At its most severe, Alzheimer's disease can lead to drastic behavioral changes by those suffering from it.

Caused by a buildup of proteins that damage and kill nerve cells in the brain, the disease causes memory loss and irrational behavior varying from fear to anger, experts say.

“This disease isn't who these people are. It's a horrible disease,” said Samantha Rapuk, executive director of Lutheran SeniorLife of Mars, which operates secure assisted living and skilled nursing homes for people with Alzheimer's and dementia. “We know they don't have control over things they say, the way they act and forgetfulness. We know that's the disease, not the person.”

Health care and law enforcement personnel receive special training to help them deal with people who are not themselves due to Alzheimer's.

According to the Alzheimer's Association of Chicago, dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Alzheimer's is the most common cause of dementia. Alzheimer's is a specific disease, but dementia is not.Alzheimer's is a degenerative brain disease that is caused by complex changes to the brain following cell damage. It leads to dementia symptoms that gradually worsen over time. The most common early symptom of Alzheimer's is difficulty remembering new information because the disease typically affects the part of the brain associated with learning first.As Alzheimer's advances, symptoms get more severe and include disorientation, confusion and behavior changes. Eventually, speaking, swallowing and walking become difficult, according to the association.Staff at Lutheran SeniorLife are familiar with the progression of the disease and the accompanying symptoms.“Short-term memory is usually first affected. Long-term memory is lost in later stages,” Rapuk said. “You'll see mood changes. People who weren't anxious or angry before show those signs.”Those in care homes can become fearful because they don't remember why they are staying there. Some forget words and how to speak in sentences. Others have to be fed because they don't recognize hunger.“Some show aggression,” Rapuk said. “They try to protect themselves because they don't know why they're in the situation they're in.”Some residents act out and injure staff, but the staff is trained to work with Alzheimer's and dementia patients, she said.“We train staff on how to approach. Our staff knows our patients. They know what triggers anxiety and fear and try to avoid it,” she said.Staff de-escalate potentially volatile situations by speaking with the patient and backing away if their safety is at risk. Patients are given a few minutes to calm down and, if needed, someone the patient knows is called to come and talk to them.“You don't argue with someone with dementia. There's no reasoning with dementia,” Rapuk said.When a patient says they want to see their mother who died long ago, staff can't tell them their mother died because that could trigger fear or anger, she said.Others say they have to pick up their children from the school bus stop, but they don't have to.“We ask about their kids and change the subject. Our staff is phenomenal. They know how to talk, calm down and work with them,” Rapuk said.

Training for how state police respond to incidents involving people with mental illness begins when they are cadets in the academy and continues throughout their careers through mandatory in-service training at least once every three years, said Grace Griffaton, a state police spokeswoman.In addition, troop personnel partner with local and county agencies on a variety of training topics, including mental health training, she said.Recently, state police initiated supplemental crisis intervention training that was taught by four different crisis intervention teams across the state. The 40-hour training course was modeled after the Memphis Police Department's Crisis Intervention Team, she said.If the county where an incident is occurring has resources or a crisis intervention team available to assist, they will be contacted at the time of the incident, Griffaton said.The department is also conducting mental health/tactical communication training for all corporals assigned to patrol and criminal investigation units. This two-day training course will provide the information and tools necessary to effectively manage incidents involving persons with mental illness/mental health emergencies, she said.An additional training program is also offered to police communications operators, she added.The policy statement in the department's regulations for incidents involving people with mental illness and mental health emergencies, which is posted on its website, states people who are mentally ill may have a limited ability to comprehend, communicate and reason, which can make it difficult for them to interact with police.Therefore, it is important for personnel to understand how to recognize and appropriately respond to exhibited behaviors of a mentally ill person, according to the policy.

The Mental Health Procedures Act of 1976 gives troopers the authority, with or without a warrant, to take a person to an approved facility for an emergency examination if the person's actions constitute reasonable grounds to believe they are severely mentally disabled and in need of immediate treatment, according to the regulations.Behaviors listed in the regulations of people suffering from mental illness include delusions or false beliefs, hallucinations, rapid mood swings, staring blankly or not moving for long periods of time, and inappropriate emotional states. Those behaviors can change or become more intense with the use of alcohol, illicit drugs or not taking prescribed medication.Troopers are to continually evaluate people they encounter during incidents to assess whether signs of mental illness exist and may be contributing to behavior.If troopers determine a person encountered during an incident may be suffering from mental illness, they should try to assess the risk factor for violence by reviewing historical and clinical factors that increase the risk of potential for violence. To do that, police should review the person's criminal history, previous reports and documents available through the records management and computer aided dispatch system. Clinical factors include mental illness, substance abuse, exposure to destabilizers and hazardous conditions that make the person vulnerable or that may trigger violent episodes.Troopers should call for backup and attempt to de-escalate the situation when possible by turning off emergency lights and sirens, dispersing crowds, assuming a nonthreatening manner when approaching or talking to the person, assuring them they will receive appropriate care and that police are there to help.On Nov. 1, Butler City police used their crisis intervention training to take an armed woman, who had barricaded herself in her home, into custody. Officers assisted county mental health advocates who had an involuntary commitment warrant for the 68-year-old woman.Police Chief Bob O'Neill said officers used the training to negotiate with the woman for four hours trying to find a peaceful resolution. Officers entered a bedroom area and used a robot to locate the woman before taking her into custody with no injuries. The woman was taken to a hospital for an evaluation and for the warrant. O'Neill said criminal charges would not be filed against the woman.

The Center for Community Resources crisis center provides mental health crisis services through a contract with the county human resources department, said Brandon Savochka, department director.Available 24 hours a day, crisis center staff can evaluate a person for an involuntary mental health commitment after they have been transported to a hospital, he said.The staff can also respond to a crisis, but police have to secure the scene before staff members can get involved, he said.Savochka said the staff can help the family of the person involved or the police to complete the involuntary commitment form, and contact a mental health delegate from the center to determine if an involuntary commitment warrant should be issued.The center crisis team works with the Southwest Regional Crisis Intervention Team, which provides training to first responders and mental health professionals, and can respond to incidents.