Dementia Behaviors, How To Recognize Them, And What To Do About Them
By Julia Thomas
Updated January 02, 2019
Reviewer Martha Furman, LPC, CAC
Dementia behaviors can make it difficult to care for a person who has been a major part of your life. Perhaps they were always kind, gentle, and optimistic. Maybe they were always alert, realistic, and followed a set routine as they went about their days. They may have been a great negotiator, getting what they wanted in a way that made people happy to give it to them.
Once dementia progresses past the mild stages, your loved one may behave very differently. What can you do when dementia behavior happens? You can help them if you recognize the behavior quickly, find out its cause, and respond to the need behind the behavior.
Types Of Dementia Behavior Changes
Dementia causes changes in the physiology of the brain that impairs the dementia patient's ability to think rationally and deal with emotions. Frustration, fear, anger, and sadness come easily in their situation, but they no longer have the emotional resources to manage those emotions. When that happens, they tend to express their feelings through inappropriate behaviors.
Some of the types of dementia behavior include:
- Depressive behaviors
- Sleep disturbances
- Aggressive behaviors
- Confused behaviors
- Behaviors based on poor judgment
- Paranoid behavior
Patients with any dementia can exhibit inappropriate behaviors. Some patients, though, have so much damage in the areas of the brain that influence these behaviors that they are diagnosed with dementia with behavioral disturbance. Whether they are labeled that way or not, they deserve to have their needs understood and addressed. You can only do that when you recognize the behaviors and know what to do when you see them.
Depressive Dementia Behaviors
You may know the symptoms of depression like sleeping more or less than usual, eating more or less than usual, feeling sad and hopeless, and having suicidal thoughts. However, dementia patients may not tell you what they're thinking about.
Because their condition is getting progressively worse, you may attribute sleep and eating disturbances to their dementia itself. When you're helping a person with dementia, you also need to look for specific behaviors that are sometimes less obvious signs of depression.
The Cornell Scale for Depression in Dementia is a tool used by psychologists and doctors to assess a dementia patient's level of depression. The healthcare provider first interviews a close family member or caregiver. They'll ask you questions about the dementia patient's behavior. Some of the signs of dementia with behavior disturbance include:
- Wringing hands
- Pulling own hair
- Being fidgety
- Being agitated
- Moving, speaking, or reacting more slowly than usual
- Complaining about many different physical ailments
- Loss of interest
- Loss of appetite
- Weight loss
- Lack of energy
- Trouble falling asleep or staying asleep
- Talking about suicide
- Blaming self or calling self a failure
- Being pessimistic
- Having delusions based on mood
- Social withdrawal
- Trouble concentrating
What To Do
Dementia and depression go together so often that depression treatment is nearly always a part of dementia treatment. When you recognize that the person you're caring for is showing signs of depression consistently, you need to talk to their doctor about treatments. In the meantime, you can take some steps to alleviate the situation.
- Help them find a mental health counselor. They can talk to a licensed counselor from wherever they are through com online counseling service.
- Help them stay active.
- Acknowledge their feelings.
- Talk to them about what they enjoy doing and make plans to do some of those things with them.
- Celebrate small and large occasions.
- Give them a chance to contribute in a volunteer setting or at home.
- Let them know you love and appreciate them.
- Offer them their favorite foods.
- Play their favorite music for them.
- Make their daily routine as predictable as possible.
Dementia Behaviors: Confusion
It's natural that someone whose brain is not functioning as well as it once would is confused at times. People with dementia can be confused about major events or even about where they are and what they've been doing. Recognizing confusion isn't always easy. Here are some tips.
Confusion often shows up as demanding questions or indignant statements. People with dementia may ask where they are. Or, they may tell you, but their answer doesn't make sense. They typically become confused about where home is, and they want desperately to be in their own home, where they were once competent and in control.
On the other hand, some dementia patients show their confusion in their facial expressions or in their hesitancy to trust. Their confusion is a result of wanting to be in a safe and familiar place even though they may no longer have the ability to recognize they're already in such a place.
What To Do
Dementia confusion can't be solved by pointing out 'the truth.' Giving details and arguments doesn't work, because they can't process what you tell them. If they did, they wouldn't be confused in the first place. Don't tell them they're wrong.
Instead, it's better to redirect them to another activity. Tell them what they need to feel safe. If that means not telling them the exact truth, it's okay. Their need for safety is more important to them at such times than their need to know why they're 'wrong.'
Fear, Anger, And Aggression
Fear and anger often lead to aggression for dementia patients. The reasons behind this dementia behavior are partly biological, as their brain has damage that makes them more impulsive. It's partly psychological, too, because the situation they're in is extremely frustrating for them. You can do everything for them that can be done, but their dementia continues to get worse, and that's a hard thing to take without lashing out at the nearest person.
When fear is the emotion behind the aggressive behavior, the person with dementia is trying to deal with a situation where people, places, and objects seem less familiar than they once did. At the same time, they know they have less control over themselves and their environment now. For them, the bravado of aggressive acts gives them a momentary feeling of control over others.
People with dementia may become belligerent, shouting what they will or won't do. They may call someone hurtful names or use profanity even if they never have before. They may even act out physically, by hitting, kicking, tripping, or biting you or someone else. Sometimes, they might throw objects or destroy someone's personal belongings.
What To Do
When someone you care for has dementia and anger becomes a problem, you must deal with aggressive acts and words immediately. Then, you can address the needs behind their anger.
Perhaps more than with any other dementia behaviors, you need to get very quickly to the cause of the aggression and the need it represents. Don't argue with them or tell them no. Don't restrain them unless it's needed for safety.
It's better to let the subject you're arguing go for the moment and focus on the need. Talk to them kindly without touching them or hovering over them. Walk away for a moment to give them space and time to work it out for themselves. Then, you can talk to them more to find out how they would like you to help. Even if you can't do what they ask of you, you can listen to them and acknowledge their needs.
Inappropriate sleep behaviors can be very difficult to resolve. The person with dementia may have problems with sleep that are purely biological. Their brain isn't functioning as well as it once did in many ways, and sleep may be one of them. They're probably less active than they were when they were younger, too, which can influence their ability to sleep. They may have other challenges that cause interrupted sleep, too, such as poor bladder control or nighttime pain. There are some ways you can help them.
Recognizing Dementia Sleep Behaviors
People with dementia often also have REM sleep behavior disorder(RBD). RBD causes them to act out their dreams as they sleep. People without RBD sleep typically stay very still and relaxed as they sleep and dream. But, when someone has RBD, their muscles don't relax, and they move as if they were doing what they're dreaming about.
The dementia patient might wake up in the middle of the night and not know the time. Rather than trying to find out, they may go about their day as if it's morning. They may also have a problem with not feeling tired if they haven't done anything active all day. Dementia patients may wander at night, making safety an issue.
What To Do
The dementia patient's safety always needs to come first. If they're wandering at night, you need to use some method to make sure they're safe. Some families install an alarm system when someone with dementia moves in with them. That way, they know immediately if their loved one has left the house.
For other problems with dementia and sleeping, you can do several things to make it easier for them to sleep well. You can make sure they do something active each day. Make sure their bed is clean and comfortable. Suggest they have a small snack in the evening, so they aren't hungry at night. If they get up to use the bathroom, that's okay. But, if they stay up each time, remind them that it isn't morning yet.
Dementia hallucinations usually happen in the later stages of the condition. Caused by degeneration of the brain, a dementia hallucination is false sensory perception. They hear, see, or otherwise sense something that isn't there. They may be simply observing the false perception, or they may interact with it.
It can be difficult to recognize when someone is hallucinating. Someone may cock their ear to the side as if listening, but they may have it in that position for another reason. Try not to jump to the conclusion of a dementia hallucination. You might be able to find out by simply asking them. If they don't or can't answer you, some signs to watch for are:
- Watching an empty part of the room intently, as if something interesting or alarming is happening there.
- Speaking as if in conversation when no one is with them.
- Holding a listening posture.
- Eyes are darting when nothing is moving in the environment
What To Do
The first thing you need to do is to think about whether the hallucination is a problem for them. If you're only worried because it makes you feel uncomfortable, that's something you need to deal with on your own. However, if it's causing a problem for them or making them feel fearful, you need to help them.
The person who is experiencing dementia and hallucinations together may have a tremendously difficult time keeping up with your conversation. They're distracted, so you need to talk clearly and keep your language simple. Don't respond to the hallucination. If you pretend it's real, you may confuse them further. Acknowledge their feelings, but don't pretend to feel the same way.
It's important to recognize that the person may know that what they're experiencing with their senses is a hallucination. So, if you go along with them, they may wonder how trustworthy you are. Or, they might lose their grasp on the difference between what their senses are telling them and what they know to be true.
When the brain of someone with dementia changes enough to cause problems with paranoia, it's important to be able to recognize these behaviors and address them.
Paranoia is a mental state that comes from a suspicious delusion. Dementia paranoia often involves distrust of their family or the care center staff where they live. They may feel that someone is stealing from them or poisoning them. They may tell you about their suspicions.
If you're one of the people who they distrust, they may not tell you directly. Instead, they may hide objects or money. They may refuse to eat or drink something you give them. They may refuse to go with you in your car or, if they suspect their doctor is going to harm them, they'll refuse to go to their doctor appointments.
What To Do
The first thing you need to do when you recognize paranoid dementia behaviors is to get in touch with their doctor. They may schedule a consultation visit with you to decide on the next steps in diagnosis and treatment.
There are also a few things you can do. You can avoid arguing with them. You can ignore them if they aren't a problem. You don't necessarily need to do anything about the paranoid behaviors unless they pose a danger to them, to you, or to your family. Reassure them that you're on their side by taking care of their needs. Rather than addressing the paranoid delusion directly, you can distract them with activities or unrelated conversation. Most importantly, you need to seek help for them.
Finding Support As A Caregiver
When someone you're caring for has difficult dementia behaviors, you need as much support as possible. You need to stay mentally healthy, so you can care for the dementia patient well and meet their needs as much as possible. BetterHelp.com has licensed counselors that can help you deal with the stress of being a caregiver. The job you're doing with your loved one is a noble thing. With help, you can do it like no one else ever could!