Can dementia patients be controlling? Understanding the behavior and how to cope

According to the National Institute on Aging, dementia results from brain cell damage that can severely impact a person's behavior, personality, and ability to process information. As a result, many families wonder, Can dementia patients be controlling? The answer is yes, though this behavior isn't intentional; it's a symptom of the disease caused by neurological damage that affects impulse control and judgment.

Quick Summary

Controlling behavior in dementia patients stems from neurological damage, not malice. It is often a reaction to fear, confusion, and a profound loss of personal control. Caregivers can manage this behavior by creating calm routines, avoiding confrontation, and using redirection and validation techniques.

Key Points

• Neurological Basis: Controlling behavior in dementia is caused by brain damage, particularly to the frontal lobe, which impairs judgment, impulse control, and emotional regulation.

• Response to Fear: This behavior is often a response to the profound fear, confusion, and loss of control that a person with dementia experiences, not a sign of malice.

• Avoid Arguing: Trying to reason or argue with a dementia patient who is being controlling is ineffective and can increase their agitation. Focus on validating their emotions instead.

• Use Distraction and Redirection: Gently redirecting their attention to a pleasant or familiar activity, such as listening to music or looking at photos, is an effective management technique.

• Create a Consistent Routine: Establishing a predictable daily routine and simplifying the environment can provide a sense of security and reduce episodes of controlling behavior.

• Prioritize Caregiver Self-Care: Caring for a person with controlling behaviors is stressful. Caregivers must seek support through groups or respite care to prevent burnout and maintain their own health.

The Neurobiological Reasons Behind Controlling Behaviors

Understanding the underlying neurological changes in a person with dementia is the first step toward managing challenging behaviors compassionately. Controlling tendencies are not a deliberate act of will but a manifestation of brain damage affecting specific cognitive functions.

Brain Regions Impacted by Dementia

Several areas of the brain, particularly the frontal and temporal lobes, are frequently affected by dementia. Damage to these regions can lead to personality changes and a loss of self-control.

• Frontal Lobe: This part of the brain is responsible for executive functions, including judgment, impulse control, and emotional regulation. When it is damaged, a person may lose their 'filter' and become disinhibited, leading to controlling or socially inappropriate behavior.
• Amygdala: This structure is involved in emotional control, and damage can trigger feelings of anxiety, fear, and anger. A person with dementia may exhibit increased agitation or aggression as a result of a damaged amygdala.
• Serotonin Levels: Changes in neurotransmitters, such as a decrease in serotonin activity, have been linked to aggression in dementia. Serotonin is a key chemical that helps regulate mood, memory, and cognition.

The Psychology of Losing Control

For a person with dementia, the world becomes increasingly confusing and unpredictable. Their controlling behavior is often an unconscious attempt to regain a sense of security and stability in a world that feels out of control.

Common psychological triggers that lead to controlling behavior:

• Fear and Insecurity: The diagnosis of dementia itself is frightening. As cognitive abilities decline, individuals can feel vulnerable and insecure. Attempting to control their environment or caregivers provides a false sense of safety.
• Misinterpretation of Events: Memory loss and a decline in reasoning can cause misinterpretations. For example, a misplaced item might be perceived as a theft, leading to accusations and attempts to control who is in their space.
• Frustration and Inability to Communicate: As verbal communication becomes more difficult, a person may express frustration through controlling or agitated behavior. They may be unable to articulate their needs for comfort, pain relief, or companionship.
• Overstimulation: A noisy, busy, or unfamiliar environment can overwhelm the sensory processing of someone with dementia. Their behavior may become controlling or aggressive as a result of being overstimulated.

Strategies for Managing Controlling Behavior

Managing controlling behavior requires patience and a compassionate approach. It is crucial to remember that you cannot reason with a person whose brain is impaired. Instead, the focus should be on managing the situation and the underlying emotion.

Comparison Table: Reactive vs. Proactive Approaches

Reactive Approach (Ineffective)	Proactive Approach (Effective)
Arguing with the patient	Validate their feelings: Respond to the emotion behind the words, not the incorrect facts. For instance, if they accuse you of stealing, say, “I can see you're upset about your missing keys. Let's find them together.”
Overwhelming with logic	Distract and redirect: Change the subject to something pleasant or suggest a different activity. For example, “Let's stop talking about this. How about we listen to some music from your favorite old album?”
Taking it personally	Remember it's the disease: Recognize that the accusations and controlling actions are symptoms of the illness, not a reflection of your relationship. Do not take it to heart.
Engaging in a power struggle	Offer limited choices: Instead of a broad question like, “What do you want to wear?” offer two specific options. “Do you want to wear the blue shirt or the green shirt?” This provides a sense of control without leading to frustration.

Creating a Supportive Environment

A structured, predictable, and calm environment can significantly reduce the triggers for controlling behaviors. Consistency provides a sense of safety when internal stability is gone.

• Maintain a routine: Predictable schedules for meals, bathing, and sleep can reduce anxiety and confusion. Keep the routine consistent as much as possible.
• Simplify the environment: Reduce clutter and noise. A busy, overstimulated space can trigger frustration and controlling behaviors. Play soothing music or dim the lights if needed.
• Check for underlying needs: The behavior may be a form of communication. Check for physical discomfort, hunger, thirst, or pain that the person cannot express.
• Create a safe space: If your loved one becomes agitated, having a dedicated calm area with familiar objects can provide comfort and a place to de-escalate.

The Importance of Caregiver Self-Care

Caring for a person with dementia who exhibits controlling behavior can be emotionally and physically exhausting. The strain is significant and can lead to burnout, anxiety, and depression in caregivers. Prioritizing your own well-being is not a luxury—it is essential.

How to care for yourself as a caregiver:

• Seek support groups: Connecting with other caregivers who share similar experiences can combat isolation and provide a space to exchange coping strategies.
• Find respite care: Take regular breaks. Respite services provide temporary care, giving you a chance to rest and recharge. Adult day centers are another option for day-to-day support.
• Focus on your health: Do not neglect your own physical and mental health. Ensure you get adequate sleep, maintain a balanced diet, and seek medical attention for yourself when needed.
• Educate yourself: Learning more about the disease helps you understand the behaviors are symptoms, not malicious acts. This knowledge can reduce personal frustration and anger.

Conclusion

Controlling behavior in a person with dementia is a distressing and challenging symptom, but it is not a personal attack. It is rooted in neurological damage and the resulting fear and confusion. By approaching the situation with patience, empathy, and effective strategies—like validation, distraction, and maintaining a predictable routine—caregivers can reduce stress for both themselves and their loved ones. Seeking support and prioritizing self-care are also vital for navigating this journey. With a deeper understanding of the causes and effective management techniques, caregivers can better cope with this difficult aspect of dementia.

Frequently Asked Questions

Why does a person with dementia want to control everything?

A person with dementia often wants to control everything because they are experiencing a profound loss of control due to cognitive decline. This behavior is an instinctual reaction to intense fear and confusion about their surroundings and their own changing abilities, and they attempt to establish control wherever they can to feel safe.

Is controlling behavior a common symptom of dementia?

Yes, controlling behavior is a common symptom, though it is usually a secondary behavior stemming from other dementia-related issues. The neurological damage impairs judgment and impulse control, while memory loss and confusion can lead to paranoia and frustration, all of which can be expressed through controlling actions.

How can caregivers deal with a dementia patient who is controlling?

Caregivers can best deal with controlling behavior by remaining calm, validating the person's underlying feelings, and avoiding arguments. Using distraction and redirection is more effective than reasoning. Limiting choices and maintaining a consistent, predictable routine can also help create a sense of security.

What if the controlling behavior is aggressive?

If controlling behavior becomes aggressive, it is important to first ensure safety. Back away and give the person space, speaking in a calm, soothing voice. The aggression is often a result of fear, pain, or overstimulation. If the behavior escalates or involves a weapon, call 911. A medical evaluation can also rule out infections or other treatable issues.

Why does redirection and distraction work with controlling behavior?

Redirection works because the person with dementia often has a short attention span and difficulty holding onto complex thoughts. By diverting their focus to a pleasant or calming activity, you can bypass the immediate source of frustration and prevent a negative behavioral cycle from escalating.

What role does routine play in managing controlling behaviors?

Routine and predictability are vital for people with dementia. They provide a stable framework in a world that is becoming increasingly confusing. A consistent schedule for meals, sleep, and activities can reduce the anxiety and disorientation that often trigger the need to be controlling.

Should I take it personally when a dementia patient is controlling or makes accusations?

No, it is crucial not to take the behavior personally. The controlling actions and accusations are symptoms of a disease-altered brain and personality, not an intentional attack. By reframing the behavior as a symptom, caregivers can respond with empathy rather than frustration or offense.