As many as 90% of people who have dementia behave in ways that challenge or worry their caregivers, according to research on dementia behaviors. For example, a person who has dementia may become more easily agitated or aggressive. Or, they may wander off and get lost in their confusion or during a bout of sleeplessness. These troubling dementia behaviors test caregivers to the core. If this sounds familiar, know that “you are not alone,” says Cleveland Clinic Center for Geriatric Medicine Section Chief Dr. Ardeshir Hashmi. Behaviors like aggression, confusion, sleep problems, and wandering are common, but they can be managed, Hashmi explains.
“Dementia-related behaviors” is often used as an umbrella term to describe a group of behavioral symptoms associated with Alzheimer’s disease and other dementias. As dementia progresses, your loved one may start to show worrisome behaviors, however, many are common. In fact, up to 90% of dementia patients are affected by some of these common behaviors:[01,02,03]
If you notice any of these behaviors, be sure to discuss them with your loved one’s physician. It’s important to discuss all new symptoms to rule out or treat any medical conditions that could be causing the behavior, such as comorbid mental illness.
Below, you’ll learn more about how and why some of the most common dementia behaviors may manifest in your loved one. You’ll also get Dr. Hashmi’s advice on how best to handle them as a caregiver — for your sake as much as that of your loved one.
Brain changes that occur with dementia can lead to confusion, often becoming more common as dementia progresses.
Common signs of confusion in a senior with dementia may include:
Caregivers who spend many hours with their loved one may hear phrases and answer questions on repeat: “I want to go home!” “This isn’t my house.” “When are we leaving?” “Why are we here?”
Like many dementia behaviors, confusion can have a number of triggers or root causes. Factors that may contribute to disorientation include the following:
“Simplification is key here,” Hashmi says. To help minimize confusion, he suggests several ways to simplify both the home environment and your interactions:
Deliberately use simple, short sentences and ask yes/no questions.
Lastly, Hashmi says, it helps if you can learn to accept the confusion. In the moment, he says, whatever your loved one thinks is real is in fact their reality. For example, they might think they’re at work when they’re really at home. If that belief isn’t hurting them or anyone else, it’s OK for you to play along a little bit. Confronting or trying to change the belief often leads to agitation and aggression.
“For us as caregivers, we have to be OK with that confusion,” Hashmi says.
Read more:What Do Dementia Patients Think About?
Verbal threats and physical aggression can be among the more serious dementia behaviors. These verbal or physical outbursts may occur seemingly out of nowhere. They tend to happen in the middle to later stage of dementia, when patients can’t communicate their needs.
One study found that aggression occurs in approximately half of dementia patients.
“I hear very palpably how upsetting that is, how distraught they feel,” Hashmi says of caregivers. “They are trying to make sense of it — ‘Why me? I’m the one who’s here for you? Why are you angry at me? I’m trying to help.’”
Aggression can stem from:
Most importantly, try not to take the aggressive behavior personally, Hashmi says.
“The classic line I always use is that this is the disease talking. It is not the person,” Hashmi says. “There is a lack of awareness in that moment. It’s not your mom or dad or spouse saying that. It’s the disease.”
When you are faced with a loved one’s aggression, Hashmi suggests employing these 4 Rs:
Dementia specialists also recommend the following tips to handle aggression in individuals with dementia:
When they’re feeling calmer, Hashmi says, you can try asking yes/no questions to help determine whether an unmet need is causing the behavior. Ask: Are you hungry? Are you thirsty? Are you in pain? Are you tired?
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While quality sleep tends to decrease as you age, people who have dementia experience more sleep disturbances than other seniors. In fact, sleep problems affect up to half of seniors with dementia.
Common sleep issues may include:
Sleep disturbances are hard on patients and caregivers alike, Hashmi says. “It’s physically and mentally exhausting to be up night after night.”
Troubled sleep is thought to be a dementia risk factor as well as a behavioral symptom. Here are some factors that may contribute to your loved one’s sleep problems:
There are ways to help your loved one get a better night’s sleep, Hashmi says.
Avoid things that disrupt sleep.
Create a routine that supports sleep.
Sixty percent of people who have dementia will wander. As their memory declines, they might leave a confusing situation or suddenly try to find someone and become disoriented and lost.
Such wandering can be dangerous, even life-threatening, yet caregivers often feel guilty for taking measures that will keep their loved one safe. The classic quandary that caregivers express is: “I don’t want my mom or dad or spouse to be a prisoner in their own home, and yet this is what I feel I’m doing,” Hashmi says.
The No. 1 priority is to keep your loved one safe, Hashmi says. He suggests the following actions:
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According to caregiver statistics, caregivers spend nearly all of their excess free time caring for their loved ones. This is even more so the case when caring for someone with dementia. Dealing with dementia behaviors can quickly wear out a caregiver or family member, causing caregiver burnout. Before burnout, it’s helpful to turn to respite care to provide you some relief as you recharge.
However, if your loved one’s dementia behaviors have progressed to the point where you cannot manage them alone, long-term help is also available. Senior care options like home care or memory care can help relieve some of the caregiving burden while also helping to keep your loved one safe.
If you are feeling resentment, anxiety, or depression, seek help. A caregiver support group, counselor, friend, or family member can offer camaraderie and advice.
“Other families, other caregivers, are going through the same thing,” Hashmi says. “They have a lot of common challenges and common solutions to share. And often those are the most effective, because they’re going through exactly the same process.”
A Place for Mom and Cleveland Clinic: Supporting seniors and their families
This article was developed in conversation with Cleveland Clinic Center for Geriatric Medicine Section Chief Dr. Ardeshir Hashmi as part of a series of articles featuring expert advice from Cleveland Clinic geriatricians.
Article updated by A Place for Mom senior copywriter Nirali Desai.
Müller-Spahn, F. (2003, March). Behavioral disturbances in dementia. Dialogues in Clinical Neuroscience.
National Institute on Aging. National Institute of Health. (2017). Alzheimer’s changes in behavior and communication.
Cerejeira, J., Lagarto, L., & Mukaetova-Ladinska, E. B. (2012, May). Behavioral and psychological symptoms of dementia. Frontiers in Neurology.
Khachiyants, N., Trinkle, D., Son, S. J., & Kim, K. Y. (2011, December). Sundown syndrome in persons with dementia: An update. Psychiatry Investigation.
Dettmore, D., Kolanowski, A., & Boustani, M. (2009, February). Aggression in persons with dementia: Use of nursing theory to guide clinical practice. Geriatric Nursing.
Rose, K. M., Fagin, C. M., & Lorenz, R. (2010, May). Sleep disturbances in dementia: What they are and what to do. Journal of Gerontological Nursing.
Agrawal, A. K., Gowda, M., Achary, U., Gowda, G. S., & Harbishettar, V. (2021, September). Approach to management of wandering in dementia: Ethical and legal issue. Indian Journal of Psychological Medicine.
American Psychological Association. (2015). Living well with dementia.
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