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Managing Behavioral & Personality Changes With Dementia

January 3, 2023Neelem Sheikh

People with dementia often experience a range of cognitive, functional, and personality changes throughout the disease course. Behavioral and psychological symptoms of dementia develop in more than 90% of people diagnosed with dementia. As the brain becomes damaged, your loved one may say things or do things that are completely uncharacteristic of the person you’ve known for many years. These changes can be extremely challenging for friends and family to accept and cope with. 

Understanding why these personality changes occur with dementia can help loved ones and caregivers identify the cause and reduce or better manage these behaviors.

Causes of Behavioral and Personality Changes With Dementia

There are many causes of dementia, including Alzheimer’s disease, Parkinson’s disease, Lewy body dementia, and frontotemporal dementia. Although changes in personality and behavior can be due to many different causes, it’s often due to the lost neurons (brain cells) in various regions of the brain.

Take Alzheimer’s disease for example. Alzheimer’s disease impacts a wide range of brain regions throughout the disease continuum. In the early stages, Alzheimer’s disease impacts the entorhinal cortex and hippocampus which are essential regions for learning and memory. Later in the disease course, Alzheimer’s disease may damage structures in the cerebral cortex, such as the frontal lobe which is considered our emotional control center and the heart of our personalities. It is involved in focus, attention, decision-making, speech, impulse control, social behavior, and other aspects of behavior and personality. Consequently, in the early stages, there may be minor changes in mood, such as increased anxiety, depression, and irritability, while in the later stages, there may be more severe changes, such as extreme confusion, delusions, suspicion, fear, and anger.

So, depending on the cause and stage of dementia, the severity and timing of possible personality changes can vary. Behavioral and psychological symptoms can also vary widely from person to person.

Common Behavioral and Personality Changes With Dementia

Depending on the cause, personality changes with dementia may include:

  • Agitation
  • Aggression 
  • Anxiety and depression 
  • Irritability
  • Fear 
  • Loss of interest in activities
  • Social withdrawal
  • Apathy
  • Disinhibition
  • Insensitivity to others
  • Delusions
  • Hallucinations
  • Wandering
  • Pacing
  • Unusual sexual behavior
  • Paranoia 
  • Sleep changes
  • Sundowning 
  • Appetite changes
  • Lack of initiative
  • Poor decision-making abilities

It’s important for caregivers to understand that these behavioral and personality changes can also be exacerbated, or even caused, by outside factors. For example, in the later stages of dementia, some people are unable or not always able to communicate their feelings or needs. This can make it difficult to communicate that they are ill, in pain, hungry, thirsty, or need to use the bathroom. Additionally, their physical surroundings may contribute to behavioral changes. If the room is not well-lit, they may become stressed and confused because they can’t figure out where they are or how to get where they are trying to go. 

Managing Behavioral and Personality Changes With Dementia

For many friends, families, and caregivers, behavioral and personality changes can be the most distressing and difficult parts of caring for someone living with dementia. It’s important to keep in mind that it is their disease that is causing them to speak and act this way—not your loved one. Embrace and enjoy the moments when your loved one is happy and acting like their “old self.” In the more difficult moments, keep your cool and try to identify the cause of the behavior. Ask yourself:

  • Are all of their needs being met? Are they hungry, thirsty, too hot, or too cold? Are they uncomfortable or in pain? Is the noise in the room too loud? Is the room too dark? Are they bored or restless and need stimulation?
  • What medications are they taking? Could they be experiencing side effects from medications?
  • What are they trying to communicate to me?
  • What happened right before these behaviors occurred? Did something outside of their normal daily routine happen today? Did they see a visitor they weren’t expecting to?
  • Has their hearing and vision been checked recently? Could they be experiencing hearing or vision impairment?
  • Did they get enough sleep last night? 

One of the best things you can do as a caregiver to help manage or reduce these changes is to stick to a routine. Establishing a familiar pattern of activities can reduce stress for people living with dementia as well as their caregivers. Knowing what to expect each day can help people with dementia feel calm and comforted. 

Additionally, it’s important to pay attention to what time each day these behaviors occur. Oftentimes, people living with dementia have “good” and “bad” times throughout the day. Their mood and functioning may be better early on in the day and poorer in the late afternoon. Try to schedule activities in accordance with the times of day when they are at their best.

Last but not least, be kind to yourself and take care of your own emotional needs. Caring for someone with dementia can be stressful and draining. Make time for the things that you love, whether that be chatting with a friend, practicing yoga or meditation, going for a walk, reading a book, or grabbing a workout.

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