Managing Dementia-Related Behaviors
Tips for caregivers on navigating symptoms of dementia-related behaviors
Reviewed by: Alyssa Aguirre, MSW, LCSW-S
Written by: Ashley Lawrence
Caring for a loved one with dementia can present unique challenges. As dementia progresses, functioning independently becomes increasingly difficult and individuals with dementia may begin to lose their ability to adequately communicate their needs and feelings through speech, forcing caregivers to rely on their behavior as a form of communication.
Symptoms of dementia-related behaviors often include changes in mood, difficulty sleeping, and psychotic episodes. While navigating changes in behavior can be challenging, UT Health Austin’s Comprehensive Memory Center is here to share tips on how to respond to symptoms of dementia-related behaviors.
Common Symptoms of Dementia-Related Behaviors
Aggressive behaviors can be both verbal and physical outbursts that can occur suddenly and without apparent reason. Oftentimes, aggressive behavior is the result of physical discomfort, environmental factors, or poor communication.
Caregiver Tips:
- Try to identify the immediate cause of the reaction by examining what took place prior to the change in behavior, addressing any aches or pains your loved one may have or any changes to their environment
- Explore whether your loved one is tired, hungry, bored, or has another unmet physical need
- Focus on your loved one’s emotions by examining the feelings behind their words or actions to help identify the problem
- Introduce a relaxing activity, such as music or exercise, to help calm your loved one
Anxious and agitated behaviors are often associated with restlessness, resulting in a need to move around or pace. Oftentimes, anxiety and agitation are a result of medication interactions or circumstances that worsen the person’s ability to think, such as moving to a new home, changes in environment, changes in caregiver arrangement, fear, or fatigue.
Caregiver Tips:
- Provide your loved one with reassurance and gentle touch, confirming that they are not alone
- Find an outlet for your loved one’s restless energy by suggesting a walk or car ride
- Engage your loved one in an activity by playing a game or creating art
- Recognize that your loved one’s behavior is not deliberate as it is often a symptom of their disease
- Make an appointment with your loved one’s medical provider to determine if anxiety-reducing medications are appropriate
Delusions involve firmly held beliefs in things that are not real and can quickly evolve into suspicion and paranoia, a feeling that you are being threatened in some way even though there is no evidence that this is true. Suspicions and delusions are often the result of increased confusion and memory loss.
Caregiver Tips:
- Redirect your loved one’s attention by focusing on a new topic or activity
- Duplicate any lost items that your loved one may fear has been stolen by another individual
Identifying depression can be difficult as depression and dementia share many of the same symptoms, such as an increase in irritability with outbursts of anger, feelings of hopelessness, difficulty sleeping, loss of interest in activities and hobbies, social isolation or withdrawal, or trouble concentrating. Diagnosis requires a thorough examination by a medial professional to rule out side effects caused by medications or other medical conditions.
Caregiver Tips:
- Talk to your loved one’s medical provider
- Encourage your loved one to join a support group or attend counseling
- Find ways your loved one can contribute to family life and recognize their contribution by celebrating small successes and occasions
- Nurture your loved one with their favorite foods, affirmations of love and appreciation, and soothing or inspirational activities
Hallucinations are false perceptions of objects or events involving the senses. Sometimes, individuals with dementia will see, hear, smell, taste, or feel something that isn’t actually there. These false perceptions can be a result of changes within the brain caused by dementia or the result of physical illness, such as an infection, medication side effects, or malnutrition.
Caregiver Tips:
- Make an appointment with your loved one’s medication provider, especially if these symptoms appear suddenly
- Do not disagree with your loved one’s false idea by arguing but do empathically respond to their feelings
- Redirect your loved one’s attention by suggesting a move to another room or turning their attention to a new conversation or activity you can do together
- Take your loved one to have their hearing and vision examined
- Increase lighting in your loved one’s environment, especially at nighttime, and close window shades to avoid confusion about reflections
Memory loss and confusion may be mild at first but will become more severe as the dementia progresses. In the beginning stages, individuals may have difficulty recalling the immediate past, such as what they ate for breakfast or who visited last week. As their dementia progresses, they may experience difficulty recognizing familiar people or places.
Caregiver Tips:
- Prepare your loved one for visits by showing them photos or reminiscing about family members or friends who will be visiting before they arrive
- When your loved one’s memory is focused on a particular time in their life, engage in their current reality by participating in the conversation
- Avoid correcting your loved one with a direct explanation when they recall a memory incorrectly
- Do not ‘test’ your loved one, avoid asking questions that rely on short-term memory for a response, and above all else, try not to remind them of how forgetful they are
Repetitious behaviors include repeating words, questions, or activities as well as the undoing of something that has just been finished. Repeating questions or comments is a very common symptom of dementia. Sometimes, repetitious behavior is the result of environmental factors or an unmet need. This can be one of the most frustrating symptoms for family caregivers; have a friend you can call or a quiet place you can safely go to in your home for a break.
Caregiver Tips:
- Provide your loved one with a brief, simple response even if you have to repeat yourself several times; It can be easy to think they are doing this on purpose, but this is rarely the case
- Engage your loved one in a new activity, such as folding clothes or petting an animal
- Use memory aids, such as notes, clocks, calendars, or photographs, to help provide your loved one with answers to repeatedly asked questions
- Remove environmental cues that can trigger repetitive questions, such as a coat rack or shoes by the door
The exact cause of problems with sleeping or sundowning (experiencing anxiety, agitation, and increased confusion at dusk and throughout the night) remains unknown. Potential factors that contribute to sleep issues and sundowning may include mental and physical exhaustion related to navigating an unfamiliar or confusing environment, a biological mix-up of day and night, reduced lighting, disorientation due to the inability to separate dreams from reality, and the need for less sleep in individuals of an older age.
Caregiver Tips:
- Schedule activities earlier in the day when your loved one is more alert
- Encourage your loved one to keep a regular waking, eating, and sleeping schedule
- Reduce stimulation during the evening hours and use indoor lighting to reduce your loved one’s confusion and restlessness at night
- Adequately treat your loved one’s pain or sleep apnea as prescribed
- Discuss with your loved one’s medical provider if there are alternative times of the day when medications can me given to help with daytime wakefulness and nighttime sleepiness
- Determine if your loved one needs to limit daytime naps, which can contribute to wakefulness overnight
- Limit your loved one’s caffeine intake and ensure they get adequate exercise
Individuals with dementia lose their ability to recognize familiar places and faces, sometimes causing them to become lost or confused about their whereabouts. Although common, wandering can be dangerous and even life-threatening. There can be many causes, including physiological (e.g., need to use the bathroom, boredom, or hunger), environmental (e.g., overstimulation or acting out of typical routine) or emotional (e.g., conflict with family members).
Caregiver Tips:
- Provide your loved one with structured, meaningful activities throughout the day
- Ensure all of your loved one’s basic needs are met and consider reducing liquids two hours before bed
- Avoid busy places that are confusing and may cause your loved one to become disoriented, such as shopping centers
- Try locks that are out of your loved one’s reach, use child-proof knobs, place warning bells over the door, or install monitors or other alarm systems
- Consider using a GPS device to help locate your loved one if they become lost
- Alert your neighbors about your loved one’s condition, keep a current picture of them, and enroll them in a MedicAlert Safe Return program
- Never leave your loved one unattended in the car or in a public space if you have concerns for wandering
Potential Causes for Symptoms of Dementia-Related Behaviors:
- Being asked to engage in an activity that has become difficult to perform
- Changes in environment or caregiver arrangements
- Fatigue
- Fear
- Infection or other medical illness
- Misperceived threats
- Pain
- Prescription drug interactions
- Travel
- Vision or hearing loss
Preventing Symptoms of Dementia-Related Behaviors:
- Allow adequate rest time in between stimulating events, such as family visits
- Avoid environmental triggers, such as excessive noise, harsh light, or other distractions
- Create a calm environment by removing stressors, eliminating noise, developing soothing rituals, and offering a security object or place of privacy
- Monitor personal comfort, checking for pain, infections, hunger, thirst, and fatigue
- Provide an opportunity for exercise
- Simplify tasks and implement daily routines
Caregiver Support
Caregiving can be both rewarding and stressful at the same time. Recognizing that caregivers also need support is critical to maintaining optimal health so that caregivers can continue to adequately care for their loved ones. The Comprehensive Memory Center offers caregivers caring for loved ones with a dementia diagnosis a variety of caregiver support services, including guidance to manage behaviors and emotional support to address concerns of daily living, increasing behaviors, and changes in mood and sleep as well as other challenges. Additionally, the care team provides education and assistance with community resources, long-term care planning, and more.
Caregiver Tips:
- Remain calm and try not to raise your voice, show alarm, or corner, crowd, criticize, ignore, or argue with your loved one
- Try not to take your loved one’s reactions or lack of recognition personally
- Be mindful of your own mental and physical exhaustion by taking a break or asking for help when needed
- Share your experience with others
Explore caregiver stress warning signs and tips for managing caregiver stress.
If you are concerned about your loved one’s change in behavior, contact their medical provider. To make an appointment with UT Health Austin’s Comprehensive Memory Center to discuss treatment options for your loved one with dementia, call 1-833-UT-CARES (1-833-882-2737) or visit here.