Coping with dementia behaviour changes

Dementia can have a big impact on a person’s behaviour. It can make them feel anxious, lost, confused and frustrated.

Although each person with dementia handles these feelings in their own way, certain behaviour is common in people with the disease. This includes:

• repeating questions or carrying out an activity over and over again
• walking and pacing up and down
• aggression, shouting and screaming
• becoming suspicious of other people

If you are experiencing these kinds of behaviour, or are looking after someone who behaves in this way, it's important to remember that this is an attempt to communicate how they're feeling. They are not being deliberately difficult. If you stay calm and work out why they're expressing themselves in this way, you may be able to calm them down.

If you recognise early warning signs, you may be able to prevent behavioural outbursts. Some people find that a distraction can focus a person’s energies elsewhere and prevent them from displaying challenging behaviour.

Your doctor may recommend behavioural therapies to help the person with dementia cope with their feelings. These therapies can be straightforward. For example, they may behave in a particular way because they're bored and have built up too much energy, and a routine involving regular exercise could help solve both of these issues.

Find out how to live well with dementia and what you can do to stay active.

Repetitive behaviour in dementia

People with dementia often repeat questions or carry out certain actions over and over again. This may be due to:

• memory loss
• boredom
• anxiety
• side effects of medication

If you think they're bored, try engaging them in an activity they enjoy, such as listening to music. Most people with dementia feel anxious at some point and will need to be reassured of your love and support. If you're concerned about the medicine the person you care for is taking, contact their GP for advice.

Walking or pacing up and down is common behaviour in people with dementia. It's very common for people at certain stages of dementia to pace up and down or leave their homes for long walks. This is a phase that doesn’t usually continue for long.

The reasons why someone with dementia walks or paces may not be obvious, but they may leave the house intending to go to the shops, or visit a friend and then simply forget where they're going. They may be bored or uncomfortable sitting at home and want to use up some energy. Or they may simply be confused about what they should be doing and where they should be.

If you notice them leaving, you might want to accompany them to guide them and make sure they don't end up being distressed.

Don't be afraid of talking to local shopkeepers and neighbours you trust to let them know about the person's dementia. Give them a contact number to call if they're concerned about the person’s behaviour. If you're lucky, you may find that your area is part of a "dementia-friendly community".

Tracking devices and alarm systems (telecare) won't solve all your worries about someone with dementia, but may give you some piece of mind.

People with dementia may be aggressive

Aggressive behaviour is a known symptom of dementia. This can be particularly scary and upsetting when it is out of character. Seeing a loved one's personality change is distressing, and may be a far more upsetting effect of dementia than memory loss.

The most common form of aggression is shouting, screaming or using offensive language, including continually calling out for someone, shouting the same word or repetitive screaming.

There are many causes of aggressive behaviour in dementia, including:

• fear or humiliation
• frustration with a situation
• depression
• no other way to express themselves
• loss of judgement
• loss of inhibitions and self-control

It's worth keeping a note of anything that has triggered someone's aggressive behaviour. This may involve some trial and error, but if you can identify these triggers, you may be able to avoid them.

During an episode of aggression, try not to make the situation worse by arguing or adopting an aggressive pose as this may make them lash out. It may help to count to 10 or remove yourself from the situation by leaving the room. One way to stay calm is to remember that even if the aggression seems personal or intentional, it is because of the illness.

When the person has calmed down, try to act normally with them. They may forget the incident quickly, or may feel awkward. Acting normally can help you both move forward.

Sometimes there are simple solutions to the aggression – for example, a night light can make some feel less anxious during the night, making them less likely to call out.

People with dementia may become suspicious of others

Dementia can make some people become very suspicious. This can be due to memory loss, lack of recognition of familiar faces and general confusion caused by the effects of the disease on the brain.

The person you care for may accuse you or their friends and neighbours of taking their possessions. They may believe that everyone is out to get them. If they lose items, they may panic and convince themselves that they have been burgled. Their behaviour may seem delusional and paranoid, but as their carer, try to remember that the way they feel is very real.

Listen to their worries, calm them down and, if you're sure their suspicions are unfounded, try to change the subject.

Drug treatment for dementia-related behaviour

In extreme circumstances – for example, if the person’s behaviour is harmful to themselves or others, and all methods of calming them have been tried – a doctor may prescribe medication.

If you want information about drugs to help manage behavioural symptoms of dementia, or if you're concerned about the side effects of medication, speak to the person’s GP.

If you are looking after someone with dementia

It may help to talk to someone about how you're feeling. If you want to speak to other carers in similar situations, contact a local carers' support group or a specialist dementia organisation. To find out what's available in your area, contact Carers Direct on 0300 123 1053. Lines are open 9am-8pm Monday to Friday and 11am-4pm on weekends, and are closed bank holidays.

Read more about caring for someone with dementia.