Although it can be hard to understand why people with dementia act the way they do, it is important to remember that your loved one may not be acting out of ill will. It may be symptom of the disease and a changing brain.
However, once the underlying cause is identified or understood, the behavior may be able to be prevented or at least decreased.
Common behaviors associated with dementia disorders include:
- Repetitive actions
- Verbal outbursts
- Sleep disturbances
- Hallucinations, delusions or paranoia
- Wandering or wanting to go home
- Hoarding or rummaging
- Abusive behavior
- Emotional changes
- Mood swings
Generally, people with dementia become agitated due to three potential trigger categories: Medical, physiological and/or environmental.
Medical triggers can include sickness, fever or pain, but it can also include issues that you might not initially think about, such as:
- Medication side effects
- Sores, open wounds, pressure areas or bruises
- Earache, toothache or headache
It is also important to remember that some people with a dementia illness cannot verbally express their pain or give accurate information about how they feel.
You cannot expect a "real" answer if you ask, "How do you feel?" However, they will express it non-verbally by exhibiting a change in behavior or functioning level.
People suffering from dementia also have a hard time processing changes in their surroundings. A move can be a little disconcerting for anyone, but for a person with dementia even rearranging objects in a room can cause agitation.
Other environmental triggers to keep in mind include:
- New or unfamiliar caregivers or separation from loved ones
- Lack of routine, such as no "agenda" to help orient to surroundings
- No activity, no stimulation and/or isolation
- Too much activity or sensory overload
- Lack of orientation cues, such as ways to find the bedroom or bathroom
- Lighting that might be too bright, not bright enough or creates shadows
- White noise such as a lawn mower outside or an appliance humming inside the home
- Room temperature (too hot or too cold)
- TV or radio that is left on all the time can cause confusion
- Clothes too tight, shoes too small or hair pulled too tight
In addition, things that we hardly notice as we go about our day-to-day activities can agitate a patient with dementia. If you are having a hard time figuring out what might be bothering your loved one, take a moment and observe your surroundings for the following triggers:
- Shiny floors: What might look nice and clean to you could look like ice or standing water to a dementia patient.
- Mirrors: When a dementia patient looks into a mirror they often do not recognize themselves or they can get "lost" in the depth of the mirror.
- Color contrast: Too much or too little color contrast can de disorienting for dementia patients. For example, an all-white bathroom can be disorienting because it can make it difficult to see the difference between the toilet set and the wall or the floor. And too much contrast can be problematic as well. Two-toned carpet, checker-board tile or black door mats can look like holes in the floor to a dementia patient.
If you are a caregiver and you are having trouble identifying the causes of your loved one’s discomfort or agitation, talk to your health care provider about potential triggers. Some simple changes could make all the difference for you and your loved one.
This article was reviewed by Lisa Hebert-Meritt, COTA/L, CDP, CADDCT, Carilion Clinic Home Care, program lead for Carilion’s Alzheimer's Disease and Dementia Management Home Care Program.
Learn more about the seven stages of dementia.
If you are caring for a loved one with Alzheimer’s or another dementia-related disorder and find that detecting and soothing your loved one’s agitation is becoming increasingly difficult, Carilion Clinic is currently conducting a research study that may help.
BESI, which stands for Behavioral and Environmental Sensing and Intervention, is a collaborative effort between clinicians at Carilion Clinic, electrical engineers at University of Virginia and systems engineers at North Carolina A&T.
The study uses wrist-worn sensors to predict what upsets a person with dementia. The hope is that the sensors can detect agitation in the stages before it becomes so severe that no one can effectively intervene.
Volunteers are currently being recruited throughout southwest Virginia. If you are caring for someone at home who has Alzheimer’s disease or other dementias and are interested in participating, please call Temple Newbold, M.S.N., R.N., research nurse coordinator for Carilion Clinic Center for Healthy Aging, at 540-266-6077 to see if you qualify for the research study.