You are here:

Alzheimer`s Disease/Brother Violent Outburst and Foul Language

Advertisement


Question
My brother has dementia, hasn't been diagnosed yet with alzheimer but showing signs. Recently, when he's talking if we interrup him (not on purpose) he's violent, yelling, and with outburst evening using foul language. My brother a Veteran of VietNam and diagnosed with PTSD also abused Alcohol for years.

I'm overwhelmed with him, yet he's young only 67. He still lives alone in a large building and it seems when we try to talk to him everyone is wrong and he's RIGHT.

Are violent outburst and using foul language a part of Dementia, Alcohol Dementia or Alzheimer?

I love my brother very much, we have a caretaker that takes him out on outings, but the other day he had an outburst at a restaurant and used and very bad word out loud and yelled at her to shut up.  WHAT SHOULD I DO?

Answer
Hi Mary, you probably know there are many causes of dementia. Dementia is just a term that means the person is confused and cognitively impaired. It's a term like fever. It describes a symptom, but is not a diagnosis, because it doesn't tell you what is causing the problem. Dementia can be caused by drug and alcohol abuse, nutritional deficiencies, hormone imbalances, psychiatric disturbances, oxygen deficiency, hydrocephalus, strokes, tumours and a huge long laundry list of other physical and neurological problems. Alzheimer's is just one cause.

The only way to be sure what you are looking at is to get him to a specialist, like a neurologist, and have a full assessment done. They go about this very systematically, starting with a full physical, blood tests, history, review of medications, psychiatric history, and then go into neurological examinations, like various types of brain scans. They are trying to rule out everything it can be.

It is really important to get to a solid diagnosis - some causes of dementia can be treated, and even reversed, if they are caught early. Others cannot be cured, but could be slowed down with certain medications, so the person retains some independence and quality of life longer. The other reason a diagnosis is important is that it can give the family insight into what is going on. I'm sure you'd like to know why this is happening, what, if anything, you can do about it, and what this might mean for the future. If you have to start making long term plans for your brother's care, I'm sure you like to know that as soon as possible, so you can be prepared with options, and have checked out what he might qualify for in terms of supports and financial assistance. You will also need to know what might happen next to him, so you are ready for any coming changes in him.

Most of the dementias result in permanent brain damage. over time that progresses. People with injured brains can't always recognize their own problems and limitations. It may be screamingly obvious to you that he is not himself, but he may be oblivious to changes in himself or his abilities. I know this can be startling. My mother in law had Alzheimer's. She became very forgetful and was getting lost even in her apartment building, couldn't manage money, couldn't get to appointments by herself etc. etc. It was very clear to us there was something really wrong with her, but she thought she was fine and we were being mean when we wanted her to see the doctor.  She would make up excuses and cover stories, or blame other people - no matter how you tried to reason with her, she just didn't "get" that something was going on. It wasn't denial. She genuinely was oblivious, probably because she couldn't remember what she had done. Her ability to be objective and rational was shot. She also could not see the impact her behavior had on other people.

Different causes of cognitive impairment can cause different behaviour patterns as they can affect the brain in different areas. A number of the causes of dementia can result in loss of inhibitions and self control. The person may scream and yell, not realizing it's socially inappropriate, or they may really not be able to stop themselves from violent outbursts. There was a lady in the same Alzheimer's unit as my mother in law who was a tiny little Scottish woman. She had been a school teacher, and a very reserved proper lady all her life. Her Alzheimer's took away her self control and also her awareness of what is acceptable language. She would scream words at the care staff that would make a sailor blush. She would even try to throw chairs - totally out of character for her as she was before she got sick.

Since this is obviously a major change in his behavior, you are absolutely right to be alarmed. Yes it could be a sign of a dementia - but it also could be a sign of other problems. The only way to find out is to get him to a doctor and have some screening done, and then hopefully get sent to someone like a neurologist with a speciality in cognitive problems.

Sometimes when people with cognitive impairments flip out, it is called a "catastrophic reaction".  They can be under a lot of stress, just trying to cope with every day life. Everything becomes a big confusing jumble. Then if there are any demands or extra stress is on them, it can be too much and they just snap. It's kind of like a toddler having a tantrum or a melt down when they are tired and hungry and mom makes them leave the playground. They are at the end of their coping rope.

Hang in. I hope you have powers of attorney for financial and medical care decisions for him. It would also be a good idea to get written permission from your brother to enable you to talk directly with his doctors. If he is impaired, he may not be able to really give the doctors good information about what is happening, much less recall what he is told. You will want to be able to with him, or at minimum, chat with the doctor before or after the appointment to find out what they think.

What we found really helpful was to write the doctor a letter, explaining the kinds of behaviors you are seeing and why it seems very unusual to you. You can mail or fax it to the doctor, so he is forewarned something is up, and is ready the next time your brother comes in.  My mother in law could pull herself together when she visited the doctor. She had him fooled completely. She'd seem totally fine and with it in the office, even when she was alarmingly addled anywhere else. It wasn't until I alerted the doctor that he started asking the right questions of her. There are a number of simple screening tests they can do in an office - basic memory and reasoning tests - that can show if a person is in trouble cognitively. No one was more shocked than her own doctor. He is a very perceptive guy and had missed the signs entirely.

I know this is very overwhelming, but I promise you, you will feel much better when you take some action towards finding out what this is. It's always much more scary and upsetting when you are fearing the worst, but have no information to help you. You need some solid facts to base future decisions on.  

If you think he won't cooperate, do not hesitate for one minute to fib to him, or to get the doctor or other friends and family in cahoots with you. You would never forgive yourself if you found out this was something treatable if he'd be seen earlier. Bribe him, pat, soothe, fib, flatter, whatever it takes to get him there.

Thinking of you.  

Alzheimer`s Disease

All Answers


Answers by Expert:


Ask Experts

Volunteer


Mary Gordon

Expertise

Several years direct experience as caregiver for family member who died of end stage AD. Did lots of research and dealt with a lot of health care professionals and caregivers over the 7 years from diagnosis to the end. Used various care options from community based resources to increasing levels of institutional. Mother of three, two born during our loved one's decline, so I know what it is to be the ham in the sandwich, taking care of the older generation and the younger at the same time and trying to balance everyone`s needs. Ask me, I`ve probably been there, done that. We made lost of mistakes and learned everything the hard way - but you don`t have to! If I can`t answer your question, I`ll steer you to a place or person who can.

Experience

Currently a program manager for a large utility company. My Alzheimers experience comes from having the illness in our family. Out of necessity, we did a lot of research in order to understand the disease, plan for what might come next, and make the right decisions to help and support our loved one. Please note, I am a Canadian living in Toronto, and therefore am not the best person to ask about US regulations and insurance rules!

©2016 About.com. All rights reserved.