UPDT_Challenging behaviours

The guide to

Challenging Behaviors and Dementia

Managing dementia-related behaviors

Caregiver support and behavioral insights

Behavioral changes in dementia

narration

Behavioral changes and dementia

For dementia patients suffering from cognitive issues and neurodegeneration, the behavioral changes that eventually arise can be especially challenging for caregivers and loved ones. Some of the behaviors are common to all patients, and some are unique to the individual, but there are practical steps that can be taken to effectively manage these changes.

Teepa's take: challenging behaviors and dementia

narration

Recognizing unmet needs

As dementia interferes with a person’s ability to remember, to communicate, and to interact with their world, unmet wants and needs related to these functions can cause unpredictable reactions. Though the behaviors that arise may be irritating or upsetting, it is important to remember that this is not an intentional action, but a means of expressing an unmet need.

narration

Memory loss

One of the most well-known symptoms of dementia is the progressive decline in memory, especially short-term memory.

What you can do:

Be consistent

Memory lane

Visual reminders

Engage in memory activities together by looking at old photos or listening to favorite music."

Use visual aids like calendars, labeled pill organizers, and sticky notes to reinforce important information.

Create a daily routine with set times for meals and activities.

narration

Read more

Difficulty with communication

Dementia often presents challenges in verbal communication, such as difficulties in expressing thoughts, finding the right words, or understanding language.

What you can do:

eva

lvin

Listen patiently

Be concise

Specify names

Give the person time to respond. Take time to listen to the person express his or her thoughts, feelings and needs.

Keep sentences short and simple, focusing on one idea at a time.

Use orienting names or labels whenever you can, such as 'Your son Justin will be here shortly’.

narration

Read more

• Use orienting names or labels whenever you can, such as 'Your son Justin will be here shortly’.

• Give the person time to respond. Take time to listen to the person express his or her thoughts, feelings and needs.

Agitation and aggression

Some individuals with dementia may exhibit agitation, restlessness, or even aggressive behaviors in response to unmet needs. For example, frustration from increased noise or loss of independence in tasks they once managed alone.

What you can do:

Reduce triggers

Play music

Be active

Maintain a calm environment and minimize potential triggers by reducing noise, clutter, or the number of people in the room.

Offer a playlist of familiar music before onset or at first sign of distress.

Consider a walk or car ride to provide an outlet for their energy, provide stimulation and keep them engaged.

narration

Read more

Wandering

It's common for people with dementia to wander aimlessly, which can pose safety risks.

What you can do:

Be concise

Stay active

Consistent daily routines

Engage in activities like item sorting or folding clothes to reduce restlessness. Physical activities may also help.

Ensure the home is secure with door alarms or locks. Add helpful signage if appropriate.

Stick to consistent daily routines for familiarity and comfort.

narration

Read more

Changes in mood

Dementia can lead to mood swings, depression, anxiety, or inappropriate emotional responses.

What you can do:

Passive Enjoyment

Stay Active

Open Up

Engage in familiar activities or hobbies that bring joy and relaxation, while making sure that they are not overwhelmed.

Stay calm and positive and encourage themto talk about or otherwise express their feelings.

Consider activities that do not require active participation, such as listening to favorite music.

narration

Read more

Patient perspective: Chris & Debra Tann

Chris Tann, a Navy veteran and dementia advocate, was diagnosed with behavioral variant frontotemporal dementia in 2019. He and his wife, Debra, spoke with Being Patient about the behavioral changes he experienced.

“Chris has a diagnosis of behavioral variant FTD. What I was noticing was a lot of behavioral changes. I remember one early morning, two or three o’clock, I was in the living room weeping. I was sad. Chris came into the living room and said, why are you crying? I said, ‘I am hurting.’ He was sitting afar. That was a cue right there. He sat there for a couple of minutes and then said, ‘Okay, I’m going back to bed.’ Empathy typically leaves first with FTD. That was the total antithesis of my husband. He would have sat next to me, embraced me, stayed up with me, encouraged me...”

Read more

Debra Tann

narration

Hallucinations and delusions

Individuals may have hallucinations or delusions, which aren't always due to dementia; they could be caused by medications or other illnesses. Consult a doctor if these symptoms persist.

What you can do:

Empathize

Remove triggers

Redirect attention

Remove potential triggers from the surroundings, like intense lights, or loud sounds that could worsen hallucinations or delusions..

Validate their emotions without arguing or confirming the hallucination or delusion. Comfort them if distressed.

Shift their attention to a soothing subject or activity, or try changing the environment by moving elsewhere.

narration

Read more

Patient perspective: Don Kent

Retired lawyer Don Kent was misdiagnosed by six different neurologists before being diagnosed with LBD at Mayo Clinic. Kent spoke to Being Patient about the first symptoms he noticed.

“The symptom I recognized first were two things. One, a change of personality. I didn’t notice it so much as my wife and my son noticed it... I’ve always been a sort of laid-back person, very slow to anger, and relatively cool under pressure. I was a trial lawyer, so in a courtroom, you have to remain that way. And all of a sudden, I became this sort of explosive personality, very angry, saying mean things to people, which I had never done before. And about the same time I also felt a loss of my sense of taste... I’ve now learned over time that it’s a hallucination, a taste hallucination. And of course, with Lewy Body we can have hallucinations with all of our senses. So mine was a loss of a sense of taste and a rather abrupt personality disorder.”

Read more

Don Kent

narration

Inappropriate behaviors

Individuals with dementia might act inappropriately, like undressing in public or neglecting personal hygiene. It's vital to respond with empathy, redirect their attention, and seek the underlying cause of such behaviors.

What you can do:

Guide privacy

Support hygiene

Redirect

If a loved one tries to undress, move them to a private area and check if they're warm, uncomfortable, or need the restroom.

If a loved one is impatient in public, remember they struggle with time perception. Gently redirect them to be polite, or ignore if it's a minor issue.

If a loved one is incontinent and avoids bathing or changing clothes, provide privacy and reassure them of your support.

narration

Read more

Left: thermometer and restroom sign Middle: angry person Right: caring hands and a heart

Caregiver — and detective

When challenging behaviors arise, you may find that at times the biggest challenge to overcome is your own reaction to the behaviors. Recognize that these behaviors are not intentional and focus on addressing the underlying needs to improve the situation.

1. Ask friends, family members, or other caregivers for help, as they may have more insight into the individual’s psychological and social needs. 2. Keep a journal to track behaviors, which may illuminate trends that reveal patterns to triggers, such as the time of day or type of environment.

narration

Read more

beingpatient.com

Explore more resources on

Learn more about challenging behaviors and dementia on Being Patient:

narration

Read more

Want to keep learning?

Visit

beingpatient.com

for the latest news and information on brain health and Alzheimer's disease

narration