $3 off popcorn and soft drink combos See more Entertainment offers >

2 Determine the cause of the abusive behavior

A geriatric psychiatrist or other clinician who has specific training in both mental health and neurocognitive disorders can help you understand why your loved one is suddenly cruel or angry. The four most likely causes can be summarized by four D's: denial, depression, delusions and disinhibition. Denial. In my practice I am less concerned about patients who tell me all they've forgotten than those like Ann who are oblivious to their cognitive changes and tend to get angry and erupt at anyone who suggests that they are impaired. Depression. Depression is extremely common in the setting of neurocognitive disorders, sometimes as a result of knowing the diagnosis but more commonly due to pathologic changes in brain structure and chemistry. Depression may manifest in irritability or anger instead of sadness, and is accompanied by symptoms such as insomnia, poor appetite and weight loss, lack of energy and interest, and physical aches and pains. Delusions. These are defined as false but fixed or deeply held beliefs, and more than half of people with Alzheimer's and other neurocognitive disorders tend to have them at some point. Delusions often involve paranoia (they might believe that someone is trying to harm or steal from them) or jealousy (accusing one's partner or spouse of having an affair, for instance). Delusional beliefs cannot be altered by logical reasoning or argument, and can lead to intense fear and anger. Disinhibition. Characterized by inappropriate, uncharacteristic or strange behaviors, disinhibition is seen in early stages of frontotemporal dementia and in later stages of Alzheimer's. In addition to verbally abusive or inappropriate comments, it may include behaviors that seem out of control, crude or embarrassing. AARP NEWSLETTERS %{ newsLetterPromoText }% %{ description }% Subscribe is a geriatric psychiatrist in Miami and the author of and AARP NEWSLETTERS %{ newsLetterPromoText }% %{ description }% Subscribe AARP VALUE & MEMBER BENEFITS See more Health & Wellness offers > See more Flights & Vacation Packages offers > See more Finances offers > See more Health & Wellness offers > SAVE MONEY WITH THESE LIMITED-TIME OFFERS