Perseveration

Perseveration is an uncontrollable repetitive emotion, thought, or action that occurs when it is no longer useful or meaningful. This behavior occurs in people affected by frontal lobe injury or disorders like HD, stroke, cancer, etc.

Perseveration is a behavior that the person with HD cannot control. Something or someone must interrupt the abnormal electrical circuit in the brain to stop the behavior. Management requires a change in the environment, a change in the behavior of the care partner or family member, or a change in the brain pathway with medication. Successful management usually involves all three of these interventions.

General Strategies:

  • Determine if perseveration is a meaningful persistence in solving a problem, or a distressing inability to stop the behavior. HD slows down the speed of thought, so the person with HD has to work harder and try longer to understand or get something done.
  • Not all perseverative behaviors are harmful, so choose your battles. Determine if the perseverative behavior is damaging or distressing to the person with HD.
  • Consider how much the perseverative behavior is disrupting family life or the care partner’s self-care and health.
  • As care needs advance, perseveration can put great strain on care partners. This is a stage of disease where extra help is usually needed to give the care partner some time away to “recharge the battery”.

Medication Management:

Perseveration can be managed with medications that are commonly available. The goal is not to rid the person of perseverative behavior completely but to reduce it to a level that a care partner can manage. For information to share with your doctor about the treatment of perseveration, also called obsessive-compulsive behaviors, see: http://www.ncbi.nlm.nih.gov/pubmed/21947193

Behavioral techniques:

Behavioral techniques, in conjunction with medication management, can reduce perseveration, and ease the work of caring for the person with HD. Since perseveration is a behavior that the person with HD cannot control, something or someone must interrupt the abnormal electrical brain circuit to stop the behavior. Behavioral management is a very important component of successful management.

Why is perseveration getting worse now?

Most increasing symptoms of HD, like irritability or perseveration, may simply be a clue that something is wrong. Triggers or other challenges to the person with HD can make symptoms worse, and the HD behavior is simply the way that the need is communicated. So the first thing to do is to ask if any of the following may be a factor.

Common Triggers

  • Fatigue Pain
  • Hunger Dehydration
  • Change in Routine Illness
  • Medication Issues Recent losses
  • Holidays, special events Political or civic events
  • Change in the lives of important family members

For tips on behavior management, see iCARE