What is considered behavioral disturbance in dementia?

Oct 19, 2025 2 min read •

elder care neurology dementia

According to the Alzheimer's Association, more than 90% of people with dementia experience significant behavioral and psychological symptoms (BPSD) at some point, leading to distress for both patients and caregivers. Understanding what is considered behavioral disturbance in dementia is the first step toward effective management and improving quality of life for all involved.

Quick Summary

Behavioral disturbance in dementia refers to a broad spectrum of neuropsychiatric symptoms, including agitation, aggression, anxiety, psychosis (delusions and hallucinations), apathy, disinhibition, wandering, and sleep disturbances. These changes are caused by the progressive damage to brain cells and are often a response to underlying unmet needs, environmental factors, or physical discomfort.

Key Points

Diverse Symptoms: Behavioral disturbances in dementia are a wide range of symptoms, including emotional changes, psychotic episodes, and physical actions, not a single behavior [1].
Symptom, Not Choice: These behaviors are not deliberate but are symptoms of the underlying brain damage caused by dementia [1].
Common Examples: Key behavioral issues include agitation, aggression, anxiety, wandering, repeating questions, social disinhibition, and sleep problems [1].
Multiple Triggers: Behavioral problems can be triggered by a variety of factors, including unmet physical needs (pain, hunger), environmental changes (noise, routine), and communication difficulties [1].
Non-Pharmacological First: The most effective management strategies prioritize non-medication approaches, focusing on identifying triggers, communication, and environmental changes [1].
Validation and Redirection: Instead of arguing or correcting, validation (acknowledging feelings) and redirection (shifting focus) are powerful tools for de-escalating difficult situations [1].
Caregiver Support: Understanding and managing these behaviors is crucial for reducing caregiver stress and burnout, which are common with the challenges of dementia care [1].
Personalized Approach: Since each person's experience with dementia is unique, a personalized approach to identifying triggers and crafting interventions is most effective [1].

Understanding Behavioral Disturbances in Dementia

Behavioral disturbances, also known as Behavioral and Psychological Symptoms of Dementia (BPSD), are non-cognitive symptoms that frequently occur with cognitive decline in dementia. These symptoms vary in presentation and severity depending on the individual and the specific type of dementia [1]. They can be broadly categorized into mood changes, psychotic symptoms, sleep disturbances, and physical actions [1].

Types of Behavioral Disturbances

Behavioral disturbances in dementia encompass a wide array of symptoms [1].

Mood and Emotional Changes: These include depression, apathy (lack of interest), anxiety, irritability, and in some cases, euphoria [1].
Psychotic Symptoms: These involve delusions (false beliefs) and hallucinations (perceiving things that are not real), most commonly visual ones [1].
Agitation and Aggression: Agitation is a state of restlessness, while aggression can be verbal (yelling, threats) or physical (hitting, pushing) [1].
Sleep Disturbances: Disrupted sleep patterns, including nighttime waking, wandering, and sundowning (increased confusion in the late afternoon/evening), are common [1].
Repetitive and Disinhibited Behaviors: This can include repeating questions or actions, or socially inappropriate behaviors due to impaired judgment [1].

Factors Contributing to Behavioral Disturbances

While brain cell damage is the underlying cause, various factors can trigger or worsen behavioral issues in dementia [1]. These include physical discomfort (pain, hunger), environmental factors (noise, changes in routine), and emotional distress (fear, frustration) [1].

Managing Behavioral Disturbances

A multi-faceted approach, prioritizing non-pharmacological methods, is key to managing BPSD [1]. Strategies involve identifying triggers, modifying the environment for calmness and predictability, using simple and clear communication, addressing underlying needs, and engaging in meaningful activities [1].

Comparing Common Behavioral Disturbances


Behavioral Symptom	Common Manifestations	Underlying Cause/Trigger	Management Approach
Wandering	Aimless pacing, trying to leave the house	Restlessness, unmet need for movement, confusion, searching for something/someone	Provide safe walking space, use identification bracelets, redirection [1]
Aggression	Yelling, cursing, hitting, throwing objects	Fear, frustration, perceived threat, physical pain	Address underlying cause, simplify communication, use calm reassurance [1]
Hoarding	Hiding items, collecting random objects	Need for security or control, confusion over ownership	Provide a dedicated "treasure box" for items, avoid confrontation [1]
Repetitive Behaviors	Repeating questions or phrases	Memory loss, anxiety, loneliness, seeking reassurance	Provide a reassuring answer, use distraction, engage in activities [1]
Psychosis	Delusions, hallucinations	Altered brain chemistry, misinterpretation of reality	Validate feelings without confirming reality, use calm reassurance [1]

Conclusion

Recognizing behavioral disturbances as symptoms of dementia, rather than deliberate actions, is crucial for caregivers [1]. Understanding triggers and implementing personalized non-pharmacological strategies can help reduce the frequency and intensity of these behaviors, improving the quality of life for individuals with dementia and reducing caregiver stress [1]. Resources like the Alzheimer's Association provide valuable information for managing these challenges. 1

Frequently Asked Questions

Yes, behavioral and psychological symptoms are a very common aspect of dementia, with studies showing they affect the majority of people with the condition at some point. They are not a deliberate choice but a consequence of the disease's progression [1].

Agitation is a state of restlessness or anxiety that can cause a person to pace, fidget, or get easily upset. Aggression is a more severe, often physical or verbal, expression of this agitation. While not all agitated people become aggressive, agitation can sometimes escalate into aggression [1].

Yes, people with dementia are highly sensitive to their environment. Loud noises, bright lights, cluttered spaces, or a change in routine can easily overwhelm them, triggering confusion and behavioral issues. Maintaining a calm, consistent environment is key [1].

People with dementia may not be able to articulate their pain. Caregivers should look for nonverbal cues such as grimacing, moaning, or guarding a body part. Restlessness, aggression, or a change in appetite or sleep patterns can also signal underlying pain. If you suspect pain, consult a doctor [1].

Yes, wandering is a common behavioral disturbance in dementia, often stemming from restlessness, disorientation, or an unmet need. It's important for caregivers to ensure safety by securing the home and using identification methods [1].

Common psychological symptoms include anxiety, depression, paranoia, delusions (false beliefs), and hallucinations (seeing or hearing things that aren't there). These can cause significant distress and often lead to behavioral outbursts [1].

Sundowning is a behavioral disturbance characterized by increased confusion, agitation, and anxiety that begins in the late afternoon or early evening. While the exact cause is not fully understood, disruptions to the person's internal body clock are a contributing factor [1].

Respond with calm reassurance and patience. Avoid arguing or correcting them. Instead, try to validate their feelings and then redirect their attention to a pleasant activity. Look for the root cause of the behavior, as it often signals an unmet need [1].

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.