The emotions of the person with Alzheimer’s span the entire spectrum of mental challenge.  Perhaps apathy and what comes through as depression top the list of crippling feelings.  Dad sleeps most of the time, or he sits and stares as if he doesn’t see.  He is disinterested in any activity, and sometimes he seems agitated – even angry.  These behaviors may be signs of developing depression which could be allayed to some extent by caregivers with creative response instincts.

Generally, caregivers are not psychiatrists or social workers.  But we can all imagine the sense of hopelessness and abysmal darkness a loved one with Alzheimer’s must feel.  Ambiguity clutters everything that was once certain in his life.  In the back of his mind lurks a passel of “oughts,” but they are not recognizable, remembered, or clear.  Questions pummel his mind, but no answers come to what is obvious to a person who is healthy:  Who am I? What do I do next?  Do I have any money?  Why am I not at work today?  In a succession of mood changes we may not even recognize, the loved one may move through a series of escalating feelings including fear, confusion, anxiety, anger, hostility, and aggression.  Ultimately the feelings can turn inward and one becomes trapped in depression.

As caregivers we may not recognize this promenade of emotions until they are earmarked by behaviors.  One-at-the-time we try to deal with the shifting emotions and the responses they prompt.

Sometimes it is useful to think about negative emotions separately, but in this time with you I want to mention some general caregiving responses which may be helpful.  Measure your responses by the severity of the loved one’s mood and the behavior he/she is exhibiting. 

·         If the loved one asks questions or expresses fear that seem unreasonable or trivial to you, enter his world and respond, not with judgment or concern for accuracy, but rather with reassurance such as “It’s going to be okay . . .” 

·         Make notes of the times, events, interactions, noise, etc. which preceded uncomfortable emotional responses from/in your loved one.  Try to avoid the same set of circumstances again.  Sometimes environmental cues, or the lack of cues and stimuli, produce a chaining effect in the patient.  For example, if we get occupied and repeatedly ignore the loved one, he can become fearful and harbor feelings of abandonment.  Reassurance, a smile, stating facts about what’s happening, what’s next, who’s here, where we are, etc., can sometimes save the moment.  Perhaps the distressing emotional trip can be stopped before it starts. 

·         Reassure your loved one that you are aware he is feeling sad and unhappy, but that you love him/her very much.

·         Think about the homemaking or career skills that engaged him/her in the past.  Involve the person in an appropriate expression of a familiar skill such as folding napkins, watering plants, raking leaves, stamping envelopes, sorting the mail, arranging magazines, weeding the garden, or sweeping the patio or garage. 

·         Provide visual and/or audio stimulation, especially if apathy and mild depression are obvious. Look at pictures from a fun vacation; play lively familiar music; look at a picture book or family album together. 

·         Avoid treating the person as if he were a child.  Children’s games or toys are not appropriate; simplicity is. Activities should have integrity and reflect his/her values and interests. 

·         Call a friend and ask him to drop by for a visit. 

While apathy and depression may be expressions of boredom and frustration, an awareness of the devastating loss of mental functioning may be at the heart of the problem.  If the condition is severe and persistent share your concerns with the doctor for medical support.