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Dementia and Repetition

By Joe CarneyJuly 13, 2021
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In people who have dementia, brain cells deteriorate slowly over time. As the disease progresses, patients often begin to exhibit common dementia behaviors, including the tendency to repeat themselves or to repeat a specific action.

“Repetitive behavior involving movements, gestures, or activities can be common in persons with Alzheimer’s disease or other dementias, particularly some forms of frontotemporal dementia,” says David Troxel, former executive director of the Santa Barbara Alzheimer’s Association and co-author of A Dignified Life: The Best Friends Approach to Alzheimer’s Care. For example, someone with dementia could spend long periods of time arranging silverware or folding clothes, according to Troxel.

Explore how dementia and repetition are connected, along with causes of these behaviors. Plus, learn valuable tips to help care for your loved one who has dementia.

Dementia and repetitive speech

As dementia progresses, it increasingly hinders the ability to express ideas and formulate questions. In the early stages of dementia, patients commonly repeat things like questions or phrases. Sentence structure and word recall also diminish as the disease deteriorates the area of the brain responsible for language, according to a study from the National Institutes of Health (NIH). When a loved one continually says the same thing, it can be difficult for caregivers to maintain patience.

Here are some common ways dementia patients repeat themselves through language:

  • Stories. Caregivers frequently complain about senior loved ones telling old stories over and over again, sometimes even repeating sentences verbatim. Your parent may forget they’ve recently told the story or are trying to connect with you by contributing to the conversation. Sometimes this is their way of connecting to the past and holding onto precious memories.
  • Questions. This is the most common verbal repetition, according to a study published by NIH. Answering the same question over and over can also be the most frustrating situation to handle as a caregiver. “Fixating on a thought or idea is a behavior called perseveration — it’s common in dementia,” says Troxel. “It is triggered by underlying worry or anxiety compounded by profound confusion and forgetfulness. For example, a person might ask about feeding the dogs dozens of times since he worries about his pets, doesn’t quite know where he is (or where they are), and quickly forgets your reply.”
  • Phrases. As speech becomes increasingly limited, dementia patients may start repeating simple phrases or repeating what someone else has just said as a means of participating in discussion.
  • Sounds. Particularly in the mid-to-late stages of dementia, patients may lose significant language abilities and start to exercise their limited vocabulary by repeating a small set of words, creating repetitious sounds (like humming), or moving their lips in a way that feels familiar to them.

These behaviors can be brought on by a whole host of causes, making it necessary for caregivers to listen keenly for what the patient is trying to tell them. Confusion, physical discomfort, anxiety, boredom, and desire for comfort are some of the many reasons a patient may repeat themselves as they wrestle with what they’re trying to say, according to Alzheimer’s Society. If these expressions fall flat with their audience, needs could go unmet and the patient’s quality of life may suffer.

Repetitive actions in dementia

Dementia and repetition can take on many forms, making it difficult to identify at times. In some cases, repetitive actions in a senior loved one can look similar to impulse disorders or can be brought on by unexpected causes.

Discover some of the most common repetitive actions in dementia patients and why they occur:

  • Simple movements. Continual tapping with fingers, hands, or feet is one of the most common actions, but simple movements can also include easy tasks, like repeatedly packing and unpacking a suitcase. “Focusing on something close and familiar can alleviate anxiety, be comforting, and help the person feel more in control of his or her environment,” says Troxel. These actions can often relate to old habits from earlier life, show a desire for entertainment, or express that the person wants to be helpful or productive.
  • Hoarding or collecting. While it may be caused separately by an impulse disorder like obsessive compulsive disorder, or OCD, hoarding can also be directly brought on by dementia, according to a study published by the National Library of Medicine. This can be caused by fear of misplacing items, worry that they won’t have items they need, or simply a lack of stimulation. Repeatedly handling similar items can also give patients a sense of familiarity and help them know where they are.
  • Bathroom trips. Dementia patients often develop a “toilet obsession” in the eyes of caregivers, wanting to use the restroom as often as every few minutes — sometimes without any bladder or bowel movements. “I have seen cases where the person constantly asks to go to the bathroom. This can create a lot of frustration for the family care partner,” says Troxel. “First, get your physician’s input to see if there are any health-related reasons, for example a urinary tract infection, prostate issues, or high blood sugar or diabetes. If there appear to be no physical causes, the behavior likely stems from anxiety or worry about getting to the bathroom, coupled with his or her profound forgetfulness.”

Tips for handling repetitive behavior in elderly

It’s essential to keep an open mind when trying to fully understand what a loved one with dementia is aiming to express. Despite the vast range of causes for repetitive speech and actions, there are a few tips you can use to help guide your interactions with a senior loved one when they’re repeating behaviors:

  1. Look for the underlying cause. Your loved one may not be able to clearly say what they’re thinking, feeling, or needing. Even if it doesn’t seem like they’re trying to communicate, see if what they’re repeating could point to something that’s on their mind, or to signs of physical symptoms. “Be sure to talk to your neurologist or physician about the issue since repetitive behaviors and movements can be a side effect of medications,” says Troxel.
  2. Calm anxious questions. If your loved one keeps asking what day it is, they may actually want to know if they’ve forgotten an important event, or they may feel disoriented and anxious. “A simple technique is to ask the person to tell you more about their concern or situation,” says Troxel. “Sometimes when the person talks more about the situation, it supports relaxation and a reduction in anxiety.”
  3. Actively listen with yes/no questions. Asking closed-ended questions that prompt a simple “yes” or “no” response can be an effective way of exploring what your loved one is trying to express. Since their language abilities may be limited, this can also be an easier way for them to engage with you and for you to promote successful communication.
  4. Understand the feelings behind the action. Because there can be many causes for the wide range of repetitive behaviors, it’s important to pay attention to any cues that may point to what your loved one is feeling. Facial expressions and body language can be indicators of feelings or thoughts.
  5. Redirect the action. If your loved one is repeating a simple motion, it may be better to give them something else to focus on. Providing a simple, productive task can be mentally stimulating for them and promote independent successes. “If the behavior is disruptive, like taking apart furniture, try to substitute another project,” says Troxel. Examples like sorting a deck of cards or working on a jigsaw puzzle can be effective alternatives.
  6. Approach with empathy. It’s easy for caregivers to become quickly frustrated by things like repeated questions or the relentless sound of tapping. “If the behavior is harmless, I wouldn’t try to dissuade the person from doing the activity,” says Troxel. Responding in a curt or blunt manner may be your first reaction, but it’s crucial to understand that your loved one is likely not trying to annoy you or cause headache. From that point of view, it’s easier to discover why they’re repeating something and then to respond in a useful, compassionate way.

Sources:

Alzheimer’s Association. “Repetition.”

https://www.alz.org/help-support/caregiving/stages-behaviors/repetition

Alzheimer’s Association. “Rummaging, Hiding, and Hoarding Behaviors.”

https://www.alz.org/media/greatermissouri/rummaging_hiding_and_hoarding_behaviors.pdf

Alzheimer’s Society. “Communication in the later stages of dementia.”

https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-progresses/communication-later-stages

Alzheimer’s Society. “Toilet problems, continence and dementia.”

https://www.alzheimers.org.uk/get-support/daily-living/toilet-problems-continence#:~:text=One%20of%20these%20%E2%80%93%20especially%20common,caused%20by%20pregnancy%20and%20childbirth.

National Institutes of Health. “Exploration of verbal repetition in people with dementia using an online symptom-tracking tool.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426314/

National Institutes of Health. “Language and Dementia: Neuropsychological Aspects.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2976058/#:~:text=Language%20deficits%20are%20frequent%20in,lack%20of%20cohesion%20in%20discourse.

National Library of Medicine. “Repetitive Behaviors in Frontotemporal Dementia: Compulsions or Impulsions?”

https://pubmed.ncbi.nlm.nih.gov/30537913/#:~:text=The%20most%20common%20repetitive%20behaviors,to%20the%20bathroom%20(13.5%25).

Social Care Institute for Excellence. “Repetition in people with dementia.”

https://www.scie.org.uk/dementia/living-with-dementia/difficult-situations/repetition.asp

The National Health Service. “Frontotemporal dementia.”

https://www.nhs.uk/conditions/frontotemporal-dementia/symptoms/

UCSF Weill Institute for Neurosciences. “Speech & Language.”

https://memory.ucsf.edu/symptoms/speech-language

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Author
Joe Carney

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