Jul 13, 2012

Changing Patterns of Behavior In Alzheimer's Patients

It is not unusual for Alzheimer's Patients to engage in repetitive patterns of behavior. Many of these patterns are disconcerting. How do you change these patterns?

Changing Patterns of Behavior In Alzheimer's Patients
95 Years Old
By Bob DeMarco
Alzheimer's Reading Room

Many of the newer readers on the Alzheimer's Reading Room think Dotty was some kind of model Alzheimer's patient that could in some cases do the impossible.

I have to admit, Dotty did do some things that amazed and fascinated me. Like read, color, and perform for the camera and video recorder even when she was in a very late stage of Alzheimer's.

It wasn't always that way. In fact, in the beginning Dotty was meaner than a junkyard dog. I could write an entire book about all the crazy, bizarre, and completely disconcerting behaviors she engage in.

For example, she would get up every night and announce she needed to start cleaning. Every night around 9:37 PM plus or minus a few minutes. I was able to change that.

Guess what I would do if I were confronted with this problem today?

I would give Dotty some ice cream at 9:30 PM, and then talk to her while she ate the ice cream. Dotty always looked so happy eating her ice cream. It immediately improved her mood.

As it turned out I did give Dotty ice cream, rice pudding, or a piece of pie almost every night. Around 9:15 PM plus or minus 15 minutes.

Below is an article I wrote several years ago. The transcript and the podcast are very similar so you can read or listen.

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Patterns. All Alzheimer's patients evidence patterns of behavior. Some of the patterns are simple -- like asking over and over what day it is. Others are more complex. One reader told us her husband was shaving four times a day and his face was getting "raw". Others pace. The list goes on and on.

My mother was evidencing all kinds of patterns of behavior -- doing the same crazy things at the same time of day or night -- over and over.

At approximately 9:37 PM, at night, my mother would get up and announce that she needed to start cleaning the house. I am talking every night. Imagine trying to explain to someone living with Alzheimer's disease that it is night time and you don't clean at bed time. I'm not sure how many times I did this, more then I want to remember -- it didn't work.

My mother would wake up at approximately 1:29 AM, get out of bed, open up our front door, take a few steps and look around. After a few minutes she would come back in and get in bed. Same thing at 4:29 AM. Each and every time, I would get up out of bed, stand back, and watch her do it. I did not intervene. After a year or so I finally started to understand why she was doing this.


After a year or so of reading research about Alzheimer's disease and dementia, I came to a conclusion -- exercise was the single most important variable in caring for someone with Alzheimer's disease. I enrolled my mother in a gym for the first time when she was 87 years old. At first I put her in the class for seniors -- the Silver Sneakers class. It helped.

One day when she came out of the class I decided to put her on the treadmill. She resisted, but she did it.

Then something started happening that changed our lives.

My mother would start walking on the treadmill and at the 6 minute and 30 second mark she would bend over like she was going to fall. She would grab the side rail on the treadmill and more or less hang over it. Her feet would keep moving. At the seven minute mark she would stand back up, straight, and start walking. This happened every time. It amazed me.


Patterns of behavior. I came to a conclusion through these observations. First, most Alzheimer's patients have patterns of behavior -- some good, some bad. Second, most people without Alzheimer's have patterns of behavior -- they do the same kinds of things around the same time of day, over and over.

Patterns of behavior bring homeostasis into our lives. Having well defined patterns of behavior brings comfort, organization, and a sense of stability into our lives. The fact that we live a life of patterns also helps explain why most of us don't like change. And, why we resist change.

I thought to myself, what if I could change my mother's bad patterns of behavior and channel her energy into more positive patterns.

I decided to introduce an entirely new set of behaviors and actions into our lives. Over time I introduced one new behavior after another until we reached the point where our day was organized in a way that made each day very similar to the one that came before it. Our day had a very well defined pattern and so did our daily actions and activities.


Here is a simple example of how it worked. Instead of waiting for my mother to ask me. "what day is it". Meaning what day of the week. I put the newspaper in front of her each morning and asked her, "what day it is it". Then, what is today's date? She would read this to me from the top of the newspaper.

I also bought a great big clock and put it on the wall right in front of her seat where she couldn't miss it. I also asked what time it is? I did this two or three times a day. It cured her of asking me over and over, what day is it?

Over the years I cured my mother of meanness, getting up in the middle of the night, urinary incontinence, and the dreaded bowel movement problem. I did this by introducing new patterns of behavior and news tools into our daily equation.

Did it work perfectly -- no. Well to be honest, not perfect, but pretty close.

I wrote previously about most of these issues: meanness, pee, poop, and my own metamorphosis as an Alzheimer's caregiver.

You can find loads of information about how I solved problems by searching our knowledge base. Use the search box on the right hand side of every page on this

For example, type "exercise" (without the quotes) into the search box. I think you will be surprised at how much information we have about Alzheimer's and exercise on this website. For the fun of it, type in poop.

I decided I will write and speak about patterns of communication and behavior in greater detail in the weeks and months ahead. I will explain in detail how I accomplished change and offer suggestions on how you might accomplish a similar mission.

In other words, how I developed the proper mind set and learned how to create a third world that is the intersection of my mother's life and my life -- I call this Alzheimer's World.

My name is Bob DeMarco, I am an Alzheimer's caregiver.

Dotty is gone now but I will tell you this. We lived our life. Together we overcame the burden and lived a life filled with Joy.

You can do it too.

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Bob DeMarco is the Founder of the Alzheimer's Reading Room and an Alzheimer's caregiver.

Publisher Alzheimer's Reading Room
Author Bob DeMarco
JUly, 2012
Title: "Changing Patterns of Behavior In Alzheimer's Patients"

Originally published in the Alzheimer's Reading Room,