What Are the Behavioral Problems of Dementia Patients?

According to studies, up to 90% of people with dementia experience behavioral and psychological symptoms (BPSD), making it a significant challenge for both patients and caregivers. Understanding what are the behavioral problems of dementia patients is the first step toward effective and compassionate care.

Quick Summary

Dementia can cause behavioral changes like agitation, aggression, wandering, and repetition, stemming from damage to brain regions governing mood and behavior. Factors such as confusion, unmet needs, and changes in routine often trigger these complex symptoms.

Key Points

• Brain Damage is the Cause: Behavioral problems in dementia patients are a direct result of neurological changes, not intentional acts.

• Common Behaviors Vary: Symptoms can include agitation, aggression, wandering, repetitive actions, apathy, and psychotic episodes like delusions or hallucinations.

• Identify Triggers: Tracking the timing and circumstances of a behavior can reveal triggers like pain, confusion, or environmental stress.

• Manage with Empathy: Use calming techniques, validation of feelings, and redirection rather than arguing or correcting a person with dementia.

• Routine and Environment Matter: Establishing a consistent daily routine and creating a calm, safe environment are crucial for reducing anxiety and confusion.

• Apathy is Different from Depression: Recognize that a patient's lack of motivation (apathy) is a distinct symptom and should not be misinterpreted as sadness or laziness.

Understanding the Root of Behavioral Changes

Behavioral problems in dementia patients are not deliberate acts of malice; they are symptoms of a progressive neurological disease. Brain cell damage affects mood, memory, and impulse control, leading to a wide array of challenging behaviors. It is crucial for caregivers to recognize these actions as a form of communication, often expressing fear, pain, or confusion when the ability to use words is lost.

The Impact of Neurological Damage

Different types of dementia affect different parts of the brain, leading to varying behavioral symptoms. For instance, damage to the frontal lobes can affect impulse control and motivation, while damage to the temporal lobes can affect emotional responses. As the disease progresses, these changes become more pronounced, making it more difficult for the person to process their environment or express their needs appropriately. Recognizing this neurological basis can help caregivers approach difficult situations with more empathy and patience.

Common Behavioral Problems in Dementia Patients

Agitation and Aggression

Agitation is a state of emotional distress or restlessness, often manifesting as pacing, shouting, or emotional outbursts. When this escalates, it can turn into verbal or physical aggression, such as hitting, pushing, or verbal attacks. These behaviors are frequently triggered by feelings of confusion, frustration from misinterpreting a situation, or an unmet need like pain, hunger, or needing to use the restroom. A chaotic environment with too much noise or activity can also be a significant trigger.

Wandering and Restlessness

Many people with dementia experience a strong urge to walk or pace aimlessly, a behavior known as wandering. This can be a dangerous behavior, as the person may become lost or injured. Reasons for wandering are varied and include searching for something familiar, following old habits (e.g., getting ready for work), or feeling bored and restless. During these episodes, the individual may be unable to communicate their purpose, leading to confusion and anxiety for both the person and the caregiver.

Repetitive Actions and Speech

Repetitive behaviors are a common symptom where the person asks the same question, repeats the same phrase, or performs the same action over and over. This can be very frustrating for caregivers but is often a symptom of short-term memory loss or an attempt to seek reassurance or express an unmet need. For example, a person might repeatedly ask, “What are we doing today?” because they have forgotten the answer or feel anxious about their lack of routine.

Sundowning Syndrome

Sundowning is a phenomenon where confusion, anxiety, and agitation increase in the late afternoon and evening. This shift can turn a calm day into a challenging evening. The exact cause is unknown but may be related to the disruption of the internal body clock or reduced light exposure, which can cause increased shadows and visual misinterpretations. This period often leads to sleep disturbances and nocturnal restlessness.

Apathy and Disengagement

Apathy, a lack of interest, motivation, and emotion, is a frequent and often frustrating behavioral problem. It is different from depression, as it does not involve feelings of sadness or guilt. A person with apathy may show little interest in activities they once enjoyed, neglect personal hygiene, or become withdrawn and unresponsive. This can be especially hard on family members who interpret the behavior as a personal rejection, not realizing it is a symptom of the disease.

Psychotic Symptoms: Delusions and Hallucinations

In some cases, dementia can cause psychotic symptoms. Delusions are false, unshakeable beliefs, such as believing a loved one is an impostor or that someone is stealing their possessions. Hallucinations involve seeing, hearing, or feeling things that are not there. These are very real to the person experiencing them, and arguing with them or challenging their reality can cause increased distress and paranoia.

Managing Behavioral Problems: A Compassionate Approach

Successfully managing behavioral problems requires patience, observation, and a willingness to adapt. The following strategies can be very effective:

• Identify Triggers: Keep a journal to track when and where behaviors occur. Look for patterns related to time of day, environment, people present, or specific activities. Identifying triggers is key to prevention.
• Maintain a Consistent Routine: A predictable daily schedule for meals, bathing, and activities provides a sense of security and reduces confusion and anxiety.
• Create a Calm Environment: Reduce noise, clutter, and distractions. Use familiar objects and soft lighting, especially in the evening, to minimize confusion.
• Simplify Communication: Use simple language, short sentences, and a calm, reassuring tone. Avoid open-ended questions that require complex thought, and don't argue or try to reason with them when they are agitated.
• Validate Feelings: Acknowledge the emotion behind the behavior. If they are asking to go home, respond to the feeling of missing home rather than correcting them. Validation helps de-escalate emotional distress.
• Use Redirection and Distraction: When a behavior starts, distract them with a pleasant activity. For a person who paces, offer to take a walk together. For repetitive questions, offer a favorite snack or play some music.

Comparison of Behavioral Triggers and Responses

Trigger or Event	Healthy Person's Response	Dementia Patient's Behavioral Response
Change in routine	Minor inconvenience; adapts or re-schedules.	Heightened anxiety and agitation due to confusion and disorientation.
Physical pain (e.g., arthritis)	Expresses discomfort clearly and seeks relief.	May express pain through aggression, restlessness, or refusal of care.
Misplacing an item	Feels annoyed; retraces steps to find it.	Paranoid delusions; may accuse a caregiver of stealing the item.
Chaotic, noisy environment	Feels overwhelmed; seeks a quieter space.	Increased agitation, emotional distress, and potential aggression.
Seeing own reflection	Recognizes oneself in the mirror.	Mistaken identity or a belief that a stranger is in the house.

Conclusion

While the behavioral problems associated with dementia can be challenging and emotionally taxing, they are not insurmountable. By approaching these symptoms with empathy and understanding, caregivers can significantly improve the quality of life for the person with dementia. Focusing on communication, a supportive environment, and routine can help manage these behaviors and strengthen the bond between the patient and their loved ones. Remember that patience and compassion are the most valuable tools in a caregiver's arsenal.

For more resources and information on coping with dementia behaviors, the Alzheimer's Association offers extensive support and guidance. Learn more about managing challenging behaviors.

Frequently Asked Questions

Why do people with dementia repeat questions?

Repetitive questioning is often caused by short-term memory loss. The person may forget they've asked a question and the answer they received. It can also be a way of seeking reassurance or expressing anxiety. It is best to answer calmly and briefly, and then try to redirect their attention with a new activity or topic.

What is sundowning and how can it be managed?

Sundowning is increased confusion and agitation that occurs in the late afternoon and evening. To manage it, try keeping evening routines calm and predictable, limit naps, avoid caffeine and alcohol late in the day, and ensure the home is well-lit to minimize shadows and confusion.

How should I handle aggression from a dementia patient?

When a patient becomes aggressive, remain calm, speak softly, and give them space. Do not argue or restrain them. Try to identify the underlying cause, such as pain or fear. Use a gentle distraction to de-escalate the situation and, if necessary, remove yourself until the person calms down.

My loved one with dementia thinks I'm an impostor. What do I do?

This is a type of delusion called Capgras syndrome. Do not argue with them or try to convince them they are wrong, as this will increase their distress. Instead, calmly reassure them that they are safe and focus on the feeling behind the belief. It may help for the accused person to leave the room for a short time.

Is apathy a normal part of aging or a dementia symptom?

While it can be confused with a normal part of aging, apathy is a very common neuropsychiatric symptom of dementia. It's a lack of motivation and interest caused by changes in the brain, and it's distinct from depression. Encouraging simple, engaging activities can sometimes help.

What should I do if a dementia patient starts wandering?

For a person who wanders, it's crucial to ensure their safety. Install locks on doors, secure the yard, and inform neighbors. When they express a desire to leave, validate their feeling and redirect them with a safe activity. A daily walk may also help reduce restlessness.

How can I tell if my loved one's behavior is caused by pain?

People with dementia may not be able to express pain clearly. Behavioral changes like increased agitation, moaning, wincing, or refusing to be moved or touched can indicate pain. Consult their doctor to rule out underlying medical issues like a urinary tract infection, which often causes a sudden change in behavior.