Nonpharmacological Treatment of the Behavioral and Psychological Symptoms of Dementia

One of the most contentious discussions we have ever had about driving was with a patient who was a World War II veteran. Despite several minor accidents, becoming so lost he had to be brought home by the police, and losing his car in a parking lot, he would not even entertain the possibility of not driving. His family could not even broach the subject with him without significant agitation, including yelling and throwing objects. The family asked for our help and, after several frustrating meetings, we made no progress. We finally decided to ask him to keep a daily log of where he drove. He was willing to do this task, and what emerged was that there was one place he went to nearly every day: the American Legion Post that was only a few miles from his home, but too far to walk. Other use of the car was sporadic. When we discussed with him a plan for getting him to the American Legion Post on a daily basis, his resistance to quitting driving disappeared. What we did here was to let the patient know (reassure him) that he was in a loving environment where people cared for him, respected his needs, and would do what was necessary to meet these needs.

Several years ago, we encountered a patient who was exhibiting inappropriate sexual behavior toward a female caregiver who visited to help with his care three times a week. His wife was quite upset when the patient would inappropriately touch the caregiver during the course of the day. The patient’s wife was also surprised because this type of behavior was entirely uncharacteristic for the patient. After considerable discussion with the patient and caregiver, we all came to realize that the genesis of this troublesome behavior was that one of the responsibilities of the caregiver was to help the patient bathe. The patient interpreted touching during bathing as sexual touching and thus in his view his touching the caregiver during the day was reciprocal and entirely appropriate. We rearranged the bathing schedule so that he was no longer bathed by a woman, which resolved the behavior.

We follow a patient who was once an excellent cook, but now has great difficulty in the kitchen. As such, her husband, the primary caregiver, has taken over the duties in the kitchen. Although he has become a competent cook, his main challenge is now to keep his wife out of the kitchen. The patient understandably continues to want to be engaged in activities in which she was once quite accomplished. The problem is that she would often cause difficult and potentially dangerous situations, such as putting a metal bowl in the microwave or putting a dish towel on the burner. These difficulties led to many confrontations and arguments. Her husband solved this problem by getting the patient her own oven—in this case a toy oven—and giving her a specific job during meal preparation that she cheerfully carries out.