Alzheimer’s Tennessee, Inc. – Support, Education and Research for Alzheimer’s Disease and Related Dementias

Behavior Changes in Dementia

A person who has dementia may exhibit challenging behaviors for many reasons.  Being sensitive to the emotion behind the behavior can help to manage stress and frustration creating more positive days.

Strategies for Managing Behaviors

Wandering

  • Do not leave a person with dementia home alone even just for a few minutes. 
  • Monitor and record wandering patterns. 
  • Consult with a physician to see if medications can help. 
  • Provide recreational activities—music therapy, physical exercise or movies, for example—to reduce boredom. 
  • Ensure that the individual is well fed, well hydrated has used the restroom since individuals may wander to fulfill basic needs. 
  • Reduce environmental stimuli like loud music or noisy and overcrowded areas. 
  • Purchase an identification bracelet, such as a Medic Alert FOUND bracelet. Put some form of identification in every jacket, wallet or pocketbook. 
  • Have a current photo readily available and find out about leaving one on file at the police department. 
  • Secure doors so they are difficult to open. 
  • Add electronic chimes or doorbells so a caregiver is alerted if the individual opens a door.
  • Identify rooms with colorful signs. 
  • Post a large sign that says "stop" or "do not enter" on exits. 
  • Disguise exit doors with a curtain. 
  • Place a large black mat or paint a black space in front of exit doors as this may be mistaken for a large hole. 
  • Put away essential items, such as coats, shoes, pocketbooks or glasses. 
  • Tell neighbors about wandering behavior and make sure they have your phone number. 

Agitation and Aggression

  • Seek a doctor's advice to determine if there is a medical cause or if medications are 
  • causing adverse side effects.
  • Limit outside noise, clutter or the number of persons in a room.
  • Keep to the same routines.
  • Reduce caffeine intake.
  • Do not move objects and furniture.
  • Dot the environment with familiar objects that promote pleasant memories.
  • Try gentle touch, soothing music, reading or walks.
  • Speak in a reassuring voice.
  • Distract the person with a snack or activity.
  • Learn to recognize behaviors - an agitated state or pulling at clothing, for example, could indicate a need to use the restroom.
  • Do not try to restrain or reason with the person who is agitated.
  • Keep dangerous objects out of reach.
  • If agitation increases at night, a nightlight may reduce confusion.

Paranoia

  • Discuss paranoid behaviors with the individual's doctor. Medications may need to be adjusted.
  • Explain to family members and caregivers that suspicious accusations are a part of the illness.
  • Respond to the feeling behind the accusation. Reassure and offer to help.
  • Try non-verbal reassurances like a gentle touch or hug.
  • If the individual suspects money is "missing," allow them to keep small amounts of money in a pocket or pocketbook.
  • Help to look for a missing object. Try to learn where their favorite hiding places are for storing objects that are "lost."
  • Avoid arguing or trying to reason with the person. 

Sundowning

Sundowning is a dementia-related symptom that refers to increased agitation, confusion and hyperactivity that begins in the late afternoon and builds throughout the evening.

  • Plan activities or outings in the morning.
  • Do only simple, calming activities in the afternoon.
  • Keep individuals awake during the day.
  • Decrease indoor lighting gradually throughout the day.
  • Ensure that the individual is not reacting to from hunger, thirst, pain or fear.
  • Remove excess stimuli and clutter.
  • Consult your doctor to see if medications may help.

Potential Causes of Behavior Changes

Inability to Meet Basic Needs: Hunger, thirst, inability to use the restroom and fatigue can produce behavioral changes. A person may show their discomfort through agitated and aggressive behavior.

Medical Problems: Pain and discomfort from a medical problem or side effects of medications can go unnoticed because of the individual's inability to tell others.

Environmental Factors: Some factors that may lead to behavioral changes include:

  • Excessive noise/ overstimulation
  • Poor or glaring lighting  that impacts visual perception
  • Cold temperatures that cause discomfort
  • Changes in the environment/routines
  • Boredom and loneliness

Sensory Impairment: Individuals with hearing or visual impairments tend to
be more paranoid, hallucinate more, and feel more frightened and frustrated.

Reaction to Loss:  We all rely on input from our environment to guide us in activities and relationships. An individual with
dementia has lost both the benefit of such input and the ability to inform us of their internal world. This may cause fear,
insecurity and frustration.

Factors Related to the Caregiver: A caregiver's attitude and knowledge of dementia affects the care of individuals with the disease. The more one knows about dementia, the more likely they will be to understand and respond  positively to behavioral changes.

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