In Western society, the population is increasingly older. The increase in life expectancy presents us with a great challenge: higher rates of pathology in old age. Here we encounter the great challenge of dementia, a syndrome that encompasses the progressive deterioration of cognitive functions and that affects the patient’s daily life. According to the World Health Organization (WHO), Alzheimer’s disease is the most common cause of dementia (between 60% and 70% of cases).
With the aim of increasing the quality of life of people with this pathology, it is important that we are informed about what dementia is, why people with dementia present behavioral alterations and how we can help them. In this PsychologyFor article, we talk about what a person with Alzheimer’s feels, Why do Alzheimer’s patients cry? and how to calm them down.
Cause of sudden crying episodes in Alzheimer’s patients
Alzheimer’s disease is the leading cause of dementia. Dementia is a condition that encompasses diverse symptoms and is defined as the deterioration of mental abilities (attention, memory, perception, language, concentration, reasoning…) and behavioral alterations (agitation, inhibition, aggressiveness…). For this reason, dementia and Alzheimer’s are sometimes talked about interchangeably. However, they are not the same, Alzheimer’s is only one of the causes of dementia, while this is not a disease as such, but a syndrome that encompasses a set of symptoms. In these articles, you will find the Difference between Alzheimer’s and senile dementia and the Differences between Alzheimer’s and vascular dementia.
Alzheimer’s is a neurodegenerative disease, since it degenerates the cells of the nervous system: the neurons. It is believed that the cause is in the role of two proteins. Amyloid plaques and neurofibrillary tangles, which are toxic to neurons, cause them to be damaged, die, and cause brain tissue to deteriorate. So much so, that changes in the brain can be seen visually with neuroimaging techniques such as magnetic resonance imaging, computed tomography, or positron emission tomography.
The damage begins in regions where neurons are most sensitive, for example, the hippocampus (whose function is related to memory and learning) is very susceptible to the effects of Alzheimer’s disease. Therefore, one of the first observable symptoms is the problem consolidating memories.
Next, brain deterioration affects the areas where highly specialized neurons are found, those responsible for higher cognitive functions such as attention and concentration, working memory, reasoning, language, behavioral execution, emotional management and impulse control. Therefore, one of the symptoms of Alzheimer’s is altered mood, emotional lability and uncontrollable crying. Alzheimer’s patients may cry for no apparent reason, because they have lost the ability to regulate their emotions and manage their behavior.
They may also cry for some good reason. We will see them in the next section.
Reasons that trigger crying episodes in people with dementia
Why do people with dementia cry? Although crying is another symptom of the illness, sometimes it can be indicating some type of discomfort that we must identify and solve as much as possible.
Physical discomforts: It may be that the person has some pain, discomfort, or physiological need and cannot verbalize it correctly due to impaired reasoning and language. Any discomfort may be causing the person to be irritable or have an episode of intense, uncontrollable crying.
External stimuli: You may also find yourself overwhelmed by sounds, lights, movement or hustle and bustle in the environment.
Psychological factors: At the beginning of the disease, there is usually awareness of the deterioration and it can be a cause of distress for the person, they can also miss loved ones, they can feel loneliness, melancholy, may become sad, afraid, etc., and cry about it. People with Alzheimer’s may also continue to cry for the same reasons as a person who does not have the disease.
What does a person with Alzheimer’s feel like?
One of the most frequently asked questions in psychogerontology is whether Alzheimer’s patients are aware of the deterioration and how they perceive it. Let’s see how patients experience their illness.
First phases
In the early phases, the patient is aware of his/her cognitive impairment. She may realize that her memory is failing, that she is disoriented, that she is not able to identify a person, that a word does not come out…, in these situations they appear frustration and fear. The fear can be very intense when the person realizes that he does not remember certain important things, he may feel that he is losing part of his being.
When a person perceives the loss of their cognitive abilities, they become very scared, they feel uncertainty and even shame about needing some help. Faced with memory and language problems, the patient feels a lot of frustration for not being able to remember something specific or for not being able to express what they think because they cannot find the right words. In general, people with Alzheimer’s may feel alone, misunderstood and confused.
Intermediate phases
Once the deterioration progresses, the person is no longer aware of the cognitive deficit, but may feel very overwhelmed by not understanding the environment. Language impairment can affect comprehension, in which case the person does not fully understand what others are trying to convey. That produces anguish and restlessness.
It is difficult for them to know the reasons for people’s actions. For example, when a caregiver helps a sick person undress, the person with Alzheimer’s may not understand their intentions and feel that they are invading their personal space and privacy and, in response to this, , react with anguish and agitation.
The abilities to regulate behavior, executive functions, cognitive flexibility and social skills such as understanding, empathy, assertiveness, etc., all of this can lead to conflicts in interpersonal relationships, deteriorate. irritability, anger, frustration…
There may also be problems in perception and they may present hallucinations (stimuli perceived by the senses that do not correspond to reality). The emotional reaction will depend on the content of said hallucinations. For example: you can hear a kind and friendly voice that does not generate anxiety, or you can see a dangerous animal that generates anxiety in the patient. panic reaction.
Another common symptom of dementia is delusions (unrealistic beliefs that are perceived and believed to be totally real and irrefutable). There are many types of delusions, a very common delusion is the delusion of ruin. People with dementia with this type of delusion believe they have lost their possessions and money. That produces a lot of worry and anxiety. Another common delusion is jealousy, in which the person is convinced that their spouse is unfaithful, without any basis. In this case, the person feels pain, distrust and anxiety. In each type of delirium, the experience will be different and will also vary depending on the person.
Advanced phases
When cognitive impairment is severe, the person loses the ability to relate to the environment, so they become isolated, the ability to perform basic activities of daily living, such as eating, walking or even sitting.
We know that one of the things that last the most are emotional memories so they can react positively to family members, familiar music, etc.
Each person is unique, and dementia patients continue to have their individual differences. They do not have to present all the symptoms or experience them in the same way.
How to calm an Alzheimer’s patient
Episodes of agitation or intense crying are common in people with Alzheimer’s due to the impact of the disease. Let’s see how to calm a person with dementia:
1. Our tone and attitude
For any intervention to work, the premise is that our tone and attitude be kind and respectful. Must speak slowly, pausing, respecting their rhythms repeat as many times as necessary… All with an attitude calm and relaxed which is what we want to convey to you.
2. Basic needs
The first thing to calm a person with dementia who is crying is to ensure that their basic needs are met: that they have eaten, drunk, rested, that they are clean, etc.
3. Comfort
Ensure that she is comfortable: that her clothing is not tight, change posture, change location, check that the temperature is comfortable, etc.
4. Health
When faced with an episode of agitation or crying, it is essential to explore your state of health. A medical examination should be performed, because crying may be triggered by pain or discomfort that you do not know how to express.
Urinary infection is very common in older women and can cause this emotional instability. If your medical history indicates a probable cause, a test strip should be performed and antibiotic treatment initiated. All of this is guided by the corresponding health personnel.
There may also be other conditions such as a contracture, and there could even be a fracture.
Hip fractures are common in older women.
The skin should be observed in case there may be allergies or irritations that bother you.
As well as the state of the stool, since you could have gastrointestinal discomfort.
5. Ask
Once we have made sure that there is no physical discomfort that we should solve, we must ask the person What happens. It may explain some reason (which may be real or a delusional belief) or it may explain nothing. We can also ask what do you need. The intervention should be adjusted to the cognitive state of the person with dementia.
6. Validate the emotion
Whatever the reason, we will validate the emotion (not the belief or the motive). We will be understanding, empathetic and we will not pass any judgment (crying is neither right nor wrong).
7. Accompany
As we have seen in the previous section, it is common for people with dementia to feel disoriented, disoriented, worried, distressed…, therefore, in crying spells, we will be by your side physically and emotionally, accompanying emotional expression, being a positive and stable pillar that favors a return to calm.
8. Emotional translation
If the state of their reasoning and language allow it, we will explain to the person why what happens to them happens. For example:
“Of course, you saw a dog that wanted to attack you (in case you had a visual hallucination) and you got nervous. That’s why you’re crying so much. Here you can cry and vent. You’re fine and you’re safe with us.”
“I understand you. You’ve seen your family and you’ve been very emotional. That’s why you’re crying. It’s normal for us to get emotional with our loved ones. I hope you really enjoy their company.”
“Sometimes we cry and we don’t even know why. Nothing happens. Crying is an emotional expression and it’s normal. Do you want a hug or for us to breathe together?”
9. Offer support
Depending on her level of understanding, we can explain to her that she can turn to us when she is nervous or overwhelmed. We can tell you that you can come to us for whatever you need, that we are there to help, etc.
We can also offer a gesture of affection, a hug, a caress, shaking hands, a smile, words of affection…
10. Distraction
Once we have left space for emotional expression, we can help them relax through distraction. We can do several things:
Offer an object that catches their attention.
Start a conversation on a topic of interest to you.
Change space.
Go for a walk.
Start an activity, whether it’s folding towels or painting pictures.
Catch their atention. For example: “Have you seen how the flowers in the garden have grown? Let’s go see them!” “Do you like my nails? Do you want us to paint yours?”
11. Positive stimuli
We can also resort to things that we know he likes and relaxes him. This involves knowing the person well. It can be a photograph of a family member, even calling a family member so that they can hear their voice, a glass of their favorite drink, a game that they like, talking about topics such as their wedding day, a perfume or a cream that they like, a massage, a stuffed animal, a song, a show of affection… There are a thousand options, it will depend on the person.
Depending on the level of deterioration and personal preferences, we will choose the most useful options for each case.
This article is merely informative, at PsychologyFor we do not have the power to make a diagnosis or recommend a treatment. We invite you to go to a psychologist to treat your particular case.
If you want to read more articles similar to Why do Alzheimer’s patients cry? we recommend that you enter our Clinical Psychology category.
Bibliography
DevÃ, J. (2015). Manual of clinical intervention in psychogerontology. Herder Editorial.
Caprara, M., & López Bravo, MD (2014). Psychogerontology.
Fernández-Ballesteros, R. (2004). The psychology of old age. Multidisciplinary meetings.
