Challenging Behaviors Mobile Guide

Being Patient's Guide to Challenging Behaviors

Behavioral changes in dementia

Managing dementia-related behaviors

Protecting your brain

Caregiver support and behavioral insights

Behavioral changes and dementia

For dementia patients suffering from cognitive issues and neurodegeneration, the behavioral changes that 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 on behavioral changes

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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.

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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:

1. Be consistant: Create a daily routine with set times for meals and activities.
2. Visual reminders: Use visual aids like calendars, labeled organizers, and sticky notes.
3. Memory lane: Engage in memory activities together.

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Difficulty with communication

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

1. Be concise: Keep sentences short and simple, focusing on one idea at a time.
2. Specify names: Use orienting names or labels whenever you can, such as 'Your son Justin will be here shortly’.
3. Listen patiently: Give the person time to respond. Take time to listen.

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Agitation and aggression

Some individuals with dementia may exhibit agitation, restlessness, or even aggressive behaviors in response to unmet needs.

1. Reduce triggers: Maintain a calm environment by reducing noise, clutter, or the number of people in the room.
2. Play music: Offer a playlist of familiar music before onset or at first sign of distress.
3. Be active: A walk provides an outlet for their energy, provides stimulation and gets them engaged.

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Wandering

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

1. Be concise: Ensure the home is secure with door alarms or locks. Add helpful signage if appropriate.
2. Stay active: Engage in activities like item sorting or folding clothes to reduce restlessness. Physical activities may also help.
3. Consistant daily routines: Stick to consistent daily routines for familiarity and comfort.

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Changes in mood

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

1. Open up: Stay calm and positive and encourage them to talk about or otherwise express their feelings.
2. Stay active: Engage in familiar activities or hobbies that bring joy and relaxation, while making sure that they are not overwhelmed.
3. Passive enjoyment: Consider activities that do not require active participation, such as listening to their favorite music.

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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.

"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 sat there for a couple of minutes and then said, ‘Okay, I’m going back to bed.’ Empathy typically leaves first with FTD.

Debra Tann

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Hallucinations and delusions

Individuals may have hallucinations or delusions, which aren't always due to dementia. Consult a doctor if these symptoms persist.

1. Empathize: Validate their emotions without arguing or confirming the hallucination or delusion.
2. Redirect attention: Shift their attention to a soothing subject or activity, or try changing the environment by moving elsewhere.
3. Remove Triggers: Consider activities that do not require active participation, such as listening to their favorite music.

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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. 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. And of course, with LBD 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.”

Don Kent

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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 needs.

2. Keep a journal to track behaviors, which may illuminate trends that reveal patterns to triggers.

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Explore more resources on beingpatient.com

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