Behavioral and psychological symptoms such as agitation, anxiety, and psychosis are very common among people with dementia. Understanding these behavioral changes can help caregivers cope and provide better care.

Dementia is a general term that describes the deterioration of memory, language, and other thinking abilities.

Although these are the hallmarks of the condition, it is also very common for people with dementia to present with behavioral, perceptual, and emotional disturbances. Research suggests that as many as 97% of people with dementia have one or more of these symptoms.

This article explores the common behavioral challenges in dementia, including their causes and the treatment options. It also provides tips on how caregivers can cope with them.

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Doctors collectively refer to neuropsychiatric symptoms as behavioral and psychological symptoms of dementia (BPSDs).

BPSDs are the most disruptive aspect of dementia for people with the condition and their caregivers. They can significantly affect the outlook for individuals and the management of their condition.

Below are behavioral changes that are common among people with dementia:

Experts do not fully understand the causes of psychosis in dementia. However, they think that alterations in signaling pathways in the brain — involving neurotransmitters such as dopamine, gamma-aminobutyric acid (GABA), and serotoninmay play a role.

Defective brain signals may prevent a person with dementia from recognizing and processing novel information, causing psychosis.

Other cognitive issues, such as poor memory and impaired visuospatial abilities, may make it difficult for a person with dementia to identify what is real and what is not.

The symptoms of psychosis include delusions and hallucinations, which tend to increase with the severity and duration of dementia.

Delusions are firmly held beliefs that are false. Hallucinations involve seeing, feeling, touching, and hearing things that do not exist in reality.

However, a 2017 study that analyzed delusions in people with dementia found that they may be due to disorientation and the attempt to fill in the gaps resulting from cognitive deficiencies.

Learn about the differences between delirium and dementia.

People with dementia may experience changes in their sleep patterns, including hypersomnia, fragmented sleep, sleep-wake reversal, and rapid eye movement (REM) sleep behavior disorder.

Many individuals experience nighttime awakenings, daytime sleepiness, and napping because of low sleep quality. Medications, the need to urinate, pain, and other factors may contribute to this.

Aberrant motor behaviors such as wandering, restlessness, and pacing are also common, affecting about one-third of people with dementia. According to the United Kingdom’s Alzheimer’s Society, these individuals may also fidget, wring their hands, pull their fingers, and pull or rub their clothes.

Wandering becomes more likely in the advanced stages of the condition. About 6 in 10 people with dementia will wander at least once, while many others will do so repeatedly.

Aggressive behaviors are among the most disruptive and frequent behavioral complications of dementia. They can come in two forms: verbal and physical.

Verbal aggression includes cursing and throwing insults and threats. People who become physically aggressive may assault, pinch, bite, or scratch others or throw items.

A person with dementia may show more aggressive behavior as the disease progresses.

Learn more about aggressive behavior in people with dementia and how to respond.

Anxiety affects up to 71% of people with dementia. A person with dementia cannot take in new information and stimuli. This difficulty in understanding their environment and adapting to it may lead to anxiety.

This symptom tends to be more common in people with vascular dementia than in people with Alzheimer’s disease. It also gradually decreases in the latter stages of the condition.

Learn more about the early signs and symptoms of dementia.

Depression is common among people with Alzheimer’s disease during the early and middle stages of the disease. It occurs in 30% of people with vascular dementia and Alzheimer’s disease and more than 40% of people with Parkinson’s disease and Huntington’s disease.

People with depression may lose interest in previously enjoyed activities and withdraw from people.

Disinhibition refers to behaviors that seem rude and offensive because they do not adhere to social conventions. People with dementia may lack control of their emotional and social behaviors in a social context.

They may display behaviors that have harmful effects without intending to, such as making sexual comments, exposing inappropriate parts of the body, and disregarding rules. They may also appear to have lost their manners and respect for others.

Learn more about the stages of dementia.

People with dementia may perform repetitive movements and vocalizations. They may also repeat questions and complaints.

Verbal repetitions and questionings are often due to lapses and gaps in memory, while repetitive motor behaviors may stem from anxiety, loneliness, insecurity, and the inability to express a need. People may also repeat activities to seek comfort, familiarity, and security.

Although BPSDs seem to happen spontaneously, many of these behaviors are due to potential triggers, such as a restriction of independence, medication changes, and unmet needs.

The loss of skills and cognitive abilities, an inability to understand and process information, and difficulty with self-expression can leave people with dementia feeling lost, angry, and frustrated.

Physical factors — such as vision or hearing loss, pain, infection, underlying medical illness, and the side effects of medications or drug interactions — can trigger behavioral and psychiatric disturbances.

Other factors may also become triggers, including:

  • being asked to do something that is now difficult due to their cognitive decline
  • unfamiliar environment
  • moving to a new place or nursing home
  • changes in caregiver arrangements
  • misperceived threats
  • traveling
  • bathing
  • fear and fatigue

Learn about why continuity of care in dementia matters.

Caregivers of people with dementia may feel frustrated, tired, and overwhelmed. A caregiver’s needs are as important as the person for whom they are caring. They should take the time to rest and care for themselves, too.

An informal caregiver can ask for help from family members or find respite care providers. They may seek caregiver support from the Alzheimer’s Association’s support group page.

Caregivers may also benefit from:

  • identifying possible triggers
  • recording behavior patterns
  • seeking input from a doctor to rule out underlying health problems
  • keeping things simple
  • following a daily routine
  • avoiding arguing with, correcting, or trying to reason with the person
  • enjoying the good times and reminiscing about the past
  • continuing doing activities that they enjoy or exploring new activities together
  • distracting and redirecting the person when they engage in repetitive behaviors
  • providing reassurance
  • engaging in activities that give pleasure and confidence, such as listening to music
  • providing a calm and quiet environment
  • being in the moment and focusing on their feelings
  • trying not to show frustration, irritation, or anger
  • using humor

Learn more about how to care for someone with dementia.

Healthcare professionals may treat behavioral and psychological disturbances using nonmedicinal interventions and prescription medications.

Nonmedicinal strategies include:

  • providing sensory-stimulating activities, such as making a memory book
  • enabling social contact
  • providing relaxation therapy and hand massages
  • reducing the stimulation in the environment
  • keeping the environment simple and familiar
  • ensuring that caregivers know how to offer the best care and have good communication skills
  • simplifying tasks and routines
  • modifying the environment, including adding visual cues and reminders
  • installing adequate lighting to reduce confusion and anxiety, especially at night

Learn more about the best activities for people with dementia.

When a person does not respond to the methods above and is causing physical or emotional harm to themselves or their caregivers, the doctor may prescribe psychotropic medications. These include:

They may only prescribe drugs for as long as necessary and strictly monitor the person’s response because of the risk of severe side effects.

Not all behavioral and psychological changes are secondary to dementia. Caregivers who notice sudden behavioral changes should consider an evaluation from a healthcare professional. They could be signs of an underlying infection, pain, or a medication side effect.

It is also important to ask the doctor to assess the person with dementia if they display increasing or persistent behavioral and psychological disturbances.

People with dementia gradually lose most of their skills and abilities. These changes accompany behavioral and psychological disturbances, such as agitation, depression, and psychosis.

Understanding these behaviors may help caregivers cope and better care for their loved ones.

Various treatments and strategies may help caregivers appropriately respond to and manage these challenging behaviors. Doctors may consider prescribing medications to address behaviors that do not respond to nonmedicinal treatments.