Managing personality and behavior changes

How does dementia affects someone's behavior?

With dementia, the changes in the brain affect more than just memory loss. It changes how people communicate, their judgment, behavior, and emotions. Neither the person, nor the behavior is the problem. The problem is the need or feeling that the person is trying to communicate with the behavior.

This can manifest in a number of ways. Perhaps someone can't verbally communicate their dislike of milk, and they express that by throwing a mil carton across the room. They might be able to dress themselves, but can't remember where their clothes are and walk around half-dressed. They can lose the ability to understand social norms and appropriate behavior and are unable to restrain impulsive behavior.

The key is assessing the situation, identifying the root problem, validating the person's concerns, and addressing the need. 

Common behaviors

Some common changes to personality and behavior may include: 

  • Repetitive behaviors: Repeating the same activity or motion, pacing, fidgeting.
  • Verbal behaviors: These can be non-aggressive (singing, babbling, moaning) or aggressive (cursing, slurs, name calling).
  • Emotional behaviors: Gets upset or worried more easily. Depressed or uninterested in activities they usually enjoy.
  • Physical aggression: Includes hitting, biting, spitting, and kicking.
  • Inappropriate behavior: Includes inappropriate touching, sexually suggestive, or relieving self in public.

Why is this happening?

In dementia, changes in the brain change how people communicate. Neither the person nor the behavior is the problem. The problem is the need or feeling that the person is trying to communicate with the behavior.

Changes are more than memory loss. There can be lack in judgment, inability to change behavior based on responses, they cannot interpret and communicate their feelings in a usual way, and they are more likely to do things that against societal norms.

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How do I know what's wrong?

Assessment is a critical step in understanding and responding to behaviors in those with dementia. Part of this is recognizing patterns of behavior and if they happen around certain places, activities or people. Here is a checklist to start your assessment of the situation:

  • Are they dealing with pain, acute or chronic?
  • Is an illness or injury sparking this problem?
  • Has there been a medication change?
  • Are there any unmet needs?
    • Hunger
    • Thirst
    • Bathroom
    • Love
    • Purpose
  • Are they exhausted?

How do I address it?

The most important thing a loved one can do for someone with dementia who is agitated is validate the person's concerns. Don't worry about being right. It can be difficult, but refraining from arguing, correcting, and reasoning are important steps to helping calm someone down. And whatever you do, don't take it personally.

In addition to validating concerns, here are some other tips to managing strong or unusual behavior:

  • Divert attention or redirect.
  • Go with the flow.
  • Accept blame when you can (even though it is not your fault).
  • Use humor can help provide levity in the right situations.
  • Try playing music, singing or dancing to change the situation
  • Focus on their feelings rather than their words. For example, say, "You seem worried." 

You do not have to be in control. By validating concerns, you can help give someone with dementia some control over what they may feel is a chaotic situation.

Assess in four steps

It's a four-step process when there are strong or unusual behaviors and communication. When it happens, take these four steps to help alleviate stress and remedy the situation.

1. Something is not right.
2. This is a warning.
3. Pay attention.
4. Do something to help me.