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Physical Causes of Challenging Behaviour in Alzheimer's Disease


Updated: September 5, 2006

We need to consider the possibility that problematic challenging behaviors such as aggression and violence, wandering, inappropriate shouting, may (a) have a physical cause and/or (b) make a significant contribution to triggering or sustaining that type of behavior.

Challenging Behavior Guidelines
Challenging behavior must be considered as a way a person with Alzheimer’s communicates distress.

  • When challenging behavior is recent or sudden, the possibility of a physical cause is high and must be thoroughly investigated.

  • Remember, it is easy to miss a physical cause in someone with Alzheimer’s disease.

  • The physical 'reason' for the challenging behavior can change and is not necessarily a fixed or a permanent cause.

  • You have to have a flexible approach to problem solving.

  • Helping a person who is exhibiting challenging behavior can be complex and difficult.

  • Physical causes are just one avenue to explore to help improve or resolve challenging behaviors
  • Some Examples of Physical causes of Challenging behavior
    Communicating a physical need such as thirst or hunger, or the need to go to the bathroom
    Communicating a physical need such as pain or discomfort, i.e. dental problems, sitting too long in one position, a wet or soiled diaper, etc
    Communicating dislike of a taste, food type, drug etc.
    Constipation, a common feature during illness and in elders

    Challenging behavior indicating the presence of diseases
    Challenging behavior can occur because the person is ill. This includes; Infections such as urinary tract infection, chest infection. Infection can cause delirium, toxic states, damage to organs
    Toxic substances such as drug side effects, interaction with other drugs, alcohol
    Food allergy
    kidney or liver disease
    Head injury
    Arthritis, bony injury, muscular injury

    Seeking help
    Some physical causes of challenging behaviors can be easily resolved, leading to a dramatic, positive effect. If you suspect an illness is causing the challenging behavior you need your doctor to diagnose and help to treat it. Meeting the considerable difficulties, especially in more complex cases, may require a multidisciplinary team approach to help you (a) identify the cause (b) to offer help/ support/ treatment.

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