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

Updated January 24, 2023by BetterHelp Editorial Team

Dementia behaviors can make caring for someone significant in your life challenging. Once dementia progresses past the mild stages, your loved one may behave very differently. What can you do when dementia behaviors start to appear or worsen? You can help if you recognize the behavior, find its cause, and respond to the need behind it.

If You’re A Caregiver, Supporting Your Own Mental Health Is Key

Dementia causes changes in the brain's physiology that impair the dementia patient's ability to reason and deal with emotions. Frustration, fear, anger, and sadness may be common with dementia patients, but they no longer have the resources to manage those emotions. When that happens, they tend to express their feelings through inappropriate behaviors.

Depression

You may know the symptoms of depression, but dementia patients may not be able to verbalize to you how they’re feeling.

If you or someone you know is experiencing suicidal thoughts, help is available. The National Suicide Prevention Lifeline can be reached at 988 and is available 24/7, or you can text the word “HOME” to 741741 to reach the Crisis Text Line.

Because their condition is getting progressively worse, you may attribute sleep and eating disturbances to their dementia itself. When helping a person with dementia, you also need to look for specific behaviors that are sometimes less obvious signs of depression.

Recognizing 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 or caregiver. They'll ask you questions about the dementia patient's behavior. Some of the signs of dementia with behavioral disturbance include:

  • Restlessness

  • 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

When you recognize that the person you're caring for is showing signs of depression consistently, 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.

  • Help them stay active.

  • Acknowledge their feelings.

  • Talk to them about what they enjoy and plan to do 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.

Confusion

People with dementia can be confused about major events or even about where they are and what they've been doing. Recognizing confusion can be challenging. Here are some tips.

Recognizing Confusion

Confusion can appear 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 need clarification about where their home is and desperately want to be in their own home, where they once felt competent and in control.

On the other hand, some dementia patients show confusion in their facial expressions or in their hesitancy to trust. Their confusion may result from wanting to be in a safe and familiar place even though they may no longer be able to recognize they're already in such a place.

What To Do

You can't solve dementia confusion by pointing out the truth. Giving details and arguing doesn't work because they may be unable to process what you tell them. If they could, 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 than trying to get them to understand that they are wrong.

Fear, Anger, And Aggression

Fear and anger can lead to aggression in 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 highly frustrating for them. Their dementia continues to get worse, and that's a hard thing to deal with without lashing out at someone.

When fear is the emotion behind aggressive behavior, the person with dementia is trying to deal with situations where people, places, and objects seem less familiar than they once were. 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.

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.

What To Do

If someone you care for has dementia and anger becomes a problem, you must immediately deal with aggressive acts and words. Then, you can address the needs behind their anger.

Perhaps more than any other dementia behavior, you need to get to 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. 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.

Sleep Changes

Inappropriate sleep behaviors can be challenging to resolve. The person with dementia may have problems with sleep that are purely biological. Their brain isn't functioning as they 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, and 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.

If You’re A Caregiver, Supporting Your Own Mental Health Is Key

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. When someone has RBD, their muscles don't relax when they sleep, and they move as if they are doing what they are in their dreams.

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 were 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 must ensure they're safe. Some families install alarm systems when someone with dementia moves in with them. That way, they know immediately if their loved one has left the house.

Ensure they do something active each day to make it easier for them to sleep well. 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.

Hallucinations

Dementia hallucinations usually happen in the later stages of the condition. A dementia hallucination is a false sensory perception caused by brain degeneration. They hear, see, or otherwise sense something that isn't there. They may be simply observing the false perception or interacting with it.

Recognizing Hallucinations

It can be challenging 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 experiencing dementia and hallucinations together may have a tremendously difficult time keeping up with your conversation. They're distracted, so 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. If you do, they might lose their grasp on the difference between what their senses tell them and what they know to be true.

Paranoia

When the brain of someone with dementia changes enough to cause problems with paranoia, you must be able to recognize these behaviors and address them.

Recognizing Paranoia

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 they distrust, they may not tell you directly. Instead, they may act like they don’t trust you by hiding objects or money. They may refuse to eat or drink something you give them or refuse to go with you in your car, or, if they suspect their doctor will 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.

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 conversations.

Finding Support As A Caregiver

When someone you're caring for has challenging dementia behaviors, you need as much support as possible. You need to stay mentally healthy to care for dementia patients and meet their needs as much as possible.

Online therapy is a good option for caregivers. One of the main benefits is that you can participate in online treatment from the comfort of your home or anywhere you have an internet connection. Plus, you can reach out to your therapist anytime, 24/7, via phone call, text, or messenger, and they will get back to you as soon as they can. 

Research shows that online therapy is effective, too. One review showed that online treatment led to a 50% improvement in symptoms of generalized anxiety disorder and depression and significantly decreased the impact of stress and chronic fatigue. To learn more, reach out to a BetterHelp therapist to get started.

Takeaway

Dementia behaviors can be challenging if you’re a caregiver, but knowing how to recognize them and how you can help can make things a little easier for you and your loved one. If you need more support when caring for someone with dementia, online therapy can help give you the support you need.

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