The researcher Goldstein, coined the term “catastrophic reaction” to describe the overreaction to minor stresses which occur in patients with advanced dementia. It is precipitated by fatigue, overstimulation, an inability to meet expectations, and persistent misinterpretations. According to Goldstein, “When the environment is misperceived and one feels threatened, the following signs are noted:

According to the researcher Mace, “Intervention becomes necessary to avert or minimize these reactions.” Any sudden deterioration in cognitive function with worsened behavior should be considered as a warning that the patient may be physically ill and will act out.

Action to be taken – Maximize the individual’s medical status with an appropriate physical evaluation and if necessary, medication for severe behavioral issues. Also recognize that these behavioral symptoms are not to be viewed as willful. Further, recognize the person with dementia who may not be able to control their behavior and will require staff intervention.

Action to be taken – Simplify tasks, requests, or the environment so that the confusion does not become overwhelming for the patient with dementia.

Action to be taken – Recognize the impending signs of a catastrophic reaction by close observation of outbursts that are often preceded by restlessness.

Action to be taken – Remove the individual, when warranted, from an unwanted stimulus by withdrawing the individual to a quiet room or space. Suggest going for a walk, which may allow time to calm down or even a chance to distract and or forget what may have caused the patient to act out.

Action to be taken – Plan a consistent daily schedule of several uncomplicated routines that may include increasingly difficult tasks for when he or she feels best and can willingly comply with a request.

Action to be taken – Grossly disoriented persons often may appear helpless and hopeless but may briefly respond with warmth and pleasure when stimulated. For them, the goal is not just orientation but rather human contact. Care should be directed toward fostering good general health, improved motor skills function in all areas of behavior.

Action to be taken – Listening with respectful attention for any opportunity to create dialogue. Communication is an essential component of care. This can include the technique of reminiscence, even though one may not fully remember the names of their spouse or children.

According to the researcher Hellebrant, “Care that is based on the premise of what is left is uniquely human and should be protected and preserved as long as possible.”

The researchers Katz and McArdle summed it up this way, “Must we be held hostage by this dread threat of old age? Can we remember that life is more than momentary cerebral synapses? It is the total piece that has been woven and if at the end there are rugged edges, are they fault or fringe?”

We know full well the strain that loved ones endure when their beloved is out of touch with reality and incapable of behaving in socially acceptable ways. Yet, when in the depth of despair, we can be reminded of the better times and celebrate them for the joy they brought and the memories that remain.