As dementia progresses, patients’ ability to express themselves becomes more challenging. This can get further complicated if their ability to understand is impaired as well. As a result, patients may use their behavior as a means of communication. It’s important to remain calm and understanding when the patient appears to be acting out – it could be their way of trying to convey a message. Fighting or arguing can worsen the situation.
Causes of behavioral changes in people with dementia
There are different causes for behavioral changes in dementia patients which don’t necessarily revolve around the disease itself. For example, behavioral changes may result from the difficulty relating to dementia, side effects of medications, changes in environment, social interactions, habits, and mental and physical health.
Behavioral changes in dementia can be categorized into three main types: biological, psychological, or social.
Changes in surrounding or lack of support from the environment is a large contributing factor to behavioral changes in dementia and can lead to disorientation. An environment that is hard to navigate can add extra stress to the patient.
Instead of becoming frustrated or upset about certain behavior, it’s important to take the time to understand what could be the underlying cause of the change.
Although patients with dementia share the same basic needs as everyone else, it can be difficult for them to recognize their needs, express their needs, or know how to address those needs. For example, a change in behavior may result in the patient feeling too hot because they are wearing a sweater but they may not be able to recognize the issue or may not realize that all they need is simply take it off.
Types of behavioral changes in people with dementia
Repetitive behavior: Patients may often repeat the same question or statement, perform the same movement, or carry out the same activity over and over. This may provide them with a sense of security, which can ease anxiety. It may also be a way for the patient to make sense of their environment or surroundings. Repetition often results from the fact that the person does not remember they already performed that action or asked that question so they keep repeating it.
Shouting or screaming: Patients may shout or scream due to pain or discomfort, under- or over-stimulation, communication problems, as a response to a hallucination, perception, or an unsupportive environment, or when attempting to communicate a feeling.
Walking: Dementia patients are often seen walking more, which may not necessarily be a problem for the patient but more so for the caregiver. The patient can leave the home unexpectedly, walk around at night or the area that is unfamiliar to the caregiver. Walking may be caused by boredom, anxiety, revisiting past habits, or confusion.
Sleep disturbances and nighttime walking: Sleep disturbances are common in dementia. If a patient wakes up during the night, they can be disoriented. They may dress themselves and leave the house. This can also cause the patient to sleep more during the day, which fuels them to stay awake at night. Over time, chronic sleep disturbances can have a negative impact on the patients’ overall well-being.
Sundowning: This refers to changes in behavior that occur in the evening when the sun sets. Patients may become more agitated, aggressive, or confused as the night comes. This is often seen in more severe cases of dementia as the disease progresses. Sundowning may be a result of disturbances to the patient’s 24-hour ‘body clock’, loss of daytime routine, insufficient or disturbed sleep, too little or too much light, prescribed medication, and excessive disturbing noise.
Hiding, hoarding, or losing things: Patients may hide, hoard, or lose things which can be frustrating for caregivers trying to locate the item. Hiding and hoarding may be a manifestation of trying to gain back control or due to paranoia that the item may be taken from them.
Accusing: Patients may accuse caregivers, friends, or family – for example, of trying to steal from the patient (the most common accusation). False accusations may be distressing, but they are often based on delusions or hallucinations and should not be taken to heart.
Trailing and checking: Patients may follow their caregivers around closely or constantly check that they are nearby. Dementia is associated with insecurities, so patients want to be sure that they are secure and the person they trust is close by. Patients may call out for the caregiver, too, which can make completing tasks difficult.
Losing inhibitions: Patients may show behaviors that others find embarrassing as they have lost their inhibitions. This may include being rude, making socially inappropriate comments, talking to strangers, and undressing in public. Common causes of lack of inhibitions include the effects of specific dementias, the need to use the toilet, boredom, or sexual frustration.
Tips to cope with behavioral changes in dementia
It’s important to recognize that your loved one’s behavioral changes are not their choice but rather are a product of dementia. Although dealing with the variety of behavioral changes can be frustrating, it’s always important to remain as calm and patient as possible – fighting back or getting angry about these behavioral changes will only worsen the situation.
Taking the time to uncover the underlying cause of the behavior is a good place to begin when dealing with behavioral changes. If you can recognize the cause, then you can act on what needs to be done in order to calm the patient down.
Taking care of a dementia patient isn’t easy. You may want to reach out to a support group or other caregivers in order to swap tips and management strategies.
It’s also important to recognize when you are no longer able to care for the person and someone else needs to step in.