Common Alzheimer's Complications

Many persons with Alzheimer’s disease seem to have excess energy, which can show up as restlessness, wandering, and/or disturbed sleep. These symptoms pose special problems for caregivers.

Restlessness And Wandering

Restlessness includes fidgeting, not being able to sit still, or not being able to stay with one activity for very long. Restlessness is only a problem because it may be annoying to others. Wandering, on the other hand, poses a real danger; the impaired person might walk out of the house and be injured or become lost.

Restlessness and wandering may have many causes. As Alzheimer’s disease progresses, your loved one’s energy level may not decline as fast as his or her abilities. Restlessness and wandering may result from this excess energy. Since the disease damages memory, your loved one may feel lost and confused most of the time. Wandering and restlessness may be a symptom of the anxious search for peace of mind. Restlessness and wandering may also be either a sign that your loved one is frustrated at not being able to express him or herself, or a side effect of certain drugs.

Disturbed Sleep

The decreased need for sleep is an ordinary part of the aging process. Older people no longer need eight hours of sleep each day, and they tend to sleep lighter and wake up more often than younger people. Disturbed sleep may also have direct physical causes, such as a full bladder, pain, or leg cramps.

When the normal decline in deep sleep mixes with the confusion of dementia, problems may occur. If your loved one wakes up in the middle of the night, he or she may wander around, putting him or her at risk of injury. Wandering might also put you and other family members in danger. Your loved one could turn the stove on and forget to turn it off.

Disturbed sleep can have a domino effect. If your loved one’s sleep is disturbed, chances are your sleep will be disturbed as well, and both of you could face serious health threats. Lack of sleep can worsen the symptoms of the illness in your loved one, and threaten your ability to cope and perform caregiving tasks.

Some causes of restlessness, wandering, and disturbed sleep respond to medical treatment. Thus, a doctor should promptly examine all problems of this sort. However, if these behaviors are simply the result of the progression of Alzheimer’s disease, they probably won’t respond to treatment.

Observation And Diagnosis

If the person in your care begins to be restless, wander, or have disturbed sleep, a doctor should examine him or her promptly. This visit is needed to make an early diagnosis. You may then be asked to observe your loved one for a while to determine future treatment. Be sure to ask the doctor how you can keep your loved one safe during this time.

You may need to look for signs of a pattern or of a worsening trend, and for side effects from prescribed drugs. These facts will help the doctor make a final diagnosis. The doctor can then plan the treatment routine with you. As you care for your loved one, try to observe him or her carefully and be prepared to answer the following questions:

  • Can you see any pattern in the wandering? Does your loved one often go to a certain place or in a certain direction?
  • Does wandering or restlessness occur at certain times of day? Does your loved one normally wake at a certain time of night
  • When you first noticed the problem, were there any other changes in the way your loved one behaved?
  • Were there any big changes in the home at the time?
    • Did anyone move in or out?
    • Did anyone in the family die or become ill?
    • Did you acquire new pets or furniture?
    • Were any of the rooms painted?
  • Does anything seem to trigger the restlessness?
    • Does it occur when your loved one needs to go to the bathroom?
    • Does it occur after your loved one has taken a prescribed drug?
    • Does your loved drink high-caffeine liquids like tea, coffee, or cola?
    • Do the problems occur when you have visitors?
    • Do the problems occur when there is a certain show on TV?
    • Do they seem to have anything to do with the size or timing of meals?
  • Have there been any changes in the kind or amount of food or drink your loved one consumes?
  • Has your loved one started any new drugs? Has he or she changed the dosage of a drug?
  • Has your loved one fallen recently?

Be sure your doctor knows about all of the drugs your loved one takes, even over-the-counter drugs.
Treatment And Management

After a diagnosis is made, your doctor may be able to treat some of the symptoms of restlessness. The treatment may be simple, such as cutting out all caffeine from your loved one’s diet, or you may have to administer prescription drugs.

Drugs can reduce restlessness or wandering, and might help with sleep, but there could be unwanted side effects. Some drugs that slow people down also cause, or worsen, confusion. Discuss this subject with your doctor. And never give your loved one over-the-counter medicines—or drugs prescribed for you or someone else—without first talking with your doctor. The sleeping or anti-anxiety pill that works well for you might be harmful to your loved one.

Keep in mind that the prescribed treatment may not work, or it may solve only part of the problem. It may be that there is no real cure. Times of restlessness or disturbed sleep could just be part of Alzheimer’s progression. Still, you and your health care team should work to develop techniques to manage the situation.

Coping Tips

Problems of restlessness, wandering and disturbed sleep can be managed. Talk with your doctor or nurse, make a plan, and see what works best. If a plan doesn’t seem to be working, let the doctor know and the two of you can come up with an alternative. Consider the following suggestions:

  • Maintain a regular pattern in your loved one’s life.
    • Make sure your loved one gets exercise and eats well.
    • Try to keep him or her awake and active during the day.
    • Include work and recreational activities in the daily routine.
    • Limit the number and length of naps in the daytime.
    • Try to make the hours before bedtime a calm time.
  • Monitor meals and snacks.
    • Serve the major meal at midday.
    • Avoid large meals at night.
    • Avoid overly fatty or salty foods.
    • Limit the amount of liquids that your loved one drinks after dinner.
    • Make sure your loved one uses the toilet before going to bed.
  • Review your loved one’s problem habits.
    • Do you see any patterns?
    • Does restlessness occur at any certain time or in response to any event?
    • Try to cut out any triggering events, and figure out ways to distract your loved one when restlessness or wandering begins.
  • Set up safeguards in case your loved one wanders away.
    • Obtain a Medic-Alert bracelet. Such a bracelet includes your loved one’s name, address and phone number; it should also indicate that he or she is “memory impaired.”
    • Inform neighbors that your loved one may wander. Give them your phone number and ask them to call if they see your loved one out alone.
    • Leave contact information—along with a photo—at your local police precinct.
  • Prevent your loved one from wandering away.
    • Bells on the doors will let you know when they have been opened.
    • Install deadbolt locks that can only be opened with a ke
    • An oddly placed latch—up high or down low—may make it hard for your loved one to use the door.
    • A sturdy fence around your yard will allow your loved one to wander but keep him or her from leaving.
  • Make sure your loved one feels safe and comfortable. Check his or her room:
    • Is it too hot or too cold?
    • Is there good light?
    • Is the room calm or noisy?
    • Is there too much activity around your loved one?
    • Think carefully about any changes you make around the house. If the pattern of activity changes, your loved one may become confused and upset.
  • Seek help. You need to be well and rested.
    • Take some time away so that you can keep up with your rest.
    • Take naps when your loved one naps.
    • Ask friends or family members to take over for you once in a while.
    • Consider hiring help or arrange for your loved one to go to a respite care facility for a while.

Living With The Problem

Restlessness, wandering and disturbed sleep add to your caregiving task. Work with your doctor or nurse to plan coping techniques, and figure out ways to predict and prevent the problem. Also protect your own health and peace of mind. As a caregiver, you have a lot on your shoulders, but you don’t have to do it all yourself.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from Special Care Problems: Aggressive and Violent Behavior, by Kenneth Hepburn, PhD. Department of Veterans Affairs Medical Center, Minneapolis, Minn.

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