People are shocked when someone who never uttered a swear word or acted inappropriately suddenly begins to do one or both as the dementia progresses. Families are horrified and embarrassed. What is going on? What can be done?
I have a colleague who never used profanity in my presence. One day, I asked his opinion about a specific physician that my mother was going to see. “Great surgeon, but a total asshole otherwise.” I was caught off guard and blurted, “I didn’t think you even knew that word!” People have knowledge of many naughty words but can CHOOSE not to swear or use vulgar language. This choice involves the front and side part of the brain, the frontal and temporal lobes. This choice is influenced by culture, upbringing, even geography.
Speaking of choice, I choose to use profanity as a stress reliever, especially when driving. I also choose to exert control and use phonetic substitutions like “sugar” or “fudge” for naughty words. My emotions, however, can over-ride my self control. Literally. A couple of weeks ago, I was riding my horse and we were going over jumps. Jumps are both terrifying and exciting, so I am always super emotionally charged during these lessons. As Zydeco and I thundered toward one particular jump, Zydeco suddenly ducked and ran past the jump! I was simultaneously surprised and angry and called him a f***er before I realized what had come out of my mouth. The 2 young riders (7th graders) thought my faux pas was hilarious; I felt horribly embarrassed. This scenario can also happen with persons living with dementia, especially in people who used swear words infrequently. High emotions, like a strong tornado, can plough through the controls and out pops a foul word.
Septic Tank in the Brain
I often tell people that the sides of the brain contain word dictionaries. I also like to think that the same parts of the brain have a “septic tank” of sorts where the naughty words and thoughts are kept. People who maintain verbal and behavioral composure have strong boundaries around their septic tank, so there is no leakage or back flow. The strong boundaries are enforced by the frontal and temporal (side) lobes of the brain.
Enter dementia. As neurons die in the brain, especially those in the frontal lobes and temporal lobes, the walls around the “septic tank” weaken. At first, strong emotions push the nasty words out of the septic tank and they flow from the person’s mouth. As the dementia worsens, the walls around the septic tank become so weak and leaky that the vulgar words simply ooze out during simple conversations. This behavior is not a poor reflection on the person with dementia, anymore than a backed-up septic tank means the homeowner is a bad person. Sh*t literally does happen sometimes.
The use of vulgar or foul language, or acting out in a sexually inappropriate way, is often seen early in people with FTD because the front and side parts of the brain (the septic tank walls) are the first to go while other parts of the brain stay intact. For people with other types of dementia, the frontal and temporal lobes shrink later in the disease, so you may see this behavior as the person moves into the moderate to severe stages.
Handling Difficult Situations
So what do you do if your loved one is using vulgar or foul language, or acting in a sexually inappropriate way? One approach is to engage in public activities at times when the person is the most rested. Tired neurons “give up” faster than rested neurons. That is why you may notice this behavior when the person living with dementia becomes fatigued, such as in the late afternoon…or even early morning following a sleepless and active night. Other strategies include changing the conversation or introducing an activity (“let’s pet the dog”). I’m a big fan of having business cards that read, “My loved one has a brain disease, thank you for your patience,” and handing them out. I also suggest avoiding stressful situations like crowds, which may also “use up” any frontal lobe control and result in the septic tank overflowing.
The bottom line is that this behavior is caused by the disease and is no reflection on the character of the person living with dementia, or the character of the caregivers. Unfortunately, there are a lot of people who judge. Tell them Rita said to go @#$# off.
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Dr. Rita Jablonski
Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.