by Carolyn Lukert, MBA, CGCM,
PAC Consultant and Mentor
Dear PAC Consultant,
I am wondering if you could clear something up for me. I am helping to support my brother, who has recently been diagnosed with Alzheimers Disease. One of the most surprising things I have noticed is his hair-trigger temper. It is so unlike him. Up until fairly recently, he was one of the most easy-going people I have ever known. In fact, that was what really stood out about him. Now it’s so different. It seems like he is always on the edge of exploding and when he does explode, it’s pretty ugly. Please help me understand what’s happening. Even better, would you share some tips and techniques for ways I can better support?
Curious in Clearwater
Dear Curious in Clearwater,
Thanks for reaching out. It brings me such hope when I hear from siblings who are wanting to learn how to best support each other. I know it is hard to see these changes. Learning how to respond, not react is what we hope to help you do. Hopefully, that will make things a bit better for everyone involved.
First to your question about what is happening. There are a few different possibilities, all related to the changing brain. Across many of the dementia-related conditions, the part of the brain that is responsible for our automatic reactions, the amygdala (located deep inside the brain), becomes hyperactive. This part of the brain is, among other things, responsible for our fright, fight, and flight response. So, any kind of surprise, even one that is intended to be positive, can trigger this automatic reaction. When the amygdala is triggered, it takes charge of brain function, and the ensuing response can be quite extreme.
Another part of the brain that is likely playing a role is the frontal lobe, which helps with our self-control. So, when the amygdala is fired up, and our self-control is dialed down due to dementia, it can result in a challenging situation, for sure.
A third area of the brain that can contribute are the temporal lobes, where language abilities are stored and managed. If I am having difficulty understanding what you are saying, and/or struggling with getting my words out, the mounting frustration can contribute to an amygdala reaction. To make matters even more interesting, the right temporal lobe, which stores our negative words (swear words and sex talk, for example) often works fine until very late in the disease. So, I might say some things that you would have never heard me say when dementia was not onboard. Putting it all together:
Lack of impulse control (frontal lobe) + Hyperactive automatic response (amygdala) + Easier access to certain words (temporal lobes) = High Distress Reaction!
Taking it a step further, guess what likely happens to your brain when your brother expresses himself in this way? We all can have an amygdala response!
Now on to your second question about how to best respond. My first thought would be to see what you can notice about what might be triggering your brother’s responses. I am wondering if keeping a log might help with detecting patterns. For example, could his distress relate to specific topics that you are discussing, or perhaps to being rushed. Or maybe even to being told what to do or what not to do. There are many possibilities. So, what do you notice? And then, perhaps think about what you might be able to do to change so that trigger switch doesn’t get flipped.
If an extreme reaction is already happening, I am wondering if you might consider doing the following:
- If what you are doing might be triggering a reaction, stop what you are doing, and back off.
- Step away and take a few deep breaths, so you can regain your composure. Click here to view a video for more information.
- Use the term, I’m Sorry, to reset. Click here to view a video to further demonstrate.
If you are interested in taking a deeper dive into techniques for setting the stage for success, here are few resource options to explore:
Thanks again for reaching out, Curious, and please do not hesitate to contact us at firstname.lastname@example.org for additional support.
Sincerely, PAC Consultant