Early stage dementia can appear with depression or anxiety. In moderate stage, delusions, hallucinations, or paranoia are more common.

Published: August 4, 2022 | Updated: December 8, 2022

When a loved one is diagnosed with dementia or any memory disorder, the first thought might be that they will begin to forget things. While that is true, there are a host of other symptoms and changes that will occur.

“As caregivers, we want to know what is normal and if there’s anything we can do,” said Rachel N. Hart, D.O., a geriatric medicine specialist with Norton Neuroscience Institute Memory Center.

Here are the causes of changing behavior with dementia, strategies for managing symptoms without medication and considerations for medication if that is deemed necessary.

What causes behavioral changes in dementia patients?

“About 97% of people at some point may experience neuropsychiatric symptoms,” Dr. Hart said. Neuropsychiatric symptoms (NPS) describe a set of behavioral or psychological symptoms. These symptoms can range from delusional to physical (pacing or restless wandering) to verbal (incoherent speech or negativism). It can vary in level of aggression, and can include yelling, hitting or biting.

“Every person is different, and the way the disease presents itself in these symptoms depends on so many factors,” Dr. Hart said.

Behavior changes are affected by the stage of dementia. Early stage dementia can appear with depression or anxiety. In moderate stage, delusions, hallucinations, or paranoia are more common. The type of dementia also plays a role. NPS appear differently in patients with Alzheimer’s disease, Lewy body dementia or frontotemporal dementia.

How can caretakers handle behavioral changes?

Here are five ways to help loved ones if you are a caregiver:

1. Clear and simple communication: Use short sentences and simple words. Long, complicated sentences are confusing and frustrating for someone who is losing their language capabilities.
2. Approach with care: Give the person time to recognize who is coming toward them. Walk slowly and speak softly.
3. Keep questions simple: Avoid open-ended questions and narrow down choices: A question that is better than asking, “What do you want to wear today?” would be: “Do you want to wear the blue dress or the green dress?”
4. Practice patience: Try not to point out mistakes or lose your temper. This can worsen anxiety and agitation in individuals with dementia.
5. Maintain a routine: Doing the same things at the same time is comforting and can help decrease anxiety.

“Most often it comes down to impaired communication,” Dr. Hart said. “We all have needs and desires we want to be addressed. We want companionship and safety. Individuals with dementia are gradually losing the ability to have those needs met and those desires satisfied.”