Behavioral Disturbances in Patients with Dementia

Many caregivers have been hit, scratched, and even bitten by their loved ones. Unfortunately, behavioral disturbances are incredibly common among dementia patients, and disturbances stem from anxiety or agitation that can quickly turn into verbal or physical aggression. However, because all people are different, some dementia patients might not experience any behavioral disturbances at all.

Caregiving is difficult, emotional work. And, when a loved one has drastic behavioral disturbances, it can often lead to major changes. The good news? There are ways to manage your loved one’s new behaviors. Read on to learn what dementia may look like with and without behavioral disturbances, find advice and support for a worn-out caregiver, and know when it’s time to seek extra care.

Behavioral disturbances in dementia are drastic changes in behavior which may seem to occur out of nowhere. They can include changes in behavior, perception, thoughts, and mood. Behavioral disturbances are most common in the middle and later stages of dementia and afflict most dementia patients across all types of dementia, such as Alzheimer’s disease, vascular dementia, Lewy body dementia, Parkinson’s disease dementia, and frontotemporal dementia.^[01]

Sadly, these changes in behavior affect the majority of dementia patients and are responsible for tremendous caregiver burden. Keep an eye out for signs of behavior disturbance in your loved one. Knowing what to look for can help you later address the issues at hand.

Behavioral disturbances in dementia may include the following:

• Pacing or restlessness
• Excessive wandering
• Hoarding
• Urinary incontinence
• Suspiciousness
• Accusatory behaviors
• Verbal or physical aggression
• Lack of inhibition ^[02]

The following psychological symptoms are also related to behavioral disturbances:

• Depression
• Anxiety and psychosis
• Agitation
• Sleep disturbances
• Paranoia
• Hallucinations
• Delusions ^[02]

Causes of behavioral disturbances in dementia

The primary cause of dementia with behavioral disturbances is the progressive deterioration of brain cells, according to the Alzheimer’s Association.^[03] Because of accumulating brain damage, seniors with dementia tend to be much more sensitive to environmental stressors and can become more reactive.

If you’re trying to pinpoint the cause of your loved one’s behavioral disturbance, some possible contributing factors may include:

• Side effects from medications
• Discomfort from infections or other conditions
• Changes in routine
• Bright lights, loud noises, and crowds
• Triggering situations, like moving residences or adjustments in caregiver arrangements
• Uncorrected problems with hearing or vision
• Inability to effectively communicate

To make matters worse, dementia can make it more difficult for your loved one to communicate any stressors or frustrations properly. On top of behavioral disturbances and psychological symptoms, their inability to communicate exactly where they’re feeling discomfort may cause even more anxiety and agitation — in turn, worsening their symptoms.

Let our care assessment guide you

Dementia without behavioral disturbances simply means a person is presenting signs and symptoms of dementia and has a dementia diagnosis, but they lack any symptoms of behavioral disturbances. This is much less common than dementia with behavioral disturbances. In fact, less than 10% of dementia patients experience dementia without behavioral disturbances.^[04]

Unspecified dementia is dementia without a specific diagnosis. It’s also known as mild or mixed dementia. This can happen for a few reasons:

• A person’s mild cognitive impairment has yet to be diagnosed as a specific type of dementia.
• Multiple types of mental and physical conditions are present at once.
• Rarely, a person shows dementia onset patterns that don’t fit the mold of any known type of dementia.^[05]

A person can have unspecified dementia with or without behavioral disturbances. When behavioral disturbances are present in unspecified dementia, they tend to be milder and less aggressive. They can include impaired concentration, apathy, anxiety, and agitation.

Talk with a Senior Living Advisor

Whether your loved one is in the early or late stages of a dementia diagnosis, anyone who develops behavioral changes should have a thorough medical evaluation.^[03]Even if the behavioral disturbances are an effect of dementia, a thorough examination could potentially reveal other dementia-like conditions related to the new behavior.

Ways to soothe your loved one at home

Because behavioral changes are often the result of unaddressed mental and sometimes physical discomfort, there are many person-centered approaches to dementia care you can incorporate at home:

• Keep conversations simple. Speak in a calm voice, ask one question at a time, and use humor when you can.
• Stick to a daily routine. This way, your loved one can expect certain things to happen. Changes or surprises may cause anxiety.
• Avoid arguing, getting angry, or showing your frustration. Instead, reassure your loved one that they’re in a safe space and you’re there to help.
• If your loved one is pacing a lot, give them a safe space to walk. Provide comfortable, sturdy shoes, light snacks, and make sure they stay hydrated.
• Try incorporating favorite music or singing and dancing into the daily routine. For someone who is anxious or frustrated, this can help calm the nerves and distract them from what’s agitating them.^[06]

When to seek care assistance for behavioral disturbances in dementia

First and foremost, to provide good care to your loved one, you also need to be feeling well. Avoid caregiver burnout by caring for yourself, practicing mindfulness, resolving disputes, and setting clear boundaries. If self-care doesn’t feel like enough, a caregiver support group might be a good option. These support groups are available online or in person and can offer immense support and encouragement for caregivers.

Ultimately, a significant behavioral change may be an indicator that your loved one’s needs are drastically increasing and they may soon need extra help. When the time comes that you can no longer manage caring for a loved one with behavioral disturbances on your own, in-home care services and memory care communities are great options for seniors with dementia and other cognitive impairments. These options can provide a great relief to families and give your loved one the specialized care they require.

Memory care

Memory care communities can not only provide family caregiver relief, they also offer a range of benefits for seniors with Alzheimer’s and other types of dementia:

• Dementia-care specialized staff
• Safe, calming environment
• Supportive therapies
• Structured routine
• Around-the-clock care
• Enriching and stimulating activities

Home care

In-home caregivers can provide a range of senior services that help preserve your loved one’s quality of life, so they can remain living at home. A part-time, in-home caregiver can also take some weight off your shoulders. While their services typically depend on your or your loved one’s specific needs, the following services are commonly provided by in-home caregivers:

• Light housekeeping
• Reliable transportation
• Cooking
• Medication management
• Incontinence care
• Mobility assistance

At any point in your journey, feel free to reach out to one of A Place for Mom’s Senior Living Advisors for help with finding extra care. These friendly professionals offer free, expert advice and can connect you with local care options suited to your family’s needs.