Dad’s a holy terror.

Neither Mom nor Dad can care for themselves anymore. When Mom’s mental health declined, she took well to living in a memory home, and before Dad’s dementia diagnosis, my dad was a quiet family man. He never raised his voice or got temperamental about anything. Now for some reason, he shouts at everyone. I’ve never seen an old man so upset, and I’m wondering if it’s just decades of repressed anger or if it’s something to do with the disease. I’ve talked to friends whose parents had dementia, and none of them report this kind of behavior. What’s actually going on here?

The differences between types of dementia

Without going into a whole lot of clinical detail, it’s worth knowing that there are different types of dementia, some of which aren’t closely associated with aging, so I’ve skipped them here. Most of the time, patients in dementia care have one of the following.

• Alzheimer’s

• Lewy Body Dementia

• Parkinson’s Disease

• Mixed Dementia

• Vascular Dementia

• Frontotemporal Dementia (FTD)

Alzheimer’s is the most common type of dementia, accounting for 60-80% of all cases. It manifests as progressive cell death in the brain, which some think may be brought on by exposure to certain infectious agents—but no one knows for sure. It’s characterized by forgetfulness, disorientation, neglect for personal care, behavioral changes, and sometimes delirium.

Lewy Body Dementia (15-20% of cases) is caused by protein deposits in or on nerve cells, which causes memory loss and disorientation. Difficulty moving, sleep problems and hallucinations can also be present.

Vascular dementia, which accounts for 17-30% of dementia cases, is primarily caused by circulatory problems in the brain. As victims experience a series of mini-strokes, different brain functions seem to “burn out” like lights in an old house. Depending on where the mini-strokes occur, patients may fall for no reason; and like the other types of dementia, may neglect self-care, become frightened in familiar surroundings, experience memory problems, or hallucinate. In my mother’s case, she retained her vocabulary almost up to the end, but the words she chose almost felt like “filler” for concepts she could no longer express—as they had been generated by an AI that didn’t really understand what it was saying.

Parkinson’s Disease (Michael J. Fox, approx. 3-4% of cases) is primarily a neurological disorder that can manifest as dementia as it advances. It’s characterized by difficulty starting or stopping movement, and often shows up in patients as rhythmic small movements in the hands or gait.

Much of the time, it’s hard to distinguish among these by looking at symptoms alone. In fact, some patients may have what’s called “mixed dementia”, which is exactly what it sounds like: a mix of the above.

FTD, however, is a whole ‘nother ball of wax. It’s fairly rare, accounting for only 2-5% of cases, and is thought to be caused by a gene mutation. It primarily affects language and behavior, often rendering victims angry, paranoid, combative, and aggressive. It also affects control of inhibitions and impulses. Some caregivers report that “dad has suddenly taken to peeing on the front lawn” in full view of neighbors, or similar behavior. Unlike most of the other types of dementia, memory appears to be the last, or nearly last, thing that’s lost.

Also, because they don’t appear confused and don’t have any trouble remembering where they are, patients with FTD can sometimes end up being picked up by the police for indecent exposure, resisting arrest, etc.

The fact that you have a diagnosis for your dad is a good first step, because it will save you both a lot of heartbreak.

Don’t let frontotemporal dementia go undiagnosed or unaddressed

Because the symptoms are so different, FTD tends to go undiagnosed. Fortunately for you, you suspected something was wrong and had Dad checked out.

Unfortunately, FTD doesn’t have many effective treatments.

However, you CAN do a few things to address the problem.

Since Dad’s aggressive and impulsive, make sure he doesn’t have access to guns or sharp knives. Be sure to take his car keys away (that’s a whole different topic we discuss in detail elsewhere), and get him the kind of care he needs. You won’t be able to reliably calm him or constrain his movements, and he’ll probably look for an opportunity to sneak out of whatever care you provide.

Your best bet in the short term is to remove Dad from whatever is causing him to get agitated, or alternatively, ask a gerontologist about medications that can calm his symptoms. Even then, he’s probably going to be a bit of a problem.

A lightly staffed dementia care home is probably going to find him difficult to manage. You may need to have Dad housed in a facility that can ensure he doesn’t harm other patients, himself, or present a serious flight risk. That probably means something more like a traditional nursing home and less like a group “residence” with a homey vibe.

Puppies and ice cream

You’re probably going to have to change the way you deal with Dad once you get him stabilized. Even with his meds, don’t bring up topics in conversation that you know are going to trigger an angry response, such as politics, the economy, or an annoying neighbor.

Don’t bring board games if you know he’s going to be a sore loser. In fact, if you go that route, make SURE he wins.

Ask the staff at his facility if they ever bring therapy animals in. Focus on sharing happy experiences. Bring cake, cookies, or ice cream if you know Dad likes those!

And do what you can to keep Dad comfortable and happy.