Dementia - changed behaviours

Dementia can cause changes in the behaviour of a person. Such changes are very common, but they can place enormous stress on families and carers. It can be upsetting when someone who has previously been gentle and loving behaves in a strange or aggressive way.

Causes of behaviour change

Dementia affects people in different ways. Understanding why someone is behaving in a particular way may help families and carers to cope.

There are many reasons why a person’s behaviour may change. Dementia is a result of changes that take place in the brain which affect the person’s memory, mood and behaviour. Sometimes behaviour may be related to these changes taking place in the brain. In other instances, the behaviour may be triggered by changes in the person’s environment, health or medication.

Where to begin – talk to your doctor

Always discuss concerns about behaviour changes with the family doctor, who will be able to check whether there is a physical illness or discomfort present and can provide some advice. The doctor will also be able to advise if there is an underlying psychiatric illness.

Changed behaviours are not deliberate

Coping with changed behaviours can be very difficult and is often a matter of trial and error. Always remember that the behaviour is not deliberate.

Anger and aggression are often directed against family members and carers because they are closest. The behaviour is out of the person’s control and they may be quite frightened by it. They need reassurance, even though it may often not appear that way.

Ways to cope with changed behaviours

Suggestions for coping with changed behaviours include:

• Provide a calm, unstressed environment in which the person with dementia follows a familiar routine – this can help to avoid some difficult behaviours.
• Try to keep the environment familiar. People with dementia can become upset if they find themselves in a strange situation or among a group of unfamiliar people where they feel confused and unable to cope.
• If behaviour becomes difficult, do not attempt any form of physical contact such as restraining the person, leading them away or approaching them from behind. Leave them alone until they have recovered or call a friend or neighbour for support.
• Don’t take changed behaviour personally.
• Try not to raise your voice. Speak slowly in a calm and reassuring voice.
• Avoid punishment. The person may not remember the event and is therefore not able to learn from it.
• Try to remain detached; do not become provoked or drawn into an argument.

Aggression

This can be physical, such as hitting out, or verbal, such as using abusive language. Aggressive behaviour is usually an expression of anger, fear or frustration. Remember that:

• The aggression may be due to frustration. For instance, locking the door may prevent wandering, but may also result in frustration.
• Aggressive behaviour may be a way for the person to try to get what they want.
• Activity and exercise may help prevent some outbursts.

Ways to manage aggression

Suggestions to manage aggression include:

• Approach the person slowly and in full view.
• Explain what is going to happen in short, clear statements such as: ‘I’m going to help you take your coat off’. This may help to avoid the person feeling they are being attacked and becoming aggressive in self-defence.
• Try to anticipate and respond to the person’s needs.

Catastrophic reactions

Some people with dementia overreact to a trivial setback or a minor criticism. This might involve them screaming, shouting, making unreasonable accusations, becoming very agitated or stubborn, or crying or laughing uncontrollably and inappropriately. This tendency to overreact is part of the illness and is called a catastrophic reaction.

Sometimes a catastrophic reaction is the first indication that makes relatives aware of the dementia. It may be a passing phase, disappearing as the condition progresses, or it may go on for some time. Some causes of catastrophic behaviour include:

• Stress caused by the excessive demands of a situation
• Frustration caused by misinterpreted messages
• Another underlying illness.

Ways to manage catastrophic reactions

This behaviour can appear very quickly and can make carers feel very frightened. However, trying to figure out what triggers catastrophic behaviour can sometimes help avoid it. Some carers find that keeping a diary can help to identify the circumstances under which such behaviour occurs. If this isn’t possible, you may find ways to deal with the behaviour quickly and effectively using some of the guidelines listed earlier.

Hoarding

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:

• Isolation – when a person with dementia is left alone or feels neglected, they may focus completely on themselves. 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. Losing friends, family, a meaningful role in life, an income and a reliable memory can increase a person’s need to hoard.
• Fear – a fear of being robbed is another common experience. The person may hide something precious, forget where it has been hidden and then blame someone for stealing it.

Ways to manage hoarding

Suggestions to manage hoarding include:

• Learn the person’s usual hiding places and check there first for missing items.
• 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, as an inability to recognise the environment may be adding to the problem of hoarding.

Repetitive behaviour

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.

Ways to manage repetitive behaviour

Suggestions to manage repetitive behaviour include:

• If an explanation doesn’t help, distraction sometimes works. A walk, food or doing a favourite activity might help.
• It may help to acknowledge the feeling expressed; for example, ‘What am I doing today?’ may mean that the person is feeling lost and uncertain, and a response to this feeling might help.
• 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 or clothes to fold.

Where to get help

• Your doctor
• Your local community health service
• Your local council
• Carers Victoria Tel. 1800 242 636
• National Dementia Helpline Tel. 1800 100 500
• Dementia Behaviour Management Advisory Service (DBMAS) Tel. 1800 699 799 – for 24-hour telephone advice for carers and care workers
• Carer Respite Centres Tel. 1800 059 059
• Carer Resource Centres Tel. 1800 242 636
• Aged Care Assessment Services – contact your regional Department of Health office
• The Aged Care Information Line Tel. 1800 500 853

Things to remember

• Dementia can lead to behaviour changes, which may cause distress for the person with dementia and place added pressure on carers.
• Understanding why someone is behaving in a particular way can help families and carers to cope.
• Discuss your concerns about behaviour changes with the family doctor.
• Always remember that the behaviour is not deliberate.

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• Dementia - choosing residential care.
  
• Dementia - coping with placement.
  
• Dementia - diagnosis and early signs.
  
• Dementia - different types.
  
• Dementia - early planning will help.
  
• Dementia - hallucinations and false ideas.
  
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• Dementia and wandering.
  

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Last reviewed: May 2012

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Dementia can cause changes in a person's behaviour. Changes may include anger, aggression, loss of memory, hoarding and repetitive behaviour. Changes in behaviour can place stress on carers, families and friends.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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