Dementia Behaviors: Information and Resources for Caregivers

A caregiver's guide to understanding the troubling behavior and personality changes characteristic of dementia. Explore resources, advice and support for managing challenging dementia-related behaviors such as anger, irritability, agitation, repetition, wandering and aggression.

Behavioral Disturbance in Dementia

Clinically defined as neuropsychiatric symptoms; apathy, depression, anxiety, aggression and agitation are commonly noted as challenging behavioral signs of dementia. Although impaired reasoning abilities and loss of memory are the characteristic signs of dementia, behavioral and psychological changes sometimes present greater challenges for caregivers than the hallmark functional and cognitive declines.

Behavioral and Psychological Symptoms of Dementia

• Hallucinations
• Agitation
• Repetition
• Delusions
• Apathy
• Aggression
• Anxiety
• Personality / Mood Disturbance
• Paranoia
• Sleep Problems
• Wandering

Managing Dementia's Challenging Behavioral Issues

"When neuropsychiatric symptoms of dementia like severe agitation, aggression and severe symptoms of depression appear, they can be a real challenge to a patient and their caregiver," says Jacobo Mintzer, M.D., distinguished fellow with the American Psychiatric Association who has been involved in clinical research on Alzheimer’s disease for the last 20 years. In fact, a psychogeriatric study of the predictive pattern of behavioral symptoms in dementia on caregiver burden found that a higher prevalence of behavioral problems was strongly correlated with higher caregiver stress and earlier placement in long-term care settings.

Dementia, by definition, is a progressive disease- meaning it gets worse over time. Eventually, most people who have been diagnosed with dementia will experience behavioral symptoms over the span of this progression. Although behavioral symptoms rarely disappear completely, there are treatment recommendations to help caregivers manage these disruptive behaviors.

Non-pharmaceutical approaches such as redirection, validation and other behavioral-management techniques are widely recommended as the first line of treatment. A clinical evaluation that starts with examining the behavior, determining its everyday impact (i.e. insomnia, safety concerns), and working on modifiable environmental factors should be attempted before adding pharmaceutical interventions. Most antipsychotic medications are prescribed off-label, or "black box" for the treatment of behavioral and psychological symptoms of dementia. Although use in this way is technically outside of the drug's intended purpose, when prescribed in combination with other therapeutic techniques, this treatment approach can be effective in providing some measure of relief for dementia patients and consequently their caregivers.