It could be 2am or 3am, and K. Indrani (not her real name), 82, would be screaming at the top of her voice. She would bang on the door and demand to be let out of the house. She knows not what time of day it is. All she wants is to go for a walk.
The whole household would be awakened, and kept awake at ungodly hours. Her family members would try to calm her down. Then someone would phone the other family members for reinforcement. Indrani’s children who live nearby, would come over to talk their mum out of it.
During the day, Indrani would fly into a rage when her family members try to stop her from wandering outside her house. They would lock the main door or the gate. “Confined against her will, she would resort to threats and violence,” says S. Mani, a family member.
Indrani’s children first discovered their mum was suffering from Alzheimer’s when she wandered out of the house and could not find her way home. A neighbour brought her home when he found her loitering in the streets. On another occasion, she went missing for three days. She had taken a bus to an old friend’s house without informing her family.
As the symptoms of Alzheimer’s worsened over time, Indrani’s behaviour became more difficult. Sometimes she suspects her daughter-in-law is trying to poison her own husband.
When an argument broke out between her son and his wife, Indrani tried to intervene in her own bizzare way. She grabbed an empty bottle and hit her own head to warn her son to stop fighting. She screamed: “You touch her one more time, and I’ll stab you. I don’t want to watch this. I want to die.”
Family members were shocked by her violent behaviour. But they knew she was issuing an empty threat; she loves her son too much to want to harm him.
On good days, Indrani would be on her best behaviour. A chatty person, she enjoys talking with her family, friends and neighbours. On bad days, she is like a lunatic with her fits of anger.
Prof Dr Philip George, a consultant psychiatrist and president of the Malaysian Healthy Ageing Society, points out that dementia patients have very little insight into their condition, except during lucid intervals or the early stages of the illness.
Although there are specific medications to calm the emotions, Dr Philip cautions against the use of common sedatives or anxiolytics (medications that inhibit anxiety) as these can worsen dementia. “We would consider major tranquillisers such as anti-psychotics but at very low doses. Such treatments are often time-limited. When the patient is less agitated, the doses can be reduced and eventually stopped.”
To get patients to take their medication, it may be useful to tell them that it is a brain tonic, just like a vitamin supplement.
“Due to the stigma associated with seeing a mental health professional, it is important to perhaps work as a team with other primary care professionals. The patient can be referred by a general practitioner to a psychiatrist for assessment, and then the general practitioner can continue to treat the patient under the advice of the psychiatrist.
“Sometimes, if the patient refuses to seek medical help, the family can explain the situation to a psychiatrist who can then advise them on a plan for intervention,” adds Dr Philip.
Edited by C.B. Oh
A version of this article appeared in the print edition of Star2 on May 27.