Dementia Behaviors, How To Recognize Them, And What To Do About Them

Medically reviewed by Nikki Ciletti
Updated February 26, 2024by BetterHelp Editorial Team
Content Warning: Please be advised, the below article might mention trauma-related topics that include suicide which could be triggering to the reader. If you or someone you love is having suicidal thoughts, contact the 988 Suicide & Crisis Lifeline at 988. Support is available 24/7. Please also see our Get Help Now page for more immediate resources.
Once dementia progresses, your loved one may behave very differently.

What can you do when dementia behaviors appear? You can help by recognizing the behavior, finding its underlying cause, and responding to the need behind it.

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If you’re a caregiver, supporting your own mental health is key

Fear, anger, and sadness are common among dementia patients. But, a person with dementia may have an impaired ability to reason and manage emotions. As a result, they may express feelings through inappropriate or troubling behavior, which can be a drastic change in a person's personality.

Depression

People with dementia may also experience depression but not verbalize it.

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You may attribute an eating or sleep disturbance to the disease process of dementia itself. However, these and other difficult behaviors sometimes indicate that depression has developed.

Recognizing depression

The Cornell Scale for Depression in Dementia is a tool used by professionals to assess depression in a person with dementia. Healthcare providers interview close family members or caregivers, asking questions about certain behaviors the person with dementia engages in. Signs of depression in dementia include:

  • Restlessness and fidgeting

  • Hand wringing

  • Pulling own hair

  • Agitation

  • Moving or reacting more slowly than usual

  • Complaining about many physical ailments

  • Loss of interest in things

  • Loss of appetite

  • Weight loss

  • Lack of energy

  • Trouble sleeping

  • Talking about suicide

  • Self-blame

  • Pessimism

  • Delusional beliefs

  • Social withdrawal

  • Trouble concentrating

Responding to depression

When you recognize that the person you're caring for shows consistent signs of depression, talk to their doctor. In the meantime, you can take some steps to alleviate the situation.

  • Help them find a mental health counselor.

  • Help them stay active.

  • Acknowledge their feelings.

  • Talk with them about what they enjoy and do those things together.

  • Celebrate special 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 predictable.

Confusion

People with dementia can become confused about major events or even about where they are and what they've been doing.

Recognizing confusion

Confusion can appear as demanding questions or indignant statements. People with dementia may ask the same question over and over, or they may tell you that they are somewhere they are not. 

On the other hand, some people with dementia show confusion in their facial expressions or in their hesitancy to trust. Their confusion may result from not realizing they're in a safe place.

Responding to confusion

You can't solve dementia confusion by pointing out that they're saying incorrect things. Explaining and arguing don't work because they may be unable to process what you tell them. 

Instead, it's better to redirect someone with dementia to another activity when they act confused. Tell them what they need to feel safe. If that means not telling them the exact truth, it's okay.

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Fear, anger, and aggression

Fear and anger can lead to aggression in some people with dementia. This brain disorder can result from biological changes to the brain or from feeling highly frustrated by not understanding the current situation. 

When fear is the emotion behind aggressive behavior, the person with dementia is trying to deal with people, places, and objects that seem less familiar than they once did. They may also sense they have less control, and aggression might help them feel safe or in control.

Recognizing anger

People with dementia may become belligerent, 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.

Responding to anger

If someone you care for has dementia and anger becomes a problem, first deal with aggressive acts and words. Perhaps more than any other dementia behavior, you need to figure out the cause of the aggression and the need it represents. Don't argue or tell them no. Don't restrain them unless you need to for safety purposes.

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, talk to them more to find out how they would like you to help. Stay calm. Even if you can't do what they ask of you, listen and acknowledge their needs. 

There are some things you can do to try to help stop angry outbursts before they start. Using visual cues may help avoid anger outbursts. For example, you can use visual cues, like photos or simple written instructions, to guide them through their daily routine and prevent them from getting frustrated. You can also give them a simple job to do, like folding laundry, that can help them feel useful. The repetitive nature and soft touch of the fabric in an activity like folding towels can give them something to stay focused on and possibly diffuse some of their tension. Also, avoid asking open-ended questions that require them to weigh multiple options and formulate a response, as this can cause stress for someone with dementia. For example, instead of asking, “What do you want for breakfast?” ask, “Do you want oatmeal or eggs for breakfast?” 

Sleep changes

Sleep issues can be challenging to resolve. A person with dementia may struggle with sleep because of changes in their brain. Multiple factors, like physical pain, health problems, or a need to use the bathroom more frequently, can also interrupt sleep as a person ages.

Recognizing dementia sleep behaviors

People with dementia can also develop REM sleep behavior disorder (RBD). RBD may cause them to act out their dreams as they sleep. 

Also, a dementia patient might wake up in the middle of the night and not know the time, then go about their day as if it were morning. They may also have trouble falling asleep or may wander at night, making safety an issue.

Responding to dementia sleep behaviors

If a person with dementia is wandering at night, ensure they're safe. Sometimes, people living with someone with dementia install an alarm system so they know immediately if the person leaves the house.

If a person with dementia is more active during the day, they may sleep better at night. If they wake up at night thinking it's morning, show them the time and gently encourage them to get back in bed. Adjusting the lighting to minimize shadows, which can confuse people with dementia, may also help diminish confusion at night, which may help them fall and stay asleep.

Hallucinations

Dementia hallucinations usually happen in the later stages of the condition. A dementia hallucination is a false sensory perception caused by brain degeneration. People may start seeing or hearing things that aren’t really there.

Recognizing hallucinations

It can be challenging to recognize when someone is hallucinating. 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, even though no one is there

  • Holding a listening posture or facial expression as if something else has the person's attention

  • Moving the eyes as if watching something when nothing is moving in the environment

Responding to hallucinations

First, assess whether the hallucination is a problem for them. If it makes you feel uncomfortable but doesn't seem to negatively impact them, it might not need to be dealt with. However, if a hallucination is causing a problem or making them feel fearful, you can help them.

Talk clearly and speak slowly. Don't pretend the hallucination is real. Acknowledge their feelings, but don't pretend to feel the same way. If you do, they might lose their grasp on the difference between what their senses are telling them and what they know to be true. For example, if the hallucination is that there is someone else in the person’s room that is scaring them, you can tell them you know they are feeling scared, but do not pretend that you are afraid of the person in the room.

Paranoia and false beliefs

Sometimes, the brain of someone with dementia changes enough to cause problems with paranoia, which can significantly impact dementia care.

Recognizing paranoia

Dementia-related paranoia often involves distrust of family or caregivers. A person with dementia may say they suspect that someone is stealing from them or poisoning them. 

If you're one of the people they distrust, they may not tell you directly. Instead, they may hide belongings or money, refuse to eat or drink something you give them or refuse to go with you in your car. If they distrust a doctor, they may resist going to appointments.

Responding to paranoia

If you recognize paranoia in a person with dementia, get in touch with their doctor. They may schedule a consultation to decide on potential treatments.

You don't necessarily need to do anything about the paranoid behaviors unless they pose a danger or there are safety concerns. Reassure the person experiencing paranoia that you're on their side by taking care of their needs. Rather than arguing, distract them with activities or unrelated conversations.

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If you’re a caregiver, supporting your own mental health is key

Finding support as a caregiver as dementia progresses

When someone you're caring for has challenging dementia behaviors and decreased thinking skills, you need as much support as possible. Self-care, like regular exercise and a good sleep routine, can be helpful, but talking to someone can help. You may be able to find a support group in your area that can help you connect with people who are going through something similar. Online therapy may be a good option for caregivers, too. You can participate in online therapy from the comfort of your home. Plus, you can reach out to your therapist anytime, 24/7, via phone call or in-app message, and they will get back to you as soon as they can. 

Online interventions have been found to effectively help dementia caregivers. They may provide support and improve the mental health of caregivers. To learn more, reach out to a BetterHelp therapist.

Takeaway

Dementia behaviors in older adults can be challenging if you’re a family caregiver, but knowing how to recognize them and respond may make things a little easier for both the person with dementia and the person caring for them. If you need more support when caring for someone with dementia, online therapy can help give you the support you need.

Navigate the challenges of dementia

The information on this page is not intended to be a substitution for diagnosis, treatment, or informed professional advice. You should not take any action or avoid taking any action without consulting with a qualified mental health professional. For more information, please read our terms of use.
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