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Dementia
Alzheimer's Disease

How Does Dementia Change Behavior?

Kim Trevey on Oct 23, 2022
How Does Dementia Change Behavior? - The Breckinridge Memory Care - Lexington, KY

If you’re a caregiver for someone with dementia or the loved one of someone with dementia, you have probably noticed a change in this person’s behavior. That’s what tipped you off to his or her dementia in the first place.

The most noticeable and tell-tale sign of dementia is memory loss. This is the symptom most often associated with dementia and Alzheimer’s. But dementia includes an array of symptoms that affect someone’s behavior, not just memory loss.

Table of Contents
  1. Why does dementia affect behavior?
  2. Losing neurons in the brain
  3. Areas of the brain associated with dementia and Alzheimer’s
  4. Environmental effects
  5. Medical Issues
  6. Communicating physical, psychological and social needs
  7. Physical needs
  8. Psychological needs
  9. Social needs

Behavioral changes caused by dementia include:

  • Trouble sleeping
  • Anxiety or depression
  • Agitation
  • Delusions
  • Hallucinations
  • Confusion
  • Irritability
  • Difficulty learning new things
  • Difficulty completing a task due to decreased attention span
  • Trouble with language and finding certain words
  • Loss of inhibitions

Regardless, it’s important to know that behavioral changes in someone with dementia are normal, should be expected and shouldn’t be judged or reacted to harshly. People with dementia need empathy and understanding. They are navigating the world in a completely new way. This is very disorienting. The better you can understand their experience, the better you will be able to handle and care for these behavioral changes.

Why does dementia affect behavior?

Dementia affects behavior for a number of reasons, the top being:

  1. how the disease affects brain cells,
  2. environmental factors,
  3. and effects of medications or other medical conditions.

Losing neurons in the brain

Dementia and Alzheimer’s cause neurodegeneration in the brain, which is a deterioration of cells. Because our brains are what affect our behavior, anything that causes cells to break down in the brain will cause our behavior to change.

For dementia, changes in behavior depend on which area of the brain is being affected.

Areas of the brain associated with dementia and Alzheimer’s

How Does Dementia Change Behavior? - The Breckinridge - Lexington, KY

The frontal lobe is responsible for thinking, memory, behavior and movement.

How Does Dementia Change Behavior? - The Breckinridge - Lexington, KY

The hippocampus is responsible for memory retrieval. (Because short-term memory is affected more than long-term memory for those living with Alzheimer’s, the hippocampus is associated more with retrieving short-term memories.)

How Does Dementia Change Behavior? - The Breckinridge - Lexington, KY

The amygdala is responsible for our emotional responses. (This area of the brain is typically affected later than the hippocampus for those with Alzheimer’s disease.)

How Does Dementia Change Behavior? - The Breckinridge - Lexington, KY

The cerebellum is responsible for balance and coordination. (Vascular dementia is known for causing issues with balance.)

How Does Dementia Change Behavior? - The Breckinridge - Lexington, KY

Depending on where the degeneration in the brain is occurring, that is where you will likely see behavioral changes.

Environmental effects

People with dementia can be greatly affected by their physical and emotional environment. If they are in a noisy or crowded place, they can easily feel overwhelmed. If they are trying to follow a conversation but having difficulty due to confusion or their attention span, they may become agitated.

People living with dementia also pick up on the emotions of those around them. So if you’re feeling anxious or worried, they might notice that and also feel anxious or worried.

Of course if the above is true then so is the opposite. People with dementia thrive better in a calm environment surrounded by people who are patient and not easily irritated. Regular routines and schedules are also helpful for behavioral symptoms of dementia.

Medical Issues

With dementia come other medical issues, both physical and emotional. Those with dementia often develop anxiety or depression due to their diagnosis or neurodegeneration. They may also develop an infection such as a urinary tract infection that they aren’t able to communicate clearly. They are in pain but can’t tell you why. This may cause them to feel anxious, agitated or to lash out.

Medication can also cause side effects for those with dementia, causing changes in their behavior.

Communicating physical, psychological and social needs

One of the most difficult parts of dementia, for those living with dementia and for caregivers, is the inability to effectively communicate needs. People who are living with dementia don’t have the communication skills they once had. Their memory and language are greatly affected by the disease. When they are uncomfortable, hungry, thirsty, sick or tired, they may not know how to tell you this. Instead, they may get angry or agitated. They may shut down and not communicate at all.

This can be very frustrating for caregivers but is the area where caregivers must pay closest attention because being in tune with your loved one’s needs will allow you to meet those needs and, therefore, help the challenging behavior in the moment as well as help prevent it in the future.

Physical needs

Like all of us, people with dementia have physical needs. If they’re not able to get these needs met, their behavior may change. They might become agitated, angry or confused.

Physical needs that can be difficult to communicate for those with dementia include:

  • Comfort.
    They may feel uncomfortable in their chair or bed or around a certain group of people. 
  • Illness.
    Those with dementia may experience infections like we mentioned above or other ailments connected to other health conditions. When they are in pain or feeling sick, they may not know how to tell you how they’re feeling or why they’re feeling that way.
  • Sight or hearing loss.
    If dementia, or something else, is affecting their sight or hearing, they may grow frustrated with not being able to hear or see well.

If your loved one is showing signs of aggression, agitation or is shutting down, consider if any of these physical needs are not being met and how you could meet them. Once their basic physical needs are met, their behavior will change.

Psychological needs

While you may feel confused about your loved one’s behavioral changes, they are most assuredly more confused. They are experiencing life in a new way. They’re not able to do the things they once could. All of this can lead to great emotional and psychological distress, causing depression, anxiety, delusions and hallucinations.

If you’re noticing any of these psychological changes, talk to a professional. Therapy and counseling can be helpful for the psychological distress caused by dementia.

Social needs

People living with dementia often feel lonely or isolated. Due to their diagnosis, they might pull back from social activities or conversations, afraid they won’t be able to participate like they once could. Even though they may fear social interactions or be tempted to avoid them, being around other people and feeling socially connected is crucial for those with dementia.

In addition, due to isolation, they may feel bored because of a lack of stimulation. If they watch T.V. all day or sit in the same place, they will need more stimulation for their senses.

Be aware of your loved one’s social needs. They may need to be encouraged to socialize or they may need help getting out of the house for stimulating activities.

How you can deal with behaviors that are challenging

When you’re caring for someone with dementia who is exhibiting challenging behaviors, the DICE tool can be helpful.

D

Describe what happened.

What did they do?

What was the effect of the behavior?

Is safety a concern?

I

Investigate possible causes.
What need isn’t being met?

C

Create a plan.
How could you meet that need or ask someone else to help you meet that need?

E

Evaluate the plan.
Was your plan effective?

Did you get to the root of what they needed?

What do you need to do differently next time to help prevent this behavior?

Behavior that requires more intervention

Most dementia-related behavior is innocent and can be dealt with if you understand the underlying cause of the behavior.

However, certain types of behavior might require more intervention such as:

  • Threatening or acting physically violent
  • Accusing you of stealing from them or cheating on them
  • Emotional fits or outbursts
  • Wandering away from home and getting lost

If your loved one is showing any of the above behaviors, the Memory and Aging Center of the University of California San Francisco offers a helpful list of how to respond to each behavior here. You can also call the Alzheimer’s 24/7 helpline at 1.800.272.3900.

If you’re a caregiver or the loved one of someone living with dementia or Alzheimer’s, their behavioral changes can be difficult at first.

You feel like you’re losing the person you love. But know that these changes are inevitable with this type of disease. It’s not that you’re losing the person you love so much as you’re losing the way this person used to communicate. They, and you, simply must find improvements in their behavior.

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Continuing an Environment of Caring in Times of COVID-19


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As the coronavirus (COVID-19) pandemic continues to evolve, our communities are focused on keeping our Residents and staff safe while also maintaining Resident engagement and daily fulfillment. We are taking a cautious approach, balancing the highest level of safety within the least restrictive environment.

We will continue to follow and augment State and C.D.C. safety recommendations:

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Physical Changes: We have installed ultraviolet lights in our air conditioners that supply air to the common areas of the houses. This method is believed to be helpful in killing bacteria that is cycled through the systems and pushed back into the house. We’ve also enhanced our HVAC filters to near HEPA levels, trying to add additional layers of protection to keep COVID-19 out of the building. Most importantly, air purifiers have been added to common areas and each resident room.

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The uncertainty surrounding COVID-19 affects us all. At our communities, we are not letting it stop us from safely offering a life well-lived. Above all, we are providing the utmost attention to the safety and well-being of our Residents. Our Program has always revolved around the individualized needs of each Resident and this has not changed during COVID-19. Residents are still able to connect with each other and staff while maintaining a safe physical distance. Weather permitting, we enjoy the patio and large backyard. We continue to keep our Residents engaged through cognitive, physical, recreational experiences. We offer enjoyment and connection throughout the day even during these unprecedented times.

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Since early March we have restricted facility access to prevent the spread of COVID-19.

Essential Visitors: Healthcare providers including physicians, home health, private duty services, physical therapy and hospice staff have not been allowed in the communities unless there is an acute, essential need for our Residents. These services continue as needed through FaceTime, tele-med and phone conversations. If physical access is absolutely necessary, the individual will complete our questionnaire and screening for temperature and oxygen stats. No one is allowed in the community if they fail to meet our screening criteria.

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Move-Ins: We are accepting a limited number of move-ins (unless otherwise instructed by public health department). New Residents must be tested for COVID-19 prior to move-in. Upon admission, we will place a new resident in their room to quarantine as an additional precaution.

We will share community-specific information with residents and families as our quarantine measures continue to evolve with new information of COVID-19.

We are honored to care for your family member and loved one.

 

Comments we’ve received from our families during COVID-19.

“We appreciate all of your efforts. Your team clearly is a leader in the response to COVID. Thank you for keeping our loved ones safe.”

Joseph

“Thank you, thank you, thank you for ALL you have done and are doing to keep the residents and staff in a safe environment! The continuous learning and improvements empower caregivers and families to do better at home and in our communities.”

Tommy

“I appreciate you taking the time to update us and share them with my family living in AL, GA, VA, MD, FL…we are extremely grateful and comforted by your proactive and decisive measures! We’ll continue to keep you in prayer for health, safety and more.”

Rebecca

“In keeping with the parade theme you had, the employees there are super heroes. They are plowing forward in the midst of this horrible virus and taking care of their patients selflessly. I just wanted to acknowledge their bravery and dedication and thank them from the bottom of my heart for the goodness in their hearts and their dedication to their patients and jobs.”

Abigail

“Thank you! You locked down early & your diligence has paid well.

The Bader support group continues meeting once a month by Zoom. We all appreciate you so much. Everyone comments on how grateful we are that our parents are at The Breckinridge!

We appreciate everything: sending us pictures, calls, alerts to bring supplies/clothes as needed, staying in virtual contact with hospice.
Blessings to each of you.”

Marsha

“Thank you for all y’all and all the staff are doing for my mom and the other residents. We truly appreciate your hard work.”

Carol

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