Your elder is acting strangely. He's hoarding the strangest things, or he's verbally aggressive, accusing, forgetful, making unreasonable demands constantly, or has developed  a hygiene problem. Disturbing behavior changes in an older adult usually mean something is very wrong. Here's what to do first.

Unless your elder has always been outrageous, understanding that these behaviors aren't "normal" is the first step. The next step, which can be difficult, is diagnosing the cause of the changes you are seeing.

Just as you can't diagnose what's causing a change in your car's performance without lifting the hood, you can't diagnose the cause of behavior changes without looking at the machine that is the human body. Your car's performance may have declined because of bad gas, a broken part, an electrical short, and so on. We can use the same analogies for the brain.

The performance of the brain may have changed or gotten worse because of malnutrition, dehydration, medications and so on (bad gasoline). There may have been the equivalent of an electrical short in the brain (a stroke, for instance). Or, the body may have picked up something along the road that is interfering with how it performs (a disease such as Alzheimer's Disease, Parkinson's, a urinary tract or other infection, or thyroid disease for instance).

Without looking "under the hood" of the brain we can't know what is causing the engine to run poorly. In order to lift the hood and learn more about the possible causes of the problem you will need the help of a physician or two (these are your "car mechanics"). Start with your relative's general physician. He or she may then refer you on to a neurological or a psychiatric specialist for fine tuning of a diagnosis. Just as it sometimes takes a lot of time and effort to figure out why your car is running poorly and how to fix it, it may take some time and considerable effort to get a good diagnosis and treatment recommendations for your senior.

Try to be with your elder when he or she visits the doctor. It's the only way you will be sure that the doctor's questions have been answered correctly, and it's the only way you can press for a deeper evaluation if you think it's needed. A diagnosis of Alzheimer's or Parkinson's, for instance, is time consuming. It's a rare primary care doctor who can accurately diagnose these diseases in a 15-minute office visit. You may have to push for a referral to a specialist if your doctor suspects one of these complex diseases. It's important that you do so, because an effective treatment for one disease can be the worst possible thing for another disease with similar symptoms.

Unfortunately, while we can almost always fix a car if we have enough time and money, we can't always "fix" what ails the human body. If we can't "fix" the problem, we can learn about the probable reason for the problem, use the science available today to help with the symptoms, and get the information we need to plan for the future.

It all starts with a trip to the doctor.