Behavior and personality often change with dementia. People with The behavior changes you see often depend on which part of the brain is losing cells. As stages of Alzheimer's or other dementias progress, behaviors change, as does the During the middle stages of Alzheimer's, the person living with dementia will sleep changes somehow result from the impact of Alzheimer's on the brain. Aug 31, Persons with dementia have reduced cognitive abilities. The image panel below shows the brain changes that happen in Alzheimer's.
Changes in the environment, such as moving to a new home or having to be hospitalised, can cause disorientation and confusion. Keep the environment as consistent as possible. Provide adequate lighting if shadows, glare or poor lighting are contributing to agitation and hallucinations. Move the mirror in the bedroom if the person becomes confused when they do not recognise their own reflection or the reflection of others in the room. Install night-lights that might help cut down on confusion at night and may help the person to find the bathroom.
Place a commode next to the bed if finding the bathroom is a problem. Make sure the bed and bedroom are comfortable and familiar, because familiar objects may help to orient the person. Avoid having daytime clothing in view at night, because this may make the person think it is time to get up. Make sure that the person is getting enough exercise — try taking one or two walks each day. Other causes of sleeping problems in dementia Other causes of sleeping problems may include: Managing sleeping problems with food and drink Some suggestions include: Cut down on caffeine coffee, cola, tea, chocolate during the day and cut them out altogether after 5 pm.
Cut down on alcohol and discuss the effects of alcohol and medication with the doctor. If you think the person may be hungry at night, try a light snack just before bed or when they wake up during the night. Herbal teas and warm milk may be helpful. Managing sleeping problems through daily routine Some suggestions include: Try not to do any tasks in the late afternoon that may be upsetting to the person.
If the person refuses to go to bed, try offering alternatives such as sleeping on the sofa. In some situations, it may be necessary to consider discussing the appropriateness of either using sedative medication or sleeping medication with the doctor.
If the person wanders at night, consider allowing this, but check that the house is safe.
Try a back rub before bed or during a wakeful period. Try a radio beside the bed that softly plays music.
- How dementia impacts behavior
Gently remind the person that it is the evening and time for sleep. Hoarding in dementia People with dementia may often appear driven to search for something that they believe is missing and to hoard things for safekeeping.
Some causes of hoarding behaviours include: The need to hoard is a common response memories of the past — events in the present can trigger memories of the past, such as living with brothers and sisters who took their things, or living through the Depression or a war with a young family to feed loss — people with dementia continually lose parts of their lives.
The person may hide something precious, forget where it has been hidden and then blame someone for stealing it. Managing hoarding Things that you can do to help manage hoarding behaviour in dementia include: Provide a drawer full of odds and ends for the person to sort out, as this can satisfy the need to be busy.
Make sure the person can find their way about — an inability to recognise the environment may be adding to the problem of hoarding. Repetitive behaviour in dementia People with dementia may say or ask things repeatedly.
They may also become very clinging and shadow the person caring for them, even following them to the toilet. These behaviours can be very upsetting and irritating for families and carers.
Managing repetitive behaviour Things that you can do to help manage repetitive behaviour in dementia include: A walk, food or doing a favourite activity might help. It may help to acknowledge the feeling expressed.
Do not remind the person that they have already asked the question. Repetitive movements may be reduced by giving the person something else to do with their hands, such as a soft ball to squeeze or clothes to fold. Persons with dementia may get disoriented because of many cognitive problems. Examples of such problems: They may have problems remembering the right word, or may not know the meaning of words others use.
They may not be able to frame sentences. They may also not know what they are feeling; they may not realize they are hungry or thirsty or hot or cold, or even that they are unwell or in pain. They may not be able to tell caregivers what they want. They may not be able to say that they are unwell or are in pain.
So their needs remain unfulfilled. If they are ill, their illness will affect their ability to do things, but caregivers may not realize why the person with dementia is behaving differently today.
In many types of dementia, persons lose recent memories and revert to older memories. They unconsciously try to fill the gaps in their memories using their imagination. Persons with dementia cannot recognize people or places. They may not even recognize their home and family.
Often, persons with dementia are unable to create new memories. They may also have problems understanding complex instructions or concepts.
Persons with dementia may find it more difficult to learn new things, use new devices, and adjust to new places. They may get stressed when they meet new people or see new things, and they start avoiding such situations. In many types of dementia, the part of the brain that tells people how to interact socially is not damaged in the beginning.
Social interaction ability deteriorates at a slower pace in most persons with dementia.Caregiver Training: Aggressive Language/Behavior - UCLA Alzheimer's and Dementia Care Program
Outsiders may therefore not believe a dementia diagnosis. The part of the brain that regulates behavior may get damaged in some types of dementia. This may result in personality changes. Emotions may get flattened and the person may show apathy.
Such problems are typical in behavior-variant fronto-temporal dementia. Poor behavior regulation often leads to embarrassing situations. For example, the person may made rude remarks even sexual commentsyell or abuse. Or the person may laugh when others are crying. Or the person may lose interest in everything and not respond to emotions of others nearby. Examples of disinhibition include publicly stroking or exposing genitals, making lewd gestures, lifting a petticoat or nightgown, etc.
In some forms of dementia, like Lewy Body Dementia, persons may suffer from hallucinations. Delusions and paranoia are also present in some forms of dementia Hallucinating persons sometimes realize that what they are seeing and hearing is not real. At other times, they may believe what they are seeing or hearing because of the hallucination and get confused or frightened.
Familiar tasks become difficult because they cannot distinguish between reality and hallucination. For example, if they see a road split into four, they cannot drive. Delusions also affect how persons with dementia interact with others.
They may accuse others of stealing their things or of trying to kill them. They may not understand explanations about what is real. It is often difficult to calm down someone who becomes paranoid because of such problems.
Dementia - behaviour changes
Persons with dementia may repeatedly say something or do the same action again and again. They may show compulsive behavior. Such behavior occurs for many reasons. They may forget what they said or did earlier, they may be bored or anxious or agitated, etc. Some such repetitive behavior is harmless. At other times it may be problematic. For example, the person with dementia may insist on eating breakfast again.
The person may even take the medication again, causing an overdose. This includes pacing at night, restlessness, etc. While causes for sundowning are not fully understood, they are likely to be related to day time activities, exhaustion, body clock, food cycles, intake of liquid foods near dinner time, and so on.
Persons with dementia start acting agitated as evening approaches.
They may be keep walking up and down in their room for many hours at night. They may seem agitated and anxious. Sleeplessness is another problem. They may keep mumbling or even shouting. All this can be very tiring for them and their caregivers. The problems caused by dementia can make persons feel insecure. Insecure persons with dementia may cling to caregivers and show more dependence.
Or they may feel threatened by the caregivers. They may try to protect themselves or even attack caregivers. Persons with dementia may hide or hoard objects. These objects may not be valuable but they may get agitated if someone touches the objects. They may accuse others of neglect or theft or bad intentions.
Insecure persons may follow the caregiver all the time also called shadowing. They may get upset if they cannot follow the caregiver, such as when the caregiver goes to the bathroom.
They may keep calling out to check where the caregiver is. Persons with dementia may show extreme emotional reactions without any apparent cause. The emotional state of someone with dementia depends on many factors, many of which are not obvious to persons around them. This topic is discussed in the next section. Some parts of the brain enable feeling and expressing emotions. If dementia damages these parts of the brain, it reduces the ability to regulate emotions.
Also, parts of the brain help us understand facial expressions to know what others are feeling. If these are damaged, the person cannot judge the feelings of others.
This brain function may be affected in someone with dementia. They may abuse others, yell, laugh or cry at inappropriate times. They may take off clothes in public or pass vulgar comments. Such behavior is especially seen in the dementias where the frontal lobe is damaged.
Persons with dementia may sense they have changed. They may know about their poorer ability to think, recognize, speak, do daily tasks, etc. But they may not understand why they are having such problems.
How Dementia Impacts Behavior | Dementia Care Notes
They may not understand the diagnosis or they may forget it. As a result, they may show a range of emotional reactions to their situation. They may withdraw or feel sad. Or they may get angry or agitated and shout at people. They may get restless or anxious, and pace of fidget. They may feel insecure and shadow trail the caregiver. They may get paranoid and fling accusations.
Memory problems mean that the person may not remember where some object is kept and therefore think someone stole it. Persons with dementia may also forget they ate a meal and demand food again or complain they are being starved. Many persons complain of mistreatment because of such problems. The physical surroundings of the person usually remain the same even after the persons gets dementia. Family and friends around them also continue to interact like before.
Persons with dementia find simple tasks and communication more difficult; they get distressed. Sometimes the agitation and frustration of someone with dementia makes that person go out of control. Consider the physical environment around the person with dementia. This directly affects what the person can do. It determines how difficult each action is. For example, the person may not be able to find something if the room is cluttered or dimly-lit.
Changes to the surroundings can make it easier for the person to do things and feel safe. Persons with dementia are also affected by the interactions with others around them. Often family members expect the person with dementia to understand and remember instructions.
They expect the person to continue doing their tasks just like they did before dementia.
The person may get agitated or may withdraw because of these unrealistic expectations. Emotional responses and facial expressions of family members also affect the emotions and behavior of someone with dementia. Or they may show them as persons who are always angry, stubborn, and even violent. Such depictions create a stigma. They generalize all dementia persons in one extreme way. Once people hear that someone has dementia, they assume the person has changed totally.
Please do not get influenced by these simplistic phrases and depictions. Persons with dementia are just persons facing more problems than others around them.
They are trying to cope. Like everyone else, they want meaningful and happy lives. If given a suitable empowering environment and support, they can have a better life. Their problems will keep increasing, and they will need more understanding and support. Some persons with dementia have written about their experiences and feelings. They have described their problems, confusion, frustration, and reduction in abilities. They have also talked abut how relieved they feel on learning that their problems were because of a disease.