Alzheimer’s and Catastrophic Reactions

What Are Catastrophic Reactions?

Catastrophic reactions are overreactions to a seemingly normal, non-threatening situation. The word catastrophic implies that there is a catastrophe, or some terrible event that occurred, and that seems to be the way it feels to the person experiencing this type of reaction.

According to research conducted by the University of Rochester Medical Center, catastrophic reactions are five times more likely to occur in people who are in the middle stages of Alzheimer’s, as opposed to the early stages or late stages. This seems to be because people suffering from moderate Alzheimer's may often still be aware of their deficits and declines in functioning, and yet not be able to compensate or cope with them very well anymore.

What Are Some Examples of Catastrophic Reactions?

• Physical aggression such as hitting, kicking or pulling hair
• Emotional outbursts such as shouting, screaming or crying uncontrollably

Why Do Catastrophic Reactions Occur in Dementia? What Causes Them?

Dementia can distort the way a person interprets reality. Feelings of being overwhelmed are common, and sometimes the environment a person is in is just too stimulating. If the lights are very bright, there are several people talking at once and the television is on, a catastrophic reaction may be more likely to occur.

Some people with Alzheimer’s also experience paranoia and delusions, which can make them very fearful of others’ intentions or actions.

Others have past traumatic experiences that may shape how they react or respond to attempts to help with bathing or dressing.

The University of Rochester study found that the most common trigger for a catastrophic reaction is assistance with personal hygiene tasks, and the evening dinner time is the most frequent time of day that catastrophic reactions are experienced.

Can Catastrophic Reactions Be Prevented?

Often, the way you interact with others can affect their reaction to you. Here are some possible approaches you can use to decrease the chance of a catastrophic reaction:

• Approach the person from the front, rather the back or side which may startle her.
• Don’t appear rushed or frustrated.
• Know the person’s preferences. For example, some people respond very positively to touch and others bristle even if someone is near them.
• Explain clearly what you would like to have the person do before attempting to do it. (“Dinner’s ready. Let’s walk together to the table.”)
• Don’t criticize or argue with a person who has dementia.
• Avoid over-fatigue if possible.
• As much as possible, avoid sudden changes in routine.
• Assess for symptoms of anxiety and offer treatment, if appropriate.

How Should a Caregiver Respond to Catastrophic Reactions?

Give the person physical space.

Don’t continue to attempt whatever it was that triggered the reaction, unless it is absolutely necessary to accomplish that particular task at that specific time.

Don’t use restraint or force.

Be respectful, not patronizing.

Use the person's name.

Allow him extra time to calm down.

Reassure her. Perhaps she has a favorite stuffed cat. Let her hold the cat and be comforted by it.

Divert him as he’s calming down. Catastrophic reactions are traumatic for those experiencing them, so encouraging him to focus on something else can help.

If the person has experienced a catastrophic reaction previously, you should always take note of what appeared to trigger the reaction before and avoid that behavior if at all possible.

If a catastrophic reaction is unusual for this person, you will also want to consider if she has any health changes that might be causing her to have pain, such as a fall or other injury, or a delirium. Delirium (usually caused by an infection or other illness) can cause a sudden change in cognition and/or behavior, and it can show up as increased confusion or uncharacteristic resistive and aggressive behavior.

Sources:

Loddon Mallee Region Dementia Management Strategy Overview. Catastrophic Reactions: Preventing and Managing Catastrophic Reactions. Accessed September 23, 2012. http://www.dementiamanagementstrategy.com/Pages/ABC_of_behaviour_management/Management_strategies/Catastrophic_reactions.aspx

University of Rochester Medical Center. Dementia Patients Aware of Losing Grasp Suffer Breakdowns Most. Accessed September 23, 2012. http://www.urmc.rochester.edu/news/story/index.cfm?id=-119

The University of Washington Alzheimer’s Disease Research Center. Specific Strategies for Coping with Physical and Behavioral Problems. Accessed September 23, 2012. http://depts.washington.edu/adrcweb/UnderstandingAD/Strategies.shtml