Mangalore: Every year, on World Alzheimer's Day, September 21, we raise awareness for patients suffering from the neurodegenerative disease and support caregivers.

Alzheimer’s disease is often understood simply as a disorder of memory, but in truth, it is much more—emotion, behaviour, personality—these are deeply affected too.

Recent research shows that depression, anxiety, apathy, agitation, aggression, hallucinations, and delusions—all may play a central role in the illness.

Below is a story illustrating what Alzheimer's means in a human life—how depression, anxiety, and behavioural changes unfold, how they affect both person and family, and how care can make a difference.

A Lighthouse in the Fog

Sheila was 68 years old when she first began forgetting where she left her keys or the names of distant acquaintances.

Her doctor diagnosed early Alzheimer’s disease. Her daughter, Shalini, noticed changes slowly: subtle at first, then more visible.

One evening, as Sheila thumbed through an old photo album, she paused. “This was my favourite dress,” she murmured.

She used to wear it to recitals, to parties. But now she didn’t go out anymore. She stopped attending the weekly dance class she once loved.

Her face, once animated, was often blank. She lost interest in cooking, stopped caring for the garden, and stopped returning phone calls.

Shalini would knock, suggest going for walks; Sheila would shake her head, close doors, retreat into silence.

These were symptoms of depression: lack of interest, social withdrawal, apathy. Sometimes Sheila would lie in bed all morning, saying she didn’t care anymore about what tomorrow would bring.

But other times, there was anxious energy—restlessness, pacing in the corridor, worrying that no one would come to visit, asking whether everyone had forgotten her.

On bad days, she clung to Shalini, fearful she might be left alone. Shalini sometimes thought her mother’s memory was deteriorating faster—only later did she understand that anxiety and depression also clouded things, making everything seem worse.

In lieu of this case, Dr Poonam Santhosh, Psychiatrist, KMC Hospital, Mangalore, said that, “Anxiety symptoms like restlessness, excessive worry, clinging behaviors sometimes mistaken for worsening of Dementia.”

The doctor said that as the disease progressed, more patterns arose. “Sheila became suspicious, asking why people were talking behind her back. Once, she accused Shalini of hiding her jewelry.

On other nights, she slept very little; at dusk, she became agitated, pacing, unable to settle. Sometimes she hallucinated—seeing people in the hallway, hearing voices that weren’t there.

Aggression emerged over small frustrations: a dropped cup, a misplaced shoe. Sheila, who had always been gentle, would lash out. Caring for her felt as hard as caring for a wild animal, Shalini revealed.

Dr Santhosh reminds caregivers of a few pointers:

  • Beyond memory loss – Alzheimer’s is not only about memory; emotional and behavioural changes are also significant and distressing.
  • Depression is common – Every 3rd person with Alzheimer’s shows symptoms like sadness, withdrawal, and loss of interest.
  • Anxiety symptoms – Restlessness, excessive worry, and clinging behaviours often appear and may be mistaken for worsening dementia.
  • Behavioural challenges – Patients may become angry, agitated, or aggressive over minor issues, creating difficulties for caregivers.
  • Advanced stage changes – Suspicion, delusions, hallucinations, lack of motivation, wandering, inappropriate behaviour, and disturbed sleep may develop.
  • Underlying cause – These changes result from neuronal circuit damage and neurochemical imbalances in the frontal–temporal regions.
  • Managing symptoms – While not curable, emotional and behavioural issues can be managed with routines, emotional support, calm environments, and in severe cases, cautious use of medication.

What caregivers can do:

1. Keep communication simple: Use short, clear sentences, repeat key points, and allow extra time for responses.

2. Validate emotions, not facts: Acknowledge feelings instead of arguing about memory gaps to reduce anxiety and outbursts.

3. Rely on non-verbal cues: Eye contact, tone, touch, and expressions often communicate more than words.

4. Maintain a steady routine: Regular schedules for meals, sleep, and daily tasks provide comfort and reduce confusion.