Catastrophic Reactions in People With Alzheimer's

Catastrophic reactions are an overreaction to a seemingly normal, non-threatening situation; they occur at times in people with Alzheimer's and other types of dementia. The word catastrophic implies that there is a catastrophe or some terrible event that occurred, and that seems to be the way it feels to the person experiencing this type of reaction.


Alzheimer's patient with caregiver
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When Do Catastrophic Reactions Occur?

According to research conducted by the University of Rochester Medical Center, catastrophic reactions are five times more likely to occur in people who are in the middle stages of Alzheimer’s, as opposed to the early stages or late stages. This may be true because people suffering from moderate Alzheimer's will sometimes still be aware of their deficits and declines in functioning, and yet not be able to compensate or cope with them very well anymore.


Dementia can distort the way a person interprets reality. Feelings of being overwhelmed are common, and sometimes the environment a person is in is just too stimulating. If the lights are very bright, there are several people talking at once and the television is on, a catastrophic reaction may be more likely to occur.

Some people with Alzheimer’s also experience paranoia and delusions, which can make them very fearful of others’ intentions or actions.

Others have past traumatic experiences that may shape how they react or respond to attempts to help with bathing or dressing.

The University of Rochester study found that the most common trigger for a catastrophic reaction is assistance with personal hygiene tasks, and the evening dinner time is the most frequent time of day that catastrophic reactions are experienced.


Often, the way you interact with others can affect their reaction to you. Here are some possible approaches you can use to decrease the chance of a catastrophic reaction:

  • Approach the person from the front, rather the back or side which may startle her.
  • Don’t appear rushed or frustrated.
  • Know the person’s preferences. For example, some people respond very positively to touch and others bristle even if someone is near them.
  • Explain clearly what you would like to have the person do before attempting to do it. (“Dinner’s ready. Let’s walk together to the table.”)
  • Don’t criticize or argue with a person who has dementia.
  • Avoid over-fatigue if possible.
  • As much as possible, avoid sudden changes in routine.
  • Assess for symptoms of anxiety and offer treatment, if appropriate.

How to Respond

  • Give the person physical space.
  • Don’t attempt to continue whatever it was that triggered the reaction unless it is absolutely necessary to accomplish that particular task at that specific time.
  • Don’t use restraint or force.
  • Be respectful, not patronizing.
  • Use the person's name.
  • Allow him extra time to calm down.
  • Reassure her. Perhaps she has a favorite stuffed cat. Let her hold the cat and be comforted by it.
  • Divert him as he’s calming down. Catastrophic reactions are traumatic for those experiencing them, so encouraging him to focus on something else can help.
  • If the person has experienced a catastrophic reaction previously, you should always take note of what appeared to trigger the reaction before and avoid that behavior if at all possible.
  • If a catastrophic reaction is unusual for this person, you will also want to consider if she has any health changes that might be causing her to have pain, such as a fall or other injury, or a delirium. Delirium (usually caused by an infection or other illness) can cause a sudden change in cognition and/or behavior, and it can show up as increased confusion or uncharacteristic resistive and aggressive behavior.

A Word From Verywell

Remember that catastrophic reactions in dementia can be difficult for both the caregiver and the person experiencing them. Trying some non-drug strategies to respond to these kinds of challenging behaviors, along with taking a deep breath, can often make the day go better for both of you.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.