Dementia affects not only memory but also behavior, presenting challenges that can be confusing and exhausting for caregivers. These behaviors are symptoms of the disease, not reflections of the person’s character. In this blog, we’ll explore the reasons behind these behaviors, discuss the top ten challenges caregivers face, and offer practical strategies to manage them.

Why Do Challenging Behaviors Happen?

Dementia changes the brain in ways that affect thinking, communication, and emotional regulation. As the disease progresses, different areas of the brain responsible for memory, judgment, and impulse control can be severely impaired. These changes can lead to behaviors that may seem irrational or out of character. Understanding why these behaviors occur can help caregivers respond with empathy rather than frustration.

Someone with dementia might:

• Struggle to express pain, hunger, or discomfort: They may not have the words to explain what they need or feel, leading to agitation or outbursts. For example, a person might yell or become restless when experiencing physical discomfort such as constipation or a headache.
• Feel confused, scared, or overwhelmed in certain environments: Dementia can make it hard to process sensory information. A once-familiar setting, like a family gathering, may now feel chaotic and frightening. Background noise, bright lights, or too many people talking at once can lead to confusion and anxiety.
• React to changes in routine or surroundings with frustration or fear: Predictability provides a sense of security. When routines are disrupted—even by small changes like rearranging furniture or switching meal times—someone with dementia may feel disoriented and lash out in fear or anger.
• Experience impaired reasoning or memory: Forgetting who people are, why they’re in a particular place, or what’s happening around them can trigger paranoia or repetitive questioning. They may accuse loved ones of stealing or become fixated on returning to a home they no longer recognize.
• Lose the ability to self-regulate emotions: Brain changes can make it harder to cope with stress or frustration, leading to exaggerated emotional responses. For example, a minor inconvenience, like waiting for a meal, might provoke an intense reaction such as shouting or crying.

Understanding these underlying causes is the first step in responding with empathy and patience. By recognizing that behaviors are symptoms of the disease rather than deliberate actions, caregivers can shift their perspective and approach challenges with greater compassion.

There are many challenging behaviors you may run into caring for a loved one with dementia, but we are going to talk about the top 10 in this blog. You can find a list of other behaviors you may run into HERE.

1. Wandering

Wandering is one of the most stressful behaviors for caregivers due to safety concerns. A common scenario involves a person wandering because they’re looking for “home” or trying to find someone they’ve forgotten is no longer around. Learn more HERE.

Example:  A caregiver found her mom repeatedly leaving the house at night, convinced she needed to catch a bus to visit her long-deceased sister. The caregiver had to constantly monitor the doors to prevent her mom from wandering into dangerous situations.

2. Aggression

Aggression can be verbal or physical and often occurs when the person feels threatened or misunderstood.

Example: A man with dementia began yelling and pushing when his caregiver tried to help him change clothes. His caregiver realized this outburst was triggered by feeling rushed and overwhelmed.

3. Agitation

Restlessness, pacing, or irritability can result from overstimulation or unmet needs. Learn more HERE.

Example: One caregiver noticed that her father’s pacing and hand-wringing increased when multiple visitors were present, leading to heightened stress.

4. Paranoia

Paranoia can manifest as mistrust or accusations, such as “someone is stealing my money.”

Example: A woman with dementia began accusing her daughter of taking her jewelry. She would search through drawers repeatedly, convinced her possessions were missing.

5. Repetitive Questioning

Hearing the same question over and over can be frustrating, but it’s often rooted in anxiety or memory loss.

Example: A man frequently asked his wife, “When are we eating?” multiple times in an hour, despite her answering each time.

6. Hoarding

Hiding or collecting items can be a way for someone with dementia to feel in control.

Example: A woman with dementia filled her dresser drawers with old receipts and scraps of paper, insisting they were important documents. 

7. Sundowning

Sundowning refers to increased confusion or agitation in the late afternoon or evening.

Example: A man with dementia became restless and began pacing every evening around sunset, often asking to go outside. Learn more HERE.

8. Resistance to Care

Refusal to bathe, eat, or take medication is common and can stem from fear, confusion, or discomfort.

Example: A woman with dementia screamed and resisted when her caregiver tried to brush her teeth, terrified of the toothbrush.

9. Delusions and Hallucinations

Beliefs in things that aren’t real (delusions) or seeing/hearing things that aren’t there (hallucinations) can be distressing.

Example: A woman insisted there were strangers hiding in her closet and refused to sleep in her bedroom.

10. Inappropriate Sexual Behavior

This can include comments, touching, or disrobing in public, often due to brain changes or misinterpreted cues.

Example: A man with dementia began making inappropriate sexual remarks to women every time him and his wife went out in public.

1. Stay Calm and Reassuring

• Your tone and body language matter. Staying calm can help de-escalate situations. Deep breathing or pausing for a moment before responding can make a difference.
• Approach your loved one with a relaxed demeanor, even if the behavior feels overwhelming.
• Use reassuring phrases like, “I’m here to help,” or “It’s okay, we’ll figure it out together.”

2. Identify Triggers

• Pay attention to patterns in behavior. Are they more agitated in noisy environments or at specific times of day? Keep a journal to track when and where challenging behaviors occur (ALZlog was designed to help track behaviors).
• Common triggers include hunger, fatigue, pain, or overstimulation. For example, loud TVs or crowded rooms can overwhelm someone with dementia.
• By pinpointing triggers, you can make adjustments to prevent similar episodes.

3. Adapt Your Approach

• Distraction and redirection can work wonders. Offer a favorite snack, a photo album, or an activity they enjoy to shift focus away from agitation.
• If they’re upset, avoid correcting or arguing. Instead, acknowledge their feelings and gently guide their attention elsewhere. For instance, if they insist on “going home,” try saying, “Let’s sit down and talk about home. Can you tell me what you remember?”
• Learn more about the correct approach HERE.

4. Create a Safe Environment

• Secure doors, remove hazards, and create spaces that promote calmness. Tools like GPS trackers can provide added safety for wanderers.
• Ensure rooms are free of clutter to minimize fall risks. Use soft lighting to reduce shadows, which can sometimes cause confusion.
• Calming elements like familiar decorations, soothing music, and comfortable furniture can also create a more reassuring environment.

5. Simplify Communication

• Use short sentences and avoid arguing. Speak slowly and maintain eye contact. For example, instead of saying, “You just ate lunch,” try, “Let’s have a snack now.”
• Avoid open-ended questions and offer choices instead. For instance, say, “Would you like tea or juice?” rather than, “What do you want to drink?”
• Visual aids, like pointing to objects, can also enhance understanding.

6. Educate Yourself on Dementia

The more you understand dementia, the better equipped you’ll be to manage challenging behaviors. Learn about the disease’s progression, triggers, and how to adapt your care approach.

Explore comprehensive caregiver education through my Understanding Dementia Course. This resource provides valuable insights and strategies to help you navigate caregiving with confidence.

When to Seek Professional Help

Some behaviors may require medical or professional intervention:

• Unmanageable aggression or paranoia.
• Sudden changes in behavior that might indicate an infection or medication issue.
• Delusions or hallucinations causing distress.

Medications can also play a role in managing challenging behaviors, particularly aggression. Doctors might prescribe antipsychotics, antidepressants, or mood stabilizers to help reduce extreme agitation or aggression. These medications should be used cautiously and under the guidance of a healthcare professional, as they can have side effects and may not be suitable for everyone.

If aggression becomes frequent or severe, it’s essential to consult a doctor to discuss these options and determine the best course of action.

Self-Care for Caregivers

Caring for someone with dementia is demanding. Don’t hesitate to ask for help or take breaks. Respite care, support groups, and connecting with other caregivers can provide much-needed relief and encouragement.

You can find others who have loved ones with dementia and dementia caregiving support in our Facebook Support group.

Conclusion

Challenging behaviors in dementia are part of the journey, but they don’t have to define it. By understanding the causes, using practical strategies, and seeking support, caregivers can navigate these behaviors with greater confidence and compassion.