Common Behaviours of Dementia

August 1, 2023

What is Dementia?

Dementia is an umbrella term used to describe a variety of symptoms¹ relating to cognitive function. Memory loss is very common among people with dementia, but it is not the only sign of the illness. Those with cognitive decline typically experience a wide range of symptoms that worsen progressively including² problems with language skills, visual perception, judgment, attention, and other behavioral changes.

Common Behaviours of Dementia Patients

Short-term memory loss is often the first sign of dementia³, but it is not the only symptom. Early signs of dementia also include inappropriate behaviors that are out of character and challenging to manage. If you know someone with dementia, it’s a good idea to familiarise yourself with the more common behavioral changes associated with the illness.

Repetitive Speech or Actions

Repetitive behavior (i.e., doing or saying the same thing over and over) is a common symptom of dementia. Dementia is characterized by progressive cognitive decline, which can cause patients to forget that they have recently completed a task or asked a question. Common repetitive behaviors among dementia patients may include:

Repeatedly carrying out the same activity
Asking the same question over and over
Repetitive gestures
Repetitive noises
Saying the same thing repeatedly

Wandering and Getting Lost

Wandering is a common behavioral problem⁴ among people with dementia and is characterized by aimless walking or pacing. This is a particularly risky behavior, as the memory loss associated with dementia often leads to wandering patients getting lost. Wandering may be triggered by a variety of factors, including:

Agitation and restlessness
A sudden change in routine or setting
Seeking a place or item they remember from their past

Resistance to Bathing

Many dementia patients refuse to bathe, as the experience can be frightening, embarrassing, or unpleasant for people with cognitive decline. Problems with depth perception can make stepping into the water scary, and many people are uncomfortable receiving help for such an intimate activity as washing.

Insomnia and Sundowning

Sundowning is a term describing behaviors⁵ that people with Alzheimer’s or dementia may exhibit around sunset. These behaviors usually flare up towards the end of the day, but they can appear at any time. Common behaviors associated with sundowning in dementia patients include:

Insomnia (i.e., inability to fall asleep)
Pacing wandering
Aggressive behavior
Violence
Crying
Shouting
Shadowing (i.e., closely following a caregiver around)
Agitation and restlessness

Hallucinations and Delusions

Dementia may cause a person to experience hallucinations⁶ where they see, smell, or feel things that are not really there. They may also have delusions, in which the patient has false beliefs that they believe to be true.

Loss of Appetite

Many people with dementia experience appetite loss and difficulty eating in the late stages⁷ of the illness. This is because cognitive decline often causes problems with chewing or swallowing, and often leads to:

Coughing or choking when attempting to eat
Refusal to swallow
Exaggerated tough movements
Throat clearing
Spitting out food
Drooling

Aggression and Anger

Anger and aggressive behavior occur in half of dementia patients and are most common in the mid to late stages of the illness. People with dementia often lash out with both verbal and physical aggression and may shout, swear, make threats, hit, scratch, spit, hair-pull, bite, and throw things. Aggression is a particularly challenging feature of cognitive decline and can be caused by a variety of factors, including:

Memory loss
Pain and discomfort
Frustration
Overstimulation
Confusion

Incontinence

Incontinence can occur in the mid to late stages of dementia and may result from a variety of medical and environmental factors. Possible causes of incontinence in dementia patients include:

Certain medications (such as anxiety medications and sleeping pills)
Medical conditions (like diabetes, urinary tract infections, Parkinson’s disease, constipation, prostate issues, stroke)
Physical disabilities that make getting to the bathroom difficult
Dehydration
Difficulty locating bathrooms due to memory issues
Obstacles that make it difficult to access the bathroom
Clothing that is difficult to remove

Approaches for Managing Dementia Patients' Behavioural Changes

Many of the common behaviors resulting from Alzheimer’s disease and dementia can be difficult to manage, especially for family caregivers. Sometimes, it can help to identify any triggers for challenging behaviors and take steps to address these. In other cases, a doctor may be able to suggest options for medical management of the common behaviors of dementia patients.

Non-pharmacological interventions

Several non-pharmacological measures can help to address behavioral changes caused by Alzheimer’s disease and dementia. These are steps you can take to create a dementia-friendly atmosphere and potentially reduce challenging behaviors.

Stay active

Staying mentally and physically active can help to reduce out-of-character behaviors among dementia patients. There are lots of ways for people with dementia to keep their minds and bodies fit, though the types of activities they can enjoy often depend on what stage of dementia they have.

Social activities, regular exercise, dementia toys, suitable dementia puzzles and brain stimulating games, and memory books are all good ways for a person with dementia to keep themselves occupied. For those with more advanced dementia, therapies involving music, animals, aromatherapy, and massage may be more effective.

Maintain a daily routine

A daily routine can be very helpful for people with Alzheimer’s and dementia, as it can help to combat some of the difficulties caused by memory loss. This can help the person to feel more confident and at home in their surroundings, which may reduce agitation and improve their mood.

Create a calm, reassuring environment

A quiet, calming environment can help to combat agitation, fear, and confusion among dementia patients. In turn, this can help to reduce stress and agitation and alleviate challenging behaviors.

Medication management

Some changes in behavior are caused by physical health problems like urinary tract infection, constipation, or pain. Mental health problems like depression and anxiety can also cause behavioral changes. In these cases, medication may help to alleviate discomfort or distress.

If the behavior of someone with dementia suddenly changes, it is wise to schedule an appointment with their doctor. A medical professional will be able to assess their physical health and suggest pharmacological treatments to help manage the underlying cause of their behavioral changes.

Support for Caregivers

Caring for someone with dementia can be challenging, but it is important to remember that you are not alone. There are lots of resources and support networks that can help you to navigate the behavioral changes and other symptoms that arise as dementia progresses.

Conclusion

Dementia is a progressive illness characterized by memory loss and other behavioral changes relating to mood, sleep, mental health, and communication. Many people with dementia exhibit behaviors that are out of keeping with their character and can be difficult for caretakers to manage. If you are caring for someone with dementia, there are several things you can do to create a safe and reassuring home environment. Sometimes, non-pharmacological interventions like dementia-friendly gifts and activities, social interactions, and various sensory therapies can help to reduce inappropriate behaviors. Other times, behavioral changes are caused by physical health conditions and should be addressed by a doctor.