Common Behavior Problems in Dementia

Did You Know

Providing activities that reflect both the interests and skills of people with dementia appears to be more effective at reducing aggression and passivity than activities that reflect only their skills or only their interests, but not both (Kolanowski and Litaker, 2006).

Caregiver Story

My mother was diagnosed with Lewy Body dementia 6 years ago and is now in an assisted living facility. When I was visiting her yesterday, a staff member told me that Mother has been "sexually aggressive" towards some of the male residents. Apparently she has been making suggestive comments and touching some of the men inappropriately, and a wife got upset - understandably. I am embarrassed and confused -- Mother is such a modest and chaste woman and I never even heard her talk about sex once in my life, much less act like this. They knew how to be firm with her about not doing this and they started seating her away from the men. I had to get over my embarassment about it and be firm with her about appropriate limitations myself.

Video

Watch a video that describes why some people with dementia start swearing more often (1 minute 40 seconds long).

Persons with dementia may gradually lose their so-called "internal critics" that would tell them what things are and are not appropriate to do in public or in certain company. For instance, some caregivers find that their loved ones will use curse words or seek out alcohol more frequently as the disease progresses. Curse words, obscenities, and similar behaviors are some of the most taboo and sometimes most basic forms of expression that someone can use. When a person with dementia is surprised or frustrated, these words might spring to mind.

Similarly, people with some forms of dementia may no longer recognize what is considered socially or sexually appropriate. For instance, a person with dementia may try to shoplift or take off his pants when you have visitors. He may try to seek out intimacy more often - sometimes even with complete strangers - or perhaps not at all.

Dealing with Inappropriate Behavior

If inappropriate behavior presents problems or is disturbing, caregivers should be respectful but firm with loved ones. If they are unable to calm or refocus them on another activity or task, it may be best to remove them from the situation. Even though these kinds of situations may be embarrassing and frustrating for caregivers, they should try to not get angry with their loved ones, since they may not understand that they are doing something wrong.

Agitation and Aggression in Late Stages of Dementia

In later stages of dementia, many people behave in an agitated, aggressive manner. These behaviors commonly occur during showering/bathing or in response to overstimulation in the environment, physical discomfort, changes in routine, and frustration with not being able to communicate or do something.

When this agitation happens repeatedly, medications (anxiolytics and antipsychotics)

Other Medications to Treat the Symptoms of Dementia

Medications, such as cholinesterase inhibitors and memantine, work to manage the progression of dementia in the brain. Individuals with dementia may also be prescribed medications that help deal with difficult behaviors and problems that arise as a result of the disease.

The most commonly prescribed types of other medications are listed below:

Anxiolytics

Dementia can be a frightening and worrying process for individuals as they lose their abilities and independence. If the anxiety is mild, it can be managed without medication, for instance by finding ways to relieve stress through exercise or meditation. However, more severe responses, such as panic attacks and emotional outbursts, may need to be treated with anxiolytics, medications that help calm and relax.

Common Drugs (Generic Name):

  • Ativan® (lorazepam)
  • Buspar® (buspirone)
  • Klonopin® (clonazepam)
  • Serax® (oxazepam)
  • Valium® (diazepam) Xanax® (alprazolam)

Antidepressants

Many individuals with dementia also experience depression. Loss of mobility, interactions with the world, and independence can result in a loss of appetite, fatigue, and a lack of interest in daily activities. Antidepressants may help improve both mood and function for these people.

Common Drugs (Generic Name):

  • Aventyl® (nortriptyline)
  • Celexa® (citalopram)
  • Effexor® (venlafaxine)
  • Paxil® (paroxetine)
  • Prozac® (flouxetine)
  • Zoloft® (sertraline)

Antipsychotics

As dementia progresses, the grasp on the difference between fact and fiction, real and imagined, becomes blurred. As this happens, people with dementia may have hallucinations or believe that other people are "out to get them." Sometimes, the person may become agitated, uncooperative, or even hostile. Antipsychotics are prescribed in these more serious cases to help manage these difficult behaviors when anxiolytics may not be enough.

Common Drugs (Generic Name):

  • Abilify® (aripiprazole)
  • Clozaril® (clozapine)
  • Geodon® (ziprasidone)
  • Risperdal® (risperidone)
  • Seroquel® (quetiapine)
  • Zyprexa® (olanzepine)

Hypnotics

Individuals with dementia can also have difficulties getting to sleep or staying asleep. Many of the medications commonly prescribed to dementia patients can fatigue them during the day. This may make it harder for them to get to sleep or to sleep through the night. Some caregivers find it useful to limit the number of naps their loved ones take during the day. If increasing their daily activity does not help, hypnotics may help them find restful sleep.

Common Drugs (Generic Name):

  • Ambien® (zolpidem)
  • Restoril® (temazepam)
  • Sonata® (zaleplon)

The purpose for many of these medications is to protect and promote the safety and well-being of the individuals with dementia and those around them. There are often ways to address the problematic behaviors and symptoms that can reduce or remove the need for a pharmacological solution. However, these decisions are best made in cooperation with your loved one's physician. Additionally, particular forms of dementia may not benefit as well from some of these drugs, so be sure that you and your physician are aware of the individual's diagnosis and its particular needs.

are sometimes prescribed and may help the person with dementia to relax. However the medications may have unwanted side effects, such as drowsiness. Emotional outbursts may also be an indication of untreated pain that the person cannot describe; caregivers who witness this should consider getting a medical evaluation for their loved one. Caregivers should also remember that the safety of everyone involved needs to be considered in these situations.

Suggestions for Caregivers

There are some other specific problem behaviors that may occur among people with dementia. The following text describes these behaviors and strategies for coping:

  • Refusing help

    Persons with dementia may sometimes refuse help or they may only accept help from a specific individual.

    Suggestions: Sometimes it is a matter of how they are approached. For instance, you might say that their regular caregiver is coming back in a little while and tell them that you will help out until she returns. If worry over an upcoming event brings a lack of cooperation, it may be helpful to not give advance warning of potentially upsetting events, such as a visit to the doctor. If the person with dementia is being uncooperative in order to gain a sense of independence or control, it may help to give him a task to do, for example, "How about you start combing your hair while I finish tying those shoes?"

  • Hoarding

    Some people with dementia may hoard food or other items, creating their own private collection or supply. This is often a harmless behavior which often makes the individual feel in control and safe. As with lost items, they may hide things in places where they kept things earlier in life, such as underneath mattresses, in dresser drawers, or inside jars.

    Suggestions: Rather than confronting and correcting your loved one, try adapting to it. Check their usual locations and then also be sure to check through the trash or dirty laundry. Some caregivers also find it helpful to keep extra closets and cabinets locked when they are not regularly in use, so as to limit the number of new hiding places.

  • Repetition

    People with dementia may repeatedly say or do something over and over again. For example, they may repeat a word or question or pace back and forth.

    Suggestions: Try accepting the behavior if it causes no harm or redirecting it to a harmless or even useful activity if necessary. Distract them with another activity.

  • Sleeplessness

    Some people with dementia may have trouble sleeping. Or they may sleep for long hours during the day but then be up all night.

    Suggestions: Use natural or artificial lighting to help cue your loved one when it is daytime and when it is time to sleep. You may want to prevent your loved one from taking too many naps during the day. Avoid giving your loved one caffeine, especially after lunchtime. Simple exercise or activity during the day also can contribute to better sleeping at night. Plan for a calmer, quieter but structured time in the late afternoon and evening, such as a quiet walk. You may need to consult a physician for medication, although there may be unwanted side effects. Keep your loved one's safety in mind, in case he or she is awake while you sleep.

  • Sundowning

    "Sundowning" refers to an increase in confusion, agitation, disorientation, and other troubling beginning with dusk and continuing into the night. Sundowning is experienced by some people with dementia and may be due to being tired at the end of the day. Also, confusion due to problems with the biological clock, which is an bodily sense of the time of day, may contribute to sundowning.

    Suggestions: To avoid confusion and agitation that occurs at the end of the day, close curtains before it gets dark outside and turn on inside lights. Handle abnormal behaviors and sleeplessness as described above.

View References Kolanowski A, Litaker M. Social interaction, premorbid personality, and agitaiton in nursing home residents with dementia. Arch Psychiatr Nurs. 2006; 20(1):12-20. Retrieved March 27, 2009.
Resources
Source: 
Alzheimer's Society (United Kingdom)
Description: 
This web page, printable as a PDF, addresses less common behaviors and emotions such as repetitive behavior, restlessness, issues with inhibition, and hoarding behavior, among others.
Source: 
Better Health Channel (Australia – Victoria)
Description: 
This web page discusses how intimacy and sexuality can be affected by dementia and provides suggestions for dealing with changes.
Source: 
Alzheimer's Association
Description: 
This fact sheet addresses how dementia can affect sexuality, discusses what is considered appropriate behavior, and provides guidance on how to deal with changes in sexual behavior.
Source: 
www.zarcrom.com
Description: 
This comprehensive directory discusses many different behaviors that you may notice in your loved one, and is organized alphabetically. The website offers possible explanations for these behaviors, and also offers many ideas on how to prevent and handle them.
Source: 
Alzheimer's Association
Description: 
This article explains the behavioral problem known as "sundowning", which includes confusion, and agitation, that some Alzheimer's patients experience in the evening hours. It also gives advice on how to lessen such behavioral problems.
Source: 
Alzheimer's Association, New York City chapter
Description: 
This web page describes two common behavioral problems that some Alzheimer's patients experience in the evening, and gives suggestions on how to handle these difficult situations.
Source: 
Alzehimer's Society (United Kingdom)
Description: 
This fact sheet provides information regarding available options for treating behavioral symptoms attributed to dementia, including depression, aggression, anxiety, and sleep disturbance. Drugs used for treating each symptom are discussed, as well as the possible side effects of each. Antipsychotics, anticonvulsants, antidepressants, and antidementia types of drugs are discussed.