4 Behavioral Symptoms of Dementia and How to Manage Them

By Heather Lee, MSN, FNP-C (for the Alzheimer’s Association)

Alzheimer’s disease and other forms of dementia are common fears for patients, caregivers and healthcare providers across the United States. While the biggest worry for many is the mental decline in dementia, another group of symptoms can be even more stressful. Neuropsychiatric (behavior-related) symptoms of dementia are very common. In fact, 60-90% of patients with dementia will have at least one. As the disease gets worse, so do these symptoms. These kinds of behavioral symptoms are often underreported by patients and caregivers, so the numbers are likely even higher.

Agitation or Aggression

There are a lot of reasons that a person with dementia can be agitated. First, make sure that the patient and everyone around them is safe. Then, look for a cause:

• Infection
• Medications
• Pain
• Constipation
• Confusion
• Fear
• Poor sleep
• Depression

The first step with new agitation or aggression should be a visit to the patient’s doctor. They can look for a medical reason, such as a urinary tract infection or medication side effect.

Be sure the person has glasses or hearing aids, if needed. Misunderstandings caused by poor vision or inability to hear conversations can be aggravating to anyone.

A daily routine helps keep the person aware of what will happen next and can keep anxiety at bay. Speak slowly and calmly. Distraction and redirection techniques can be helpful, such as sharing in an enjoyable activity or offering a food they love. Don’t be afraid to take a break, if needed.

Sleep Disorders

Problems with sleep affect up to 35% of people with Alzheimer’s disease. There are many factors that can lead to this such as: medication side effects, decreased activity during the day, nighttime urination, depression and anxiety. Sleep hygiene is important to helping prepare for a good night’s sleep and should focus on:

• A bedtime routine (reading, soft music, bathing, etc.)
• Going to bed and getting up at the same time each day
• Avoiding alcohol and caffeine
• A regular physical activity program during the day
• Limiting beverages for 2-3 hours before bed

A visit to the patient’s doctor may be needed to find the reason for the sleep difficulty. Some disorders, like restless legs syndrome or REM sleep behavior disorder may be making things worse.

Wandering

People with Alzheimer’s disease often feel restless and distracted. This may lead to wandering, which carries a high risk of the person getting lost, injured or even dying. Even someone who has never been lost before is at risk.

• Signs on doors can help reorient a person
• Alarms to notify caregivers if person has left the home
• Continuous supervision
• bracelet or other item with patient’s information

Caregivers may need support, especially when it comes to the demands of continuous supervision. Local support groups, day programs and respite care can be helpful.

Sexually Inappropriate Behavior

An upsetting symptom in up to 25% of people with dementia is sexually inappropriate behavior. The actual number of people who have these behaviors may be higher, as may be an embarrassing behavior to discuss with health care providers.

There is limited research in this area, but the studies that have explored it have shown that is it mostly seen in male patients. Behaviors most often seen are inappropriate sexual talk and behavior such as, fondling, public masturbation, exposure, and grabbing. These actions are usually present with other behaviors such as aggression, depression, and/or agitation.

Ways to help stop these issues:

• Redirection
• Distraction
• Avoiding stimulants like certain content on TV, movies, etc.
• Use of medications under care of the patient’s doctor

These behaviors and others in patients with dementia can be managed. Being aware of changes in the patient and being familiar with the common reasons for behavior change is a great way to be able to get help quickly.

To learn more about Alzheimer’s disease and ways you can support families and people living with the disease, visit alz.org/RochesterNY.

The Alzheimer's Association leads the way to end Alzheimer's and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer's and all other dementia. ™ For more information, visit www.alz.org or call the 24/7 Helpline at 800.272.3900.'s>