How to Manage Behavioral Changes Associated with Dementia

Dementia is an umbrella term describing a group of symptoms leading to progressive loss of memory and function. Changes in behavior are included in that group of symptoms defining dementia. However, behaviors can begin early in the disease process, even before an official diagnosis. It may be one of the reasons families seek out medical attention.

If you are aware of the behaviors, you can learn strategies to help manage them. This will assist you and your family cope with the ever-changing disease process. In addition, you can provide a safe and secure environment for your loved one living with dementia.

Ten behaviors associated with dementia

Depression: Depression may be evident in early dementia. The Alzheimer’s Association reports that 40% of all people with dementia will experience depression at some stage. Studies have also shown that people who present with depression in mid to later life have a higher risk of developing dementia.

Agitation: Increased agitation and irritability are evident early in the disease. This may be due to the person with dementia becoming frustrated with declining memory. In addition, being unable to carry out a task they were once proficient at can also be a source of agitation.

Apathy: This can be evident early in the disease and can also be connected to depression. Apathy intensifies as the disease progresses. For example, people with dementia may have little concern about their appearance and don’t see the necessity to take a bath or change their clothes.

Sleep disturbances and sundowning: Difficulty with the amount and quality of sleep is evident early in the disease and continues throughout. Disturbances in the sleep-wake cycle can be to blame for the inability to fall or stay asleep. This begins at dusk and can last throughout the night (sundowning). This is often seen with Alzheimer’s disease.

Hoarding: The person with dementia may start to rummage through drawers and closets, or they may hide things like treasured items, mail, clothing, or food. The hoarding may reflect a purpose like hunger or concern that someone is stealing from them. But, often, we won't be able to identify a reason for this behavior.

Delusions: The false belief that something is real when it is evident to others that it isn't is an example of delusional thought. Sometimes people believe their spouse is having an affair. They may also think people are hiding things or stealing their money. They may misunderstand what they see or hear, contributing to the delusion.

Hallucinations: Due to changes in the brain, the person with dementia can falsely perceive reality. This causes them to alter what they see, hear, touch, smell, or taste and believe it is real when it is not. For example, they may tell you they see spiders on the wall when you don’t see anything. These hallucinations may be disturbing, while others may be pleasant.

Wandering: People with dementia may become confused about where they are and roam to find familiar surroundings. Sometimes they can wander throughout their own home at night and become disoriented. In addition, there is a risk of them exiting the house into the elements. The Alzheimer’s Association reports that more than half of people with dementia will wander.

Sexual behaviors: Dementia that affects the brain's nerve cells in the frontal lobe can produce loss of inhibitions. Disrobing, speaking inappropriately, or making advances are elements of behavior that can be evident with this type of dementia.

Hitting: Physical aggression may include hitting, punching, pushing, or even raising a hand to threaten. Often physical aggression occurs because the person feels overwhelmed or fearful.

Are these behaviours treatable?

There are several reasons behaviors emerge or increase in a person with dementia.

Contacting your medical practitioner is imperative as the behaviors may be due to a medical cause. Issues such as infection, pain, or medication interaction may be treatable. They may require a physical examination and diagnostic testing. Vision or hearing impairments can increase confusion, so it is essential to ensure that testing for hearing and vision is current.

Tips for managing behaviors: Redirection is key!

Try to remain calm. You may have to use the “count to ten” and “take a deep breath” technique before you address a behavior. Approach the person by facing them and speaking in a calm voice.

Don’t argue, debate, or correct, as that will likely escalate the situation. Live into their reality at the time. Identify how they are feeling. They may be “living in the past,” so reminiscing with them can provide a comforting atmosphere.

Encourage non-verbal communication. Ask them to point at what they want if they can’t verbalize it. Provide sensory techniques like a hand massage to help them relax.

Validate their feelings and provide reassurance. Say things like, “You seem upset.” This will help them to feel understood, secure, and safe.

Keep the daily routine simple without distractions. Keep instructions to one thing at a time. Invite them to participate in household activities by saying things like, "Let's fold these towels together." Use humor throughout the day to keep the atmosphere light.

Use music. Playing soft music, singing, or dancing to help redirect behavior may be helpful. Making a playlist of your loved one’s favorite music on a mobile device and using headphones can be very restful.

Safety measures for wandering behavior. Purchase inexpensive door alarms at a hardware store with a soft bell chime. They are easy to install and will alert you that your loved one has opened a door.

Find a safe place to walk. Walking programs may be available at your local community center and provide a safe place to go with your loved one for a walk. This will provide some exercise and activity in the day and an opportunity for socialization.

Counseling. You may also find counseling helpful from a therapist or a counselor from the Alzheimer’s Association. You and your loved one may benefit from strategies provided by these experienced professionals.

Conclusion

Living with and caring for someone with dementia can be challenging at times. Behaviors occur in all stages of the disease and are often in response to changes in the brain, fear, or misunderstanding of their surroundings.

If you are alert and understand the reason for behaviors, you can develop approaches to manage them. Support from organizations like the Alzheimer’s Association can educate, encourage, and support you with strategies to cope. This will help you and your loved one feel safe and secure.

Key takeaways

Behaviors in dementia can occur in all stages of the disease.

Contacting your medical practitioner is essential in new or continuing behaviors in case of a treatable cause.

Use a calm approach in your interactions with someone experiencing a behavior associated with dementia.

Redirection is key to moving the person with dementia from harmful or unsafe behavior to a place of safety and security.

Creating and maintaining a calm atmosphere will contribute to positive outcomes.

Resources:

Alzheimer’s Association. Stages and Behaviors.

Today's Geriatric Medicine. Managing the Behavioral Symptoms of Alzheimer's Disease.

National Institute on Aging. Behavior changes and communication in Alzheimer's.

National Health Service. Coping with Dementia Behavior Changes.

Focus: The Journal of Lifelong Learning in Psychiatry: Overlay of Late-Life Depression and Cognitive Impairment

Neurodevelopmental Disease Management: The sleep-wake cycle and Alzheimer’s disease: what do we know?

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