Telling the Patient. Often doctors will not tell patients that they have Alzheimer's. If a patient expresses a need to know the truth, it should be disclosed. Both the caregiver and the patient can then begin to address issues that can be controlled, such as access to support groups and drug research.

Mood and Emotional Behavior. Patients display abrupt mood swings, and many become aggressive and angry. Some of this erratic behavior is caused by chemical changes in the brain. But it may also be due to the experience of losing knowledge and understanding of one''s surroundings, causing fear and frustration that patients can no longer express verbally.

The following recommendations for caregivers may help soothe patients and avoid agitation:

- Keep environmental distractions and noise at a minimum if possible. (Even normal noises, such as people talking outside a room, may seem threatening and trigger agitation or aggression.)

- Speak clearly. Most doctors recommend speaking slowly to a patient with Alzheimer's disease, but some caregivers find that patients respond better to clear, quickly spoken, short sentences that they can more easily remember.

- Use a combination of facial expressions, voice tones, and words for communicating emotions.

- Limit choices (such as clothing selection).

- Offer diversions, such as a snack or car ride, if the patient starts shouting or exhibiting other disruptive behavior.

- Simply touching and talking may also help.

- Maintain as natural an attitude as possible. Patients with Alzheimer''s disease can be highly sensitive to the caregiver''s underlying emotions and react negatively to patronization or signals of anger and frustration.

- Showing movies or videos of family members and events from the patient''s past may be comforting.

Although much attention is given to the negative emotions of patients with Alzheimer''s disease, some patients become extremely gentle, retaining an ability to laugh at themselves or appreciate simple visual jokes even after their verbal abilities have disappeared. Some patients may seem to be in a drug-like or "mystical" state, focusing on the present experience as their past and future slip away. Encouraging and even enjoying such states may bring some comfort to a caregiver.

There is no single Alzheimer''s personality, just as there is no single human personality. All patients must be treated as the individuals they continue to be, even after their social self has vanished.

Appearance and Cleanliness. For the caregiver, grooming the patient may be an alienating experience. For one thing, many patients resist bathing or taking a shower. Some spouses find that showering with their afflicted mate can solve the problem for a while. Often patients with Alzheimer''s disease lose their sense of color and design and will put on odd or mismatched clothing. It is important to maintain a sense of humor and perspective and to learn which battles are worth fighting and which ones are best abandoned.

Driving. As soon as Alzheimer''s is diagnosed, the patient should be prevented from driving.

Wandering. A potentially dangerous trait is the patient''s tendency to wander. At the point the patient develops this tendency, many caregivers feel it is time to seek out nursing homes or other protective institutions for their loved ones. For those who remain at home, the following precautions are recommended:

- Locks should be installed outside the door, which the caregiver can open, but the patient cannot.

- Alarms may be installed at exits.

- A daily exercise program should be implemented, which may help tire the patient.

- The caregiver should contact organizations, such as Alzheimer''s Association or Medic Alert, for identification supplies and procedures that help locate patients who wander away from home and become lost.

Speech Problems. Speech therapy combined with Alzheimer''s disease medications may be helpful for maintaining verbal skills in patients with mild symptoms.

Zexuality. In many cases, the patient becomes uninhibited zexually. At the same time, the patient''s physical deterioration and receding capacity to recognize the spouse as a known and loved individual can make sexual activity unattractive for the caregiving spouse. Other patients may lose interest in zex. If sexual issues are a problem, they should be discussed openly with the doctor. Ways should be found to maintain non-sexual physical affection that can bring comfort to both the patient and the spouse.