Dementia is a multifaceted and progressive neurologic disorder affecting millions of individuals globally. Dementia is popularly linked to memory loss and confusion, with many not understanding the extensive behavioral and psychological signs that frequently feature alongside the disorder. These combined signs are classified as Behavioral and Psychological Symptoms of Dementia (BPSD), or rather behavioral disturbances, and can significantly challenge both demented and caregiving populations.
This article discusses what behavioral disturbances in dementia are, why they happen, how to manage them, and what caregivers and loved ones should know to care for someone with dementia and these challenging symptoms.
Understanding Dementia and Behavioral Disturbances
Dementia is not an individual disease but a general term that describes a group of symptoms that affect memory, thinking, and social functions severely enough to interfere with the ability to perform everyday activities. The most common type is Alzheimer’s disease, but there are others, including vascular dementia, Lewy body dementia, frontotemporal dementia, and others.
Behavioral disturbances describe the non-cognitive symptoms that frequently appear along with the more well-known cognitive decline. Some of these can be:
- Agitation
- Aggression (physical or verbal)
- Wandering
- Repetitive questioning
- Screaming/shouting
- Sexual disinhibition
- Apathy
- Hallucinations
- Delusions
- Sleep disturbances
- Anxiety and depression
These problems are not only unpleasant for the individual who has them, but they are also profoundly difficult and emotionally draining for family members and caregivers.
Causes and Triggers
Behavioral disturbances of dementia result from a mix of biological, psychological, and environmental factors. The following are some of the usual reasons why these behaviors may exist:
1. Brain Changes
With progressive dementia, the brain also sees considerable changes, which influence an individual’s way of processing feelings, perceiving the world, and managing their impulses. Loss of function to certain parts of the brain might result in disinhibition, paranoia, or mood instability.
2. Unmet Needs
Individuals with dementia may struggle to communicate basic needs such as hunger, pain, thirst, needing the bathroom, or discomfort. When they are unable to express themselves, they may act out behaviorally instead.
3. Environmental Stressors
Changes in environment, unfamiliar surroundings, loud noises, or chaotic environments can provoke confusion and agitation. Overstimulation or even under-stimulation can be problematic.
4. Medication Side Effects
Some drugs used to treat dementia or other conditions that co-occur can induce side effects such as hallucinations, drowsiness, or agitation.
5. Physical Health Problems
Unrecognized infection (e.g., urinary tract infection), constipation, dehydration, or pain can cause behavior changes. The person with dementia may not be able to describe what is wrong, leading to changes in behavior.
Common Behavioral Symptoms and How to Manage Them
Every person with dementia is unique, and the behavioral symptoms can range in frequency and severity. Knowing the specific behavior will facilitate proper intervention.
1. Agitation and Aggression
Restlessness, pacing, or verbal agitation can occur, progressing to aggression. The behaviors typically emerge when the individual feels threatened, confused, or overwhelmed.
Management Tips:
- Remain calm and avoid confrontations.
- Eliminate possible triggers and identify.
- Establish a predictable, structured routine.
- Offer reassurance and redirection with a gentle approach.
2. Wandering
Wandering is a serious safety issue. A dementia person might walk away from his or her home or care center because he or she becomes disoriented, looks for something, or because of a stimulation need.
Management Tips:
- Put safety locks or alarms on doors.
- Utilize wearable GPS tracking devices.
- Always have identification worn.
- Offer safe walking areas or formal physical activity.
3. Hallucinations and Delusions
Hallucinations (hearing or seeing things that are not there) and delusions (false beliefs) are especially prevalent in Lewy body dementia and can lead to fear and distress.
Management Tips:
- Don’t argue or attempt to reassure them the hallucination is not real.
- Acknowledge their feelings and provide reassurance.
- Look for environmental factors that might be contributing (shadows, mirrors, dim lighting).
- See a doctor if symptoms are persistent or severe.
4. Sleep Disturbances
Sleep disturbance is prevalent in dementia and can encompass difficulty sleeping, excessive night wakening, or confusion during the night (sundowning).
Tips for Management:
- Stick to a regular sleep-wake routine.
- Restrict napping during the day.
- Avoid evening stimulation (caffeine, television, excessive noise).
- Apply relaxing evening rituals and provide good lighting to limit confusion.
5. Apathy and Depression
Loss of interest, withdrawal, and depression symptoms can emerge at any phase of dementia.
Tips for Management:
- Provide gentle activity and activity involvement in hobbies.
- Provide companionship and talking.
- Watch for clinical depression symptoms and speak with a health care provider if necessary.
Treatment and Interventions
No single solution can be applied universally to treat behavioral disturbances in dementia. Successful treatment is often based on a multi-disciplinary team that integrates non-pharmacologic and pharmacologic interventions.
1. Non-Pharmacological Interventions
These need to be first-line treatment and involve addressing environment, personal style, and communication methods. These include:
- Validation therapy – Aiding the acceptance of the individual’s reality rather than correcting him or her.
- Reminiscence therapy – Utilizing pictures, music, or past events to stimulate positive emotions.
- Music and art therapy – Facilitating creativity and self-expression.
- Occupational therapy – Promoting independence and participation in meaningful activities.
2. Pharmacological Treatment
When behavior is hazardous or becomes unmanageable, medication can be used. But it should be administered judiciously and under close observation.
Medications commonly used are:
- Antipsychotics (e.g., risperidone) – Sparsely used due to potential for side effects such as stroke.
- Antidepressants – For depression or anxiety symptoms.
- Sleep aids – Short-term treatment for sleep disorders, although non-drug methods are preferred.
Supporting Caregivers
Caregiving for a person with dementia and behavioral problems can be extremely challenging. It is essential that caregivers receive support, resources, and time to rest.
Caregiver Tips:
- Become a member of a support group for dementia caregivers.
- Learn stress-reduction skills such as mindfulness or yoga.
- Take frequent breaks and seek assistance when necessary.
- Use respite care services to get a break.
- Learn about the condition to enhance understanding of behavior.
Planning for the Future
As dementia gets worse, behavioral problems may also worsen. It’s necessary to plan now for the person’s future care needs, such as:
- Advance care planning – Talking about future medical choices and care preferences.
- Legal and financial planning – Ensuring legal papers such as power of attorney and wills.
- Home care options – Searching for long-term care facilities with a focus on dementia care.
Last Thoughts
Behavioral disturbance and dementia are a complicated and frequently misunderstood phenomenon of neurodegenerative disease. Recognizing that these behaviors are a way of communicating as opposed to knowing defiance can encourage loved ones and caregivers to meet these behaviors with patience and understanding.
Though the journey can be difficult, there are many resources, therapies, and support systems in place to enhance quality of life for the individual living with dementia and caregivers alike. Through proper knowledge, preparation, and compassion, we can enable people with dementia to live with dignity and as much comfort as can be managed.
