Comprehending the behaviours associated with Dementia and Alzheimer's, along with their causes and management solutions, is vital for caregivers and family members to offer meaningful support. Dementia and Alzheimer's encompasses a range of conditions characterised by a significant decline in cognitive abilities that disrupt daily activities. It impairs memory, thought processes, and social skills, typically worsening over time. Although Alzheimer's is the most prevalent type, other forms include vascular dementia, Lewy body dementia, and frontotemporal disorders.
Dementia is a progressive neurological condition that impairs cognitive functions like memory, reasoning, and communication. However, one of the most challenging aspects of dementia for caregivers and loved ones to manage is the broad range of behavioural changes that accompany the dementia disease. Behavioural issues can range from aggression and agitation to wandering and inappropriate social interactions. Understanding and managing these behavioural changes can be challenging.
Behavioural symptoms in dementia are often a result of damage to various parts of the brain, leading to confusion, fear, and frustration in the patient. These behaviours can be distressing for the individual with dementia and their caregivers. However, with the right approach, dementia behaviours can often be managed effectively, reducing stress and improving the quality of life for everyone involved.
Behaviour management in dementia focuses on understanding the root causes of these behaviours—whether it's confusion, unmet physical needs, or environmental factors—and offering practical solutions to help manage them. By establishing routines, modifying environments, and utilising compassionate communication techniques, caregivers can better handle challenging dementia behaviours, making caregiving a more manageable and fulfilling experience.
In this guide, we’ll explore some of the most common behaviours associated with dementia, their underlying causes, and effective strategies for managing them.
Understanding and recognizing the behaviours associated with dementia can help in providing appropriate care. Below are some common behaviours:
Cause: The hippocampus, which is responsible for memory, is often one of the first areas of the brain affected by dementia.
Solution: Provide memory aids, such as calendars, labelled items, and routine schedules to help manage memory loss.
Cause: Frustration, confusion, or feeling overwhelmed often triggers aggressive outbursts. It can also result from physical discomfort, like pain or hunger.
Solution: Identify triggers for aggressive behaviours. Maintain a calm environment, offer reassurance, and avoid arguing. If physical discomfort is suspected, ensure medical issues are addressed.
Cause: Disorientation or restlessness can cause a person with dementia to wander. This often happens when they are trying to find something familiar.
Solution: Provide a safe environment by locking doors or installing alarms. Consider adding GPS trackers for monitoring, and ensure the person has a daily routine to reduce restlessness.
Cause: Dementia affects short-term memory, leading individuals to repeat questions or actions because they can’t remember the answer or what they’ve just done.
Solution: Be patient and provide simple answers. Offering distractions or redirecting attention to another activity can also help break the cycle.
Cause: Changes in the brain's sleep-wake cycle can cause insomnia or excessive daytime sleepiness.
Solution: Establish a regular sleep routine, ensure exposure to natural light during the day, and reduce caffeine and daytime naps. Medications may be required in severe cases.
Cause: These are often the result of confusion or misinterpretation of sensory information, common in later stages of dementia.
Solution: Respond calmly. Avoid correcting the person; instead, offer reassurance and redirect their focus. Consult a doctor if hallucinations become distressing.
Several factors contribute to the behaviours associated with dementia. These include:
Cognitive Decline: Damage to brain cells affects memory, communication, and problem-solving abilities, leading to confusion and frustration.
Physical Discomfort: Pain, hunger, or other medical conditions (e.g., urinary tract infections) can exacerbate problematic behaviours.
Environmental Stress: Overstimulation, loud noises, or sudden changes can overwhelm a person with dementia, leading to agitation or aggression.
Psychological Factors: Anxiety, depression, and feelings of isolation often co-occur with dementia, contributing to negative behaviours.
While there is no cure for dementia, managing behaviours effectively can greatly improve the quality of life for both the person with dementia and their caregivers. Solutions include:
Create a Routine: Predictability helps reduce anxiety. Establish daily routines for meals, sleep, and activities.
Modify the Environment: Reduce clutter, noise, and overly stimulating environments. Ensure the space is safe and familiar.
Communicate Clearly: Use simple, direct language. Be patient and allow time for responses.
Use Non-Drug Therapies: Music therapy, sensory stimulation, and exercise can improve mood and reduce agitation. Studies show music therapy, in particular, can be effective in soothing dementia patients.
Seek Medical Advice: If behaviours become difficult to manage, consult with healthcare providers. Medications can sometimes be necessary to address symptoms like aggression or sleep disturbances.
A very known behaviour in dementia is the concealment or misplacement of personal items, followed by forgetting their location. This can cause significant distress for both the individual with dementia and their caregivers.
Memory Loss: Due to short-term memory loss, people with dementia may forget where they put things, leading to the belief that items are lost or stolen.
Fear or Paranoia: Some dementia patients become suspicious of others, fearing that their belongings will be taken. To protect their possessions, they hide them.
Confusion: They may not understand the purpose of certain items anymore, leading them to place objects in unusual locations.
Create a Designated Space: Help establish a routine by creating specific places for important items like keys, glasses, or wallets. Labelling can also help.
Stay Calm: Avoid accusations or arguments about lost items. Instead, gently assist in searching for the items.
Reduce Clutter: Keep the environment simple to avoid confusion or misplacement of items.
Sudden mood changes in the evening, often referred to as "sundowning," are common among dementia patients. This phenomenon typically includes increased confusion, agitation, anxiety, or irritability as the day progresses.
Fatigue: As the day goes on, dementia patients may become physically and mentally exhausted, leading to irritability or confusion.
Changes in Light: The transition from daylight to darkness can cause disorientation. Reduced lighting can increase shadows, which may heighten confusion or fear.
Disrupted Sleep Patterns: Changes in the brain’s circadian rhythms (sleep-wake cycles) are common in dementia and can cause agitation in the late afternoon or evening.
Overstimulation: By evening, the accumulation of stimuli (like noise, visitors, or activities) can overwhelm a person with dementia.
Maintain a Consistent Routine: Encourage a regular daily routine, especially around meals, rest, and activities, to reduce anxiety as evening approaches.
Adjust Lighting: Gradually dim lights in the late afternoon to signal the approaching evening but avoid drastic changes in brightness. Use nightlights to reduce shadows.
Limit Evening Stimulation: Create a calm, quiet environment in the evenings. Limit loud noises or stimulating activities before bed.
Encourage Rest: If fatigue is contributing to mood swings, encourage short, relaxing breaks throughout the day to prevent exhaustion.
It is not uncommon for dementia patients to take off their clothes in inappropriate situations. This can be perplexing and uncomfortable for caregivers.
Physical Discomfort: The person may feel too hot, cold, or uncomfortable in their clothing but be unable to articulate this.
Confusion or Forgetfulness: They may forget why they’re wearing clothes or where they are, leading them to undress, especially in unfamiliar environments.
Need for the Bathroom: Sometimes taking off clothes is linked to confusion about needing to use the bathroom. The person may not recognize clothing as something to keep on.
Desire for Attention: In some cases, removing clothing may be a way to express a need for attention or help when they’re unable to communicate verbally.
Monitor Temperature: Ensure the room temperature is comfortable, and the clothing is appropriate for the weather.
Use Simple, Comfortable Clothing: Choose easy-to-wear clothes with soft, non-irritating fabrics. Avoid complicated fastenings like buttons or zippers, which might frustrate the person.
Establish a Bathroom Routine: Offer regular bathroom breaks to prevent confusion about when and where to undress.
Provide Distractions: If undressing is due to boredom or a need for attention, offer engaging activities or company to keep the person occupied.
Dementia patients frequently shadow or closely follow their caregivers, often checking on them multiple times throughout the day. Although this behaviour might appear strange, it is quite typical among individuals with dementia.
Causes:
Insecurity and Fear: Dementia impacts an individual's perception of reality, often leading to confusion and disorientation. The presence of attentive caregivers offers comfort and a feeling of safety.
Anxiety: Patients experiencing memory loss and confusion may become anxious when alone, and uncertain of their environment or actions.
Attachment: Dementia may lead to increased dependence on a familiar caregiver, as the presence of someone who assists them throughout their day can provide comfort.
Reassure and Redirect: Offer verbal reassurance of your presence and suggest they partake in an activity, like a puzzle or a familiar task, to maintain their focus.
Structured Routine: Maintaining a consistent daily routine can alleviate anxiety by providing predictability. Engaging in familiar activities can foster a feeling of control for an individual.
Safe Spaces: Create a safe and familiar environment where the person feels secure even when alone. Having personal items around can also reduce anxiety.
It is common for dementia patients to accuse others of theft, lying, or other misdeeds. Such behaviour can be very distressing for caregivers and family members, particularly when the accusations are baseless.
Memory Loss and Confusion: People with dementia may experience short-term memory problems, often forgetting the location of their belongings. This can sometimes result in the mistaken belief that their items are being stolen.
Paranoia and Delusions: As dementia advances, it can lead to paranoia, causing individuals to feel that others may intend to harm or deceive them.
Fear of Losing Control: Individuals with dementia may sometimes accuse others as they experience a loss of control over their environment or life, leading to feelings of frustration and anger.
Stay Calm and Reassure: Refrain from arguing or attempting to persuade the individual that they are mistaken. Rather, offer calm reassurance that you will assist in locating the missing item or addressing the problem.
Provide Visual Cues: Store essential items like keys and wallets in clear, easily reachable places to avoid misplacement leading to unwarranted accusations.
Validate Their Feelings: Recognise their frustration or fear by stating, "I understand you're upset. Let's work on a solution together." This approach can help to alleviate tension without worsening the situation.
One of the more difficult behaviours associated with dementia is the loss of social inhibitions. This may result in inappropriate comments, sexual behaviours, or a disregard for social norms.
Causes:
Damage to the Frontal Lobe: The frontal lobe, which governs judgment and self-control, is frequently compromised by dementia. This impairment may result in impulsive actions or diminished recognition of social norms.
Confusion About Social Norms: Individuals with dementia may lose the ability to recognise or comprehend previously understood social norms, resulting in actions or speech that may be deemed inappropriate.
Mood and Personality Changes: With the progression of dementia, alterations in mood, personality, and behaviour become increasingly evident. This often leads to a reduced capacity to discern socially acceptable conduct.
Solutions:
Gently Redirect: If the person acts inappropriately, gently steer their attention to another activity or topic. Avoid scolding or embarrassing them, as they may not be aware of their actions.
Modify the Environment: Steer clear of scenarios that may provoke undesirable behaviour. For example, reduce time spent in stimulating or crowded settings if they often lead to agitation or confusion.
Use Distraction Techniques: Should inappropriate behaviour occur, providing a distraction or altering the environment can be effective. For instance, proposing a move to another room or initiating an enjoyable activity may help.
Understanding the common dementia behaviours and their underlying causes is key to providing compassionate and effective care. With the right strategies, caregivers can create a safer, more supportive environment that improves the well-being of those living with dementia. By focusing on routine, environmental modifications, and non-drug therapies like music, it's possible to mitigate many of the challenging behaviours associated with this condition.