Dementia Behavioral Changes: What To Expect Following A Diagnosis

Changes in behavior can be among the most distressing symptoms for family members of a person living with dementia. Loved ones may sense that the individual is becoming a different person. As the disease progresses, keeping the affected individual safe, healthy, and content may become increasingly difficult. However, understanding what factors can influence behavior in dementia may make these symptoms easier to manage.

Apathy and disinterest in daily life are common early symptoms of dementia, often followed by suspicion, paranoia, and agitation. Loss of behavioral control leading to impulsive and socially inappropriate actions is also common, especially in certain dementia subtypes. Caregivers may be able to limit problematic behaviors by providing comforting surroundings, familiar routines, and mentally engaging activities. 

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How dementia can impact behavior

Understanding dementia behavioral changes

Among the possible effects of dementia are changes in behavior patterns and interpersonal interaction. Some forms of neurocognitive disorder can damage parts of the brain involved in functions like impulse control, social relationship management, or emotional regulation. This damage can result in seemingly dramatic changes in an affected person’s personality as their typical ways of interacting with the world change. Below are examples of possible behavior shifts and cognitive changes associated with dementia.  

Lack of energy and interest

Loved ones frequently report that a person who’s developing dementia or mild cognitive impairment has become less energetic and motivated. Affected individuals may lose interest in activities they formerly found engaging, such as participating in longtime hobbies or interacting with good friends. This change can extend to apathy about self-care activities like personal grooming or routine tasks like cleaning the house and doing laundry. 

For some people with dementia, this reluctance to take action may be increased by worries about functional difficulties. They may worry that others will become impatient with them or that they’ll make embarrassing mistakes. Others describe feeling a sense of internal resistance that prevents them from taking desired actions.

Agitation and irritability

Among the most common behavioral changes seen in dementia patients is a tendency to become restless and upset. This tendency can involve episodes of seemingly frantic and purposeless movements such as fidgeting, hand-wringing, and pacing, often accompanied by signs of anxiety or anger. In some cases, the person may become verbally or physically aggressive. 

According to the Alzheimer’s Association, agitation is often a response to distress caused by factors such as:

• Pain
• Fatigue
• Hunger
• Perception of threats
• Confusion
• Overstimulation

As dementia progresses, a person’s ability to communicate their needs and cope with challenging situations can be impaired. They may become easily overwhelmed by loud noises, complicated tasks, or changes in their routine. This overwhelm can lead to feelings of anxiety or cause frustration due to their difficulty in responding. 

Psychotic symptoms

Dementia may lead to hallucinations and delusions, making it difficult for patients to tell the difference between reality and delusion. This confusion may be more common in some dementia subtypes than others. For example, dementia with Lewy bodies is strongly associated with visual hallucinations. However, these can occur to some extent in other forms. 

Psychotic symptoms can be particularly challenging for family caregivers to manage and may significantly increase the likelihood that a person with dementia will be placed in residential care. However, hallucinations are not always distressing to those who experience them. Some hallucinations may involve pleasant experiences, such as imagining that friends from the person’s past have come to see them.

Suspicion and paranoia

Another personality shift often seen in dementia is a tendency to become distrustful or paranoid. Those affected often become convinced of negative beliefs such as:

• Other people are stealing from them
• Their spouse or significant other is unfaithful
• The house they’re staying in is not their real home
• Their loved ones are planning to abandon them
• They’re in danger
• Other people are conspiring against them

Some researchers have suggested that these paranoid ideas often result from the confusion and disorientation caused by the cognitive symptoms of dementia. For example, a person who frequently misplaces objects due to forgetfulness and inattention might conclude that they’ve been stolen, and someone who doesn’t recognize their surroundings or relatives might be convinced that strangers are holding them prisoner in an unfamiliar place.

Reckless or inappropriate behavior

People with dementia may act impulsively, engaging in inadvisable, unpredictable, and sometimes dangerous behavior. This behavior can involve an apparent lack of understanding of ethics and social customs. For example, the individual might attempt to touch a stranger sexually in public with no awareness that their actions are inappropriate. 

Socially inappropriate behavior is particularly common in frontotemporal dementia (FTD), a condition involving atrophy of the brain’s frontal lobes. These changes often include damage to areas involved in regulating impulses and understanding social relationships. People with FTD may lose the ability to understand other people’s feelings or concerns, causing them to take actions that seem selfish, cruel, or tactless. 

Some disruptive behaviors in dementia could also result from decreased awareness of place and time. For instance, a person might start taking their clothes off in a public place because they mistakenly believe they’re at home.

Sleep problems

Research suggests that disruptions in sleep patterns may be a symptom of and risk factor for dementia. Deterioration of brain areas responsible for regulating the body’s “internal clock” could cause a person to have difficulty staying awake during the day and falling asleep at night. This challenge may diminish their cognitive abilities while hampering the brain’s ability to remove toxic waste products, contributing to neurological atrophy.

Sundowning: Increased nighttime confusion for people with Alzheimer’s disease or dementia

Disturbances in sleeping and waking habits might also contribute to “sundowning,” a tendency toward increased agitation, confusion, disorientation, and distress during the late afternoon and evening. 

How to address dementia behavioral changes

Below are a few evidence-based strategies that may ease the difficulties caused by behavioral and psychiatric symptoms of dementia. 

Create a soothing environment

Providing calming surroundings for a loved one with dementia can help keep them from feeling confused and overstimulated, reducing the likelihood of agitation and other behavioral symptoms. Below are a few tips for creating a dementia-friendly living space:

• Provide bright but soft lighting, avoiding fluorescents and letting in natural light wherever possible
• Decorate with objects and images familiar to the person (family photos, personal mementos, etc.)
• Reduce clutter
• Use calming colors such as blues, greens, muted earth tones, and pastel shades
• Include plants or views of nature
• Keep decor consistent

Establish consistent routines for people with dementia

Keeping to a consistent pattern of daily activity may reduce uncertainty and anxiety for people with dementia, decreasing the odds that they’ll exhibit disruptive behavior. This approach may also reduce dementia sleep disturbances by reinforcing consistent sleep and wake times, which might help with sundowning.

Provide pleasant sensory experiences

Evidence suggests that pleasant forms of sensory stimulation, such as aromatherapy, gentle massage, and calming music, can improve behavioral symptoms. These interventions may improve a person’s mood and increase their interest and engagement in daily activities. 

Music and art therapy may be particularly effective for this purpose. In many clinical trials, interventions involving cultural engagement have improved behavior and quality of life. These activities may also have a protective effect on cognitive abilities. 

Proactively manage pain and discomfort

When one’s ability to communicate is impaired by advanced dementia, people often respond to discomfort and distress with disruptive behaviors. If the person you’re caring for is acting out, it could be a sign that they’re experiencing hunger, thirst, soreness, fatigue, or other challenges. Illnesses like urinary tract infections can also contribute to behavioral challenges. As such, maintaining awareness of the individual’s comfort and health may reduce the likelihood of mood and behavioral symptoms.  

Enable engaging activities for a person with dementia

Helping a person with dementia engage in personally meaningful activities can partially preserve critical cognitive skills and improve their behavior and sense of well-being. Social interventions like support group meetings or friendly games may be effective at encouraging positive engagement. Artistic activities enabling self-expression and a sense of accomplishment may also be beneficial.

Consider various health care treatments beyond medication

Some care providers use sleeping medication, antipsychotic drugs, selective serotonin reuptake inhibitors, and other pharmacological methods to manage problematic behaviors in dementia. However, the evidence for the effectiveness of this approach is mixed, and adverse side effects are common. Many experts now recommend avoiding medications for behavioral difficulties in dementia, except where other solutions have failed. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Counseling may relieve dementia-related grief and stress

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Caring for yourself as well as your loved ones

Dementia caregiving can be a significant source of physiological and mental stress, often leading to impaired mental health. Prioritizing self-care may benefit both you and the people relying on you. Talking with a therapist can help you manage the emotional strain of caregiving and the distress you may feel at your loved one's condition.

Finding support through online therapy

If you’re unsure how to budget time for therapy on top of the demands of caregiving, you could consider seeking online assistance. Mental healthcare delivered over the Internet is often significantly more accessible to schedule due to the flexibility of remote interactions. Through platforms like BetterHelp, clients can set a session time that works for them and choose between phone, video, or live chat sessions, offering a sense of control over the support systems they receive. 

Online approaches are backed by evidence. A 2022 paper studying various cognitive-behavioral therapy approaches found that online care was among the most effective versions of the program at relieving depressive symptoms in people providing care for dementia.