What are strange behaviors of dementia patients?

Research indicates that up to 97% of people with dementia experience behavioral and psychological symptoms at some point during their illness. Understanding what are strange behaviors of dementia patients is a crucial first step for caregivers seeking to provide compassionate and effective support.

Quick Summary

Commonly observed behaviors in dementia patients include repetition, sundowning, and paranoia, often rooted in confusion, unmet needs, or brain changes rather than intentional malice. Caregivers can respond by identifying triggers and providing a calm, predictable environment to help manage symptoms and improve well-being.

Key Points

• Behavior is communication: Dementia patients often use behavior to express unmet needs like pain, hunger, or confusion when they can no longer use words effectively.

• Recognize common patterns: Strange behaviors include repetitive actions, sundowning (late-day confusion), wandering, and paranoia, all of which have underlying triggers.

• Don't argue with their reality: Correcting or reasoning with a person experiencing delusions or hallucinations will only cause further distress; validate their feelings instead.

• Implement routine and distraction: A consistent daily schedule provides security, while calm distraction can redirect a person away from upsetting behaviors.

• Ensure safety and address physical needs: Always check for underlying physical issues like pain or infection, and take precautions to prevent harm from wandering or aggressive outbursts.

• Caregiver self-care is vital: Managing challenging behaviors is exhausting; seeking support and taking breaks is necessary to provide compassionate, sustainable care.

Understanding Behavior as Communication

For a person with dementia, brain changes diminish the ability to communicate needs, thoughts, and feelings in typical ways. What appears as a "strange" or "difficult" behavior is often their attempt to communicate something they cannot express with words. These behaviors are not intentional and should not be viewed as a reflection of the person's character. Triggers can include physical discomfort, environmental stressors, or unmet emotional needs.

A Closer Look at Common Behaviors

Several specific behaviors can cause confusion and frustration for caregivers. Identifying and understanding the cause behind each one is key to managing it effectively.

Repetitive Actions and Questions

This is one of the most common signs. A person may ask the same question repeatedly, tell the same story over and over, or engage in repetitive physical actions like rummaging through drawers or folding and refolding clothes.

• Why it happens: Short-term memory loss and anxiety are often the root causes. Asking questions or performing a familiar task can provide a sense of security and purpose in a world that feels increasingly disorienting.
• How to respond: Gently redirect their attention to a new activity or simply answer the question patiently without expressing frustration. Avoid correcting them or reminding them that they just asked. Acknowledge the feeling behind the question, such as a need for reassurance. For rummaging, provide a 'rummage box' of safe, interesting items to occupy them.

Wandering and Pacing

Restlessness that leads to wandering or constant pacing can be alarming for caregivers, especially due to the safety risks involved.

• Why it happens: The person may be feeling restless, bored, or trying to fulfill a past routine, like going to work. Sometimes, wandering is an attempt to find something or someone familiar, or to escape a perceived threat. 'Going home' is a common expression of this disorientation.
• How to respond: Ensure the environment is safe for supervised wandering. Distract and redirect with a walk or a simple task. Installing secure locks or a motion sensor on doors can alert caregivers if the person attempts to leave alone.

Sundowning (Late-Day Agitation)

Sundowning refers to a state of increased confusion, anxiety, and agitation that occurs in the late afternoon and evening.

• Why it happens: The exact cause is not fully understood, but it may be linked to changes in the brain's internal clock and fatigue. Shadows and reduced lighting can also be frightening or confusing.
• How to respond: Maintain a regular daily routine and encourage daytime activity to promote better sleep at night. Limit daytime naps. Create a quiet, calm environment in the evenings with good lighting. Offer a favorite snack or play soothing music to create a calming ritual.

Paranoia and Hallucinations

Believing that people are stealing from them or seeing things that aren't there can be deeply upsetting for both the person with dementia and their family. A specific example is Capgras syndrome, where the person believes a loved one has been replaced by an imposter.

• Why it happens: Changes in the brain can distort perception and logical thinking. The person is genuinely experiencing a different reality. Fear and insecurity often drive paranoid accusations.
• How to respond: Do not argue or try to reason with them. Validate their feelings of fear or distress and offer reassurance. Check for triggers, such as misinterpreting a reflection in a mirror. Distract them with a pleasant activity. If belongings are often misplaced, keep duplicates on hand to reduce tension.

Socially Inappropriate Behavior

This can range from making rude comments to undressing in public or other actions that ignore social conventions.

• Why it happens: Dementia can impair the part of the brain that controls impulses and judgment. The person is not being intentionally malicious but has lost the ability to self-regulate.
• How to respond: Respond calmly, without overreacting. Use distraction or redirection. Assess potential triggers, such as discomfort from clothing or misinterpreting personal care as intimacy. Consistency from all caregivers is important.

Comparison of Common Behavioral Symptoms

Behavior	Possible Cause	Caregiver Strategy
Repetitive Questions	Short-term memory loss, anxiety	Reassure patiently, use distraction, focus on feeling
Wandering/Pacing	Restlessness, unmet need (bathroom, hunger), confusion	Provide safe space, use alarms, redirect with activity
Sundowning	Internal clock changes, fatigue, light confusion	Maintain routine, limit naps, increase evening light
Paranoia/Delusions	Perceptual changes, distorted reality, insecurity	Avoid arguing, offer reassurance, distract, check environment
Inappropriate Actions	Impaired impulse control, discomfort	Redirect calmly, assess for physical triggers, maintain routine
Aggression	Frustration, pain, fear, environmental overwhelm	Stay calm, remove triggers, check for underlying illness

Practical Coping Strategies for Caregivers

Caregiving for a person with dementia can be challenging, but certain strategies can help manage and reduce distressing behaviors. The following tips can create a more predictable and supportive environment:

1. Stay Calm and Patient: Your own anxiety can be mirrored by the person with dementia. A calm tone of voice and relaxed body language can de-escalate tension. Take a deep breath and remind yourself it's the disease talking.
2. Identify Triggers: Keep a log of when behaviors occur. Was it at a specific time of day? Before a meal? When the environment was noisy? Identifying patterns is crucial for prevention.
3. Maintain a Routine: A predictable daily schedule for meals, bathing, and activities provides security and minimizes confusion. New or unexpected events are often triggers for distress.
4. Use Distraction and Redirection: When a behavior starts, distract with a calming activity. For example, if they insist on leaving, offer a snack or suggest looking at old photos.
5. Focus on Comfort and Safety: Ensure basic needs are met: check for pain, hunger, thirst, or a need to use the bathroom. Safety-proof the living space by removing tripping hazards and securing dangerous items.
6. Simplify Communication: Use short, simple sentences. Speak slowly and clearly. Avoid complex questions or giving multiple instructions at once. Visual cues and gestures can be helpful.
7. Take Care of Yourself: Caregiver burnout is real. Seek support from friends, family, or support groups. A caregiver's health and well-being directly impact the care they provide.

For more guidance on managing difficult behaviors, caregivers can refer to reputable sources like the National Institute on Aging.

Conclusion

The seemingly strange behaviors of dementia patients are not arbitrary but rather a complex form of communication and a direct result of changes in the brain. By shifting perspective from trying to control the behavior to understanding its root cause, caregivers can develop compassionate and effective response strategies. Patience, a predictable routine, and a focus on the person's physical and emotional needs can help reduce agitation and improve the quality of life for both the person with dementia and their caregivers. Every behavior is an opportunity to listen and respond with empathy.

Frequently Asked Questions

Why do dementia patients repeat themselves so often?

Repetition is a common behavior caused by short-term memory loss. The person forgets they have already asked a question or told a story, so they repeat it. It can also be a way of seeking reassurance or expressing anxiety.

What is 'sundowning' and how can I manage it?

Sundowning is increased confusion and agitation that occurs in the late afternoon or evening. To manage it, maintain a consistent routine, avoid overstimulation, and ensure the environment is well-lit as daylight fades.

How should I respond to a dementia patient who is paranoid?

Instead of arguing, validate their feelings and offer reassurance that they are safe. Avoid trying to convince them their beliefs are wrong. Use distraction to shift their focus to a pleasant activity. If they believe something was stolen, help them look for it without accusing anyone.

Is it normal for a dementia patient to wander?

Yes, wandering is a common behavior. It can be caused by restlessness, boredom, or a need to fulfill a past routine. Ensure the environment is safe, use door alarms, and redirect their energy with supervised walks or simple activities.

Why does a person with dementia refuse help with bathing?

Bathing can be frightening and disorienting. It involves a loss of control, potential fear of water, and sensitivity to cold. Try to make the experience less stressful by using gentle reassurance, maintaining a routine, and offering privacy.

What should I do if a dementia patient becomes aggressive?

First, ensure your safety and give them space. Remain calm and speak in a soothing voice. Try to identify and remove any triggers, such as noise or pain. If aggression persists, consult a healthcare provider to rule out underlying medical issues.

How can I tell if a strange behavior is from dementia or another medical problem?

Sudden or rapid changes in behavior, or fluctuations in alertness, may indicate a separate medical issue like a urinary tract infection, dehydration, or a medication side effect. Always consult a doctor to rule out other causes.