Is being self-centered part of dementia? Understanding personality changes

According to a study published by the NIH, up to one-third of subjects with mild senile dementia of the Alzheimer's type exhibited self-centered behavioral changes, with that percentage rising significantly as the disease progressed. The short answer to "Is being self-centered part of dementia?" is yes, it can be, and it's a symptom that can be particularly distressing for family members and caregivers.

Quick Summary

Self-centered behavior can manifest as a symptom of dementia, stemming from neurological damage that impairs empathy and emotional regulation. While not all forms of dementia present this symptom, it is particularly common in conditions like Frontotemporal Dementia and can intensify as the disease progresses.

Key Points

• Neurological damage causes the behavior: The seemingly selfish actions are not intentional but a direct consequence of physical changes in brain regions that control empathy and behavior.

• Frontotemporal Dementia has earlier onset: Behavioral variant FTD is particularly associated with early, pronounced personality changes, including a lack of empathy and social inhibition.

• Alzheimer's-related changes escalate later: In Alzheimer's, self-centered behavior often increases as the disease progresses and cognitive function declines, not necessarily as an initial symptom.

• Avoid taking it personally: It's crucial for caregivers to remember that the actions are disease-driven. Internalizing the behavior as personal offense can lead to emotional burnout.

• Communication and environment matter: Using simple language, establishing routines, and minimizing triggers can help manage agitation and reduce self-focused behaviors.

• Empathy for the caregiver is vital: Caregivers must set boundaries and seek support to protect their mental health. Prioritizing self-care is not selfish but necessary.

• Not all dementia causes this: While common, not all types of dementia or stages will present with self-centered behavior. Manifestations vary widely depending on the type and progression.

• Focus on the person beyond the illness: Learning about the specific type of dementia can help redefine expectations and connect with your loved one in new, meaningful ways.

Why dementia can cause self-centered or selfish behavior

Behavioral changes in dementia are a direct result of physical changes occurring in the brain. The brain's frontal and temporal lobes, responsible for personality, judgment, empathy, and impulse control, are often affected by the disease. When these areas deteriorate, a person with dementia can lose their ability to see things from another's perspective, leading to behavior that appears inconsiderate or selfish. This is not a deliberate choice but a consequence of the underlying neurological condition.

Brain regions and their impact on behavior

• Frontal Lobes: Deterioration here can directly cause a person to seem indifferent or insensitive to others' feelings. It impairs the ability to plan, organize, and control impulses, leading to uninhibited and sometimes embarrassing social conduct.
• Temporal Lobes: When these areas are damaged, it can cause changes in social behavior and emotional responses. This may manifest as a seeming lack of emotional warmth or indifference towards loved ones.
• Cognitive Decline: Confusion, memory loss, and a compromised understanding of social cues can all contribute to a more inward-focused attitude. As cognitive abilities decline, individuals may become fixated on their own needs and desires out of a sense of self-preservation.

How the type of dementia influences behavior

Different forms of dementia affect the brain in unique ways, and therefore, the presentation of self-centered behavior can vary. For example, behavioral variant Frontotemporal Dementia (bvFTD) is particularly known for this.

Comparison of Behaviors in Different Dementia Types	Aspect	Frontotemporal Dementia (FTD)	Alzheimer's Disease (AD)
Onset of behavioral change	Often an early and prominent symptom, sometimes before significant memory issues.	Typically appears in later stages, progressing alongside memory loss.
Nature of self-centeredness	May include impulsivity, loss of inhibitions, and complete indifference to others' feelings, potentially seeming rude or tactless.	Often presents as a more inward shift, fixation on personal needs, and difficulty recognizing others' emotions due to confusion.
Empathy	A significant loss of empathy is a hallmark symptom, stemming from damage to frontal lobes.	While empathy may diminish, it's often linked to broader cognitive and emotional confusion rather than a specific loss of empathy.
Social interaction	Can lead to socially inappropriate behaviors due to impaired judgment; may seem to lack consideration for others.	May lead to social withdrawal or apathy due to cognitive struggles and confusion.

Navigating self-centered behavior in loved ones with dementia

Caring for a person with dementia whose behavior has changed can be emotionally taxing. It's crucial for caregivers to understand that the behavior is a result of the disease, not a deliberate action. A shift from personal offense to empathetic understanding is a vital first step in coping with these changes.

• Avoid taking it personally: The actions are caused by brain disease, not a reflection of your loved one's true feelings. A constant reminder of this fact is essential for a caregiver's emotional health.
• Identify triggers: Keep a journal to track patterns in behavior. Are they more self-absorbed when they are tired, in pain, or overstimulated? Pinpointing the cause can help in managing the response.
• Simplify communication: Use calm, simple language and ask one question at a time. Trying to engage in complex discussions can lead to frustration and agitation, reinforcing the person's inward focus.
• Set healthy boundaries: While being empathetic, it is also important to protect your own well-being. Clearly and calmly state what behaviors are acceptable and what your limits are.
• Create a supportive environment: Stick to a consistent daily routine. A predictable environment can reduce confusion and anxiety, which are often contributors to agitation and self-centered demands.
• Seek support: Connect with other family members or support groups. Sharing the burden and learning coping strategies from others can be invaluable.

Conclusion: A shift in perspective, not character

While it is profoundly difficult to witness a loved one exhibit self-centered behavior, understanding that it is part of the dementia disease process, not a conscious choice, is essential for caregivers. The neurological damage caused by dementia directly impacts areas of the brain that regulate empathy, social behavior, and impulse control, leading to personality changes that can be misinterpreted as selfish. By adjusting expectations and adopting compassionate communication and care strategies, family members can better manage these challenging behaviors while protecting their own emotional health. This shift in perspective allows caregivers to respond with patience and empathy, focusing on the person underneath the disease and redefining their relationship based on the current reality.

Visit the Alzheimer's Association for more information and support on dealing with behavioral changes in dementia.

Frequently Asked Questions

Is being selfish a sign of early dementia?

While not a universal sign, an increase in seemingly selfish or self-centered behavior can be an early symptom of certain types of dementia, particularly Frontotemporal Dementia, where personality changes often precede significant memory loss.

Why do people with dementia become more self-centered?

People with dementia can become more self-centered due to damage to parts of the brain responsible for empathy, impulse control, and understanding others' perspectives. This is not a deliberate choice but a result of the disease's effect on their cognition and emotional regulation.

How can I cope with a loved one's selfish behavior caused by dementia?

To cope, avoid taking the behavior personally, as it is a disease symptom. Focus on empathetic communication, setting clear boundaries, and identifying triggers. Seeking support from family or support groups is also crucial.

Is it possible for a person with dementia to understand their selfish actions?

A person with dementia, especially Frontotemporal Dementia, may lack awareness of their symptoms and the impact of their actions on others. This reduced self-awareness is a direct consequence of the brain disease and means they are not deliberately trying to be difficult.

Does Alzheimer's disease cause self-centeredness like other dementias?

Yes, Alzheimer's can cause self-centeredness, although it typically appears in later stages as cognitive decline advances. Studies show that self-centered behaviors can double in prevalence as Alzheimer's progresses from mild to severe.

How can a caregiver distinguish between a person's old personality and dementia-related selfishness?

It's important to consider whether the behavior is a new development or an intensification of previous personality traits. With dementia, the behavior is often more extreme, uninhibited, and disconnected from the context, which is different from a lifelong personality trait.

What's the best way to communicate with someone with dementia who is being demanding?

Communicate calmly and with patience. Use simple sentences and avoid arguing or trying to reason with them. Instead, distract them with a different activity or validate their feelings to de-escalate the situation.