What Behavioral Challenges Can You Expect from a Loved One with Dementia?

Dementia poses many challenges for people struggling with it, for caregivers, and for others who are close to them. It can be especially hard to witness and cope with common behaviors that often arise from certain forms of dementia, including Alzheimer’s disease, frontotemporal dementia (FTD), and vascular dementia. 

Caring for a person who has any of these forms of dementia may be frustrating, confusing, and upsetting at times. Understanding why certain behaviors occur and learning how to handle a variety of situations can help smooth the path ahead. 

What Behaviors Are Common when a Person Has Dementia? 

Changes in behavior are sometimes the first sign that someone has dementia. For some people, they can come on gradually and can be hard to recognize at first. For others, the changes can be more sudden. Not all people with dementia exhibit the same behaviors. People with different forms of dementia often exhibit a combination of unusual behaviors, as listed below. Following the list are some behaviors common to Alzheimer’s, FTD, and vascular dementia. 

  • Becoming easily agitated; 
  • Repeating themselves (asking the same question over and over); 
  • Taking others’ belongings; 
  • Making odd statements; 
  • Leaving the house without telling anyone and getting lost (more common in Alzheimer’s than FTD); 
  • Experiencing changes in judgment or decision-making; 
  • Using the wrong words for certain items; 
  • Hoarding objects, such as mail or even garbage; 
  • Hallucinations and delusions are relatively common as Alzheimer’s progresses but relatively uncommon in FTD. 
  • Forgetting how to maintain good hygiene and not realizing they need to bathe; 
  • Exhibiting paranoid behavior; and 
  • Anger, aggression, and violence.  

Anger, Aggression, and Violence in Dementia 

Mood, personality, and cognitive changes causing anger, aggression, and violence often appear during the middle or moderate stages of dementia. This middle stage of dementia is the longest and can last many years. Symptoms vary but may include the following behaviors: 

  • Yelling, screaming, and calling out; 
  • Attempting to attack physically; 
  • Verbal abuse such as making threats and insults; 
  • Physical abuse such as pinching, biting, scratching, pinching, and pulling hair; 
  • Throwing things. 

Anger, Aggression, and Other Behavioral Symptoms of FTD  

Behavioral changes are often the first noticeable symptoms in the behavioral-variant FTD (BvFTD), the most common form of FTD. For someone with BvFTD, aggression can be verbal, including shouting, name-calling, cursing, and making lewd comments. It can also cause physically abusive actions, such as hitting, pushing, biting, pinching, scratching, grabbing, or disinhibited sexual behavior. The Association for Frontotemporal Degeneration (AFTD) offers an excellent resource with tips on what can be done to avoid these situations, manage them, and keep them from escalating. Please note that some people with FTD may never experience a period of anger or aggressive behavior. 

Anger, Aggression, and Other Behavioral Symptoms of Vascular Dementia 

As a person’s vascular dementia progresses, they may become more agitated or aggressive. They may also act in ways that others find embarrassing or difficult to understand. This may be because they are trying to communicate a need – for example, that they are hungry, confused, tired, or in pain. Learning about possible triggers and adopting strategies, including not arguing, giving them space, and responding calmly, may help caregivers prevent angry outbursts and better manage them. 

When it comes to vascular dementia, symptoms depend on the specific brain areas where blood flow is reduced.  

Behavioral symptoms of vascular dementia may be most obvious when they happen soon after a major stroke. 

Common early signs include uncontrolled laughing and/or crying, impaired function in social situations, and difficulty finding the right words. 

Anger, Aggression, and Other Behavioral Symptoms of Alzheimer’s 

Sometimes, people with Alzheimer’s disease get upset or angry easily. They may curse, insult, or scream at loved ones. They may even throw things or resist caregivers by pushing and hitting. This kind of aggression usually starts when people get to the mid or later stages of Alzheimer’s disease. 

Aggression may be a symptom of Alzheimer’s disease itself and could also be a reaction when a person feels confused or frustrated. If your loved one becomes aggressive, it’s important to remember that they aren’t doing it on purpose. Once you have an idea of what might be behind the aggression, see what works to calm your loved one down. Speak as softly and as calmly as you can, even if you feel frustrated, angry, or sad. If you need to and it’s safe, step away for a few minutes and take some deep breaths. 

Behavioral changes are most common as Alzheimer’s progresses, tending to occur later in the disease. 

Some of the most common behavioral symptoms of Alzheimer’s disease include agitation, yelling, repetitive sentences, repetitive questions, and wandering/exit seeking. During the later stages of Alzheimer’s disease, behavioral symptoms often get even worse, including symptoms such as: 

  • Violent physical and/or verbal outbursts. 
  • Restlessness; 
  • Pacing; 
  • Shredding paper or tissues; 
  • Hallucinations (seeing, hearing, or feeling things that are not there). 

Try Not to Take Attacks Personally 

The things a person with dementia says in anger are often due to triggers or confusion. They are typically not trying to intentionally hurt others. Symptoms of FTD are especially misunderstood. Family members and friends often think that the person is just misbehaving, leading to anger and conflict. It is important to understand that people with these disorders cannot control their behaviors and other symptoms and often lack any awareness of their illness. 

If the person is frequently aggressive or violent, you should first try to make an appointment with that person’s doctor. It could be that a new medical problem (such as a urinary tract infection) is causing these behavioral problems. If the aggressive or violent behavior isn’t due to a new health problem and is predictable and severe, doctors may prescribe a medication to help regulate mood, such as an antidepressant or an antipsychotic in cases of extreme agitation or hostility. 

If a specific behavior results in an abusive or dangerous situation that you’re not able to get under control, you may need to call 911 in order for the police or a local crisis intervention unit to come to your aid.  

Strategies for Coping with Dementia-Related Behaviors 

Caring for someone with dementia-related behavioral disturbances can be a stressful and intensely emotional experience. Feelings of anger, frustration, disbelief, grief, denial, and fear are common — for both the patient and the caregiver. Here are some strategies for handling behavioral changes: 

  • Be patient. If your loved one has difficulty recalling a word, for example, allow them time. Getting anxious or impatient will only inhibit their recall. Gently supply the word, or tell the person that you can come back to it later. 
  • To deal with your own fears, doubts, and sadness, find others you can confide in 
  • Be aware of your body language. Your loved one responds to your facial expression, tone of voice, and nonverbal cues as much as the words you choose. Make eye contact, stay calm, and keep a relaxed, open posture. 
  • Avoid questions that challenge short-term memory, such as “Do you remember what we did last night?” The answer will likely be “no,” which can be humiliating for someone with dementia and may lead to agitation or aggressive behaviors.  
  • Keep unsafe items out of sight. Put away or lock up belongings the loved one shouldn’t have — especially potentially dangerous items like car keys or cleaning fluids. Consider installing cabinet locks.   
  • Maintain respect. Don’t use patronizing language, baby talk, or sarcasm, as these things may cause hurt and confusion, possibly contributing to agitation and aggression.  
  • Use distraction. This helps when the person makes unreasonable requests or is moderately agitated. For example, acknowledge what the person is saying, and change the activity. You could say, “I see that you’re upset. Let’s go over here for a minute.” And then do an activity that engages the senses and relaxes them, such as sitting outside together, listening to music, folding socks, or eating a piece of fruit. 
  • Don’t try to reason with the person. Dementia has damaged your loved one’s comprehension. Attempting to reason might be frustrating for both of you. 
  • Take a short break if you feel your fuse getting short. Try using quick stress relief to calm down and regain your balance. 
  • As dementia changes, seek the help and support you need. Get support for yourself, such as group therapy for caregivers and their families. 

Do You or a Loved One Have Dementia? — the Time to Plan Is Now! 

Persons with dementia, and their families, face special legal and financial needs. If you or a loved one have been diagnosed with dementia, it is prudent to start your planning as soon as possible. If you have not done Incapacity Planning, Long-Term Care Planning, or Estate Planning (or had your Planning documents reviewed in the past three to five years), now is a good time to plan and get prepared! Among other services, we offer peace of mind through our four levels of lifetime protection planning: 

Level 1 — Incapacity Planning is about protecting your assets from lifetime probate. 

Level 2 — Revocable Living Trust Estate Planning is about protecting your assets from lifetime probate and after-death probate. 

Level 3 — Living Trust Plus® Asset Protection Planning provides protection from probate, lawsuits, home care, and assisted living expenses by allowing access to Veterans Aid and Attendance benefits, and nursing home expenses by allowing access to Medicaid. 

Level 4 — Life Care Planning, Medicaid Asset Protection, and Veterans Asset Protection provide comprehensive planning and filing services, often at times of crisis, though this type of planning can be done anytime someone is beyond the first step of the Elder Care Continuum, aka Aging Continuum. 

Please contact us to make an appointment to ensure that you have the appropriate level of planning in place: 

Northern Virginia Elder Law Attorney: 703-691-1888
Fredericksburg, VA Elder Law Attorney: 540-479-1435
Rockville, MD Elder Law Attorney: 301-519-8041
Washington, DC Elder Law Attorney: 202-587-2797 

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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