Lamy Center Caregiver Connection: Triggers and Dementia
Written By: Rudi Lamy, MLS, MAS, consultant to the Peter Lamy Center on Drug Therapy and Aging
Recently I had an experience that was quite educational – I inadvertantly became the trigger for a dementia response. On a recent visit with my wife at her assisted living facility, I stepped into the doorway of her room and was greeted with an angry, raucous response from her roommate. It took four people to calm the situation. I was told that the roommate reacted in this manner when she hasn’t been sleeping well. I had accidentally triggered this event without even realizing it.
Triggers for dementia sufferers don’t have to be negative. The brain works in many mysterious ways, and sometimes it can surprise you. In another triggering event, my wife was in a social group listening to music when I noticed that she was tapping her hand in time with the music. The music had clearly triggered her response and was probably something she had heard before.
I cared for my wife at home for approximately 11 years, and I previously had no idea what a trigger was. I didn’t even know that triggers existed. I just took it all in as part of the progression of her illness and gave it no more thought. But over time, with experience, and with the help and knowledge of others, I learned about triggers, what they might be, and how they present.
Yes, indeed, triggers are part of the illness, but they are, at least in my estimation, a result of environmental factors. As far as I can tell, triggers affect both the mind and the brain. The brain is where the memories of the patient are stored. The mind is how those memories are expressed.
The two examples I shared were the first times that I became aware of the dementia trigger and response phenomenon. After asking colleagues and searching for literature on the subject, triggers seem to be a fairly common occurance among patients with dementia. Here’s what I’ve learned through experience and readings.
Triggers I’ve observed and the result:
- Cold weather coat refusal, scream
- A crowd of unfamiliar people, stress or anxiety
- Refusal of shoes, kick to the chest
- Blinds being turned the wrong way, scream
- Dentist, crying
Triggers I’ve read about:
- Loud conversation or noises
- Bath or shower
- Sleep issues, psychosis, restlessness
As for the literature, it turns out there are triggers for all sorts of illnesses, which can be problematic when searching for professional literature specific to dementia. I ran my usual PubMed (NLM) and Google searches and eventualy found what I was looking for. Below are some readings if you are interested.
Thanks for taking the time to read.
Rudi
Some readings on dementia and behavioral triggers and responses
https://www.alz.org/media/documents/alzheimers-dementia-related-behaviors-ts.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181717/
https://www.medicalnewstoday.com/articles/dementia-with-behavioral-disturbances
https://www.webmd.com/alzheimers/guide/alzheimers-aggression
Rejection of Care and Aggression among Older Veterans with Dementia: The Influence of Background Factors and Interpersonal Triggers. Kang B, Pan W, Karel MJ, McConnell ES. J Am Med Dir Assoc. 2021 Jul;22(7):1435-1441.e1. doi: 10.1016/j.jamda.2021.03.032. Epub 2021 Apr 30. PMID: 33939963
Repetitive Questioning Exasperates Caregivers. Hamdy RC, Lewis JV, Copeland R, Depelteau A, Kinser A, Kendall-Wilson T, Whalen K. Gerontol Geriatr Med. 2018 Jan 9;4:2333721417738915. doi: 10.1177/2333721417738915. eCollection 2018 Jan-Dec. PMID: 29349099 Free PMC article.
Sensory and nurturing nonpharmacological interventions for behavioral and psychological symptoms of dementia. Fitzsimmons S, Barba B, Stump M. J Gerontol Nurs. 2014 Nov;40(11):9-15. doi: 10.3928/00989134-20140923-01. Epub 2014 Oct 15. PMID: 25310097
Aggressive behaviors between residents with dementia in an assisted living residence. Caspi E. Dementia (London). 2015 Jul;14(4):528-46. doi: 10.1177/1471301213502588. Epub 2013 Sep 3. PMID: 24339115
Pharmacologic therapy for behavioral symptoms of Alzheimer’s disease. Tariot PN, Ryan JM, Porsteinsson AP, Loy R, Schneider LS. Clin Geriatr Med. 2001 May;17(2):359-76. doi: 10.1016/s0749-0690(05)70073-2. PMID: 11375140 Review.
Pharmacologic therapy for behavioral symptoms of Alzheimer’s disease. Tariot PN, Ryan JM, Porsteinsson AP, Loy R, Schneider LS. Clin Geriatr Med. 2001 May;17(2):359-76. doi: 10.1016/s0749-0690(05)70073-2. PMID: 11375140 Review.