Dementia carer with client in Cumbria

Dementia Care in Cumbria

Understanding Behaviour in a person with dementia 

Changes in the ability to communicate are unique to each person with Alzheimer’s or dementia. They may also have difficulty expressing thoughts and emotions and trouble understanding others. It can become frustrating for those suffering from the condition as well as loved ones trying to care for them.

Understanding behaviours that a person with Alzheimer’s or dementia may demonstrate can help you find the best way to communicate. 

Common conditions that may affect behaviour and communication:

Insight impairment  A person lacks the ability to see things in a logical way which can happen when damage occurs to the frontal area of the brain.  A person with damage to this area can display a lack of insight and empathy, compulsive rituals, a loss of inhibitions, aggression and the development of routines or inappropriate behaviour. 

Apraxia is when a person has difficulty remembering a series of previously learnt movements or steps, e.g. getting dressed, tying laces or using cutlery.  The person with apraxia can understand what they want to do but cannot remember the next step in the sequence of events when carrying out an action. 

Visual agnosia is when a person loses the ability to recognise previously familiar objects, places and people. The parietal lobe may be damaged and this is what gives us a meaning to what we see. If there is damage to this part of the brain and we see a dog, we would still see the dog but would have difficulty in recognising it as a dog. 

Delusions A delusion is an idea or a belief that is imagined by the person and seems real to them. Delusions are ideas which are not based on reality but which are thought to be true by the person with dementia. It may lead to people with dementia acting very suspicious or paranoid of others. 

Hallucinations The term hallucination refers to the seeing, hearing, feeling, smelling or tasting things that are not actually there. Visual hallucinations are the most common type for a person with dementia. These may include seeing people, animals or objects or seeing faces in the pattern of fabrics. Auditory hallucinations occur when the individual hears voices or noises, despite the fact there is nothing there.

Night-time disturbances Many people with dementia become restless at night, some people may get up and get dressed and even decide to go outside. Melatonin levels in the brain are affected by dementia and this in turn affects their ability to feel sleepy.  Boredom during the day can also be a contributory factor.

Repetitious questions Some people with dementia will carry out the same activity, make the same gestures or ask the same question over and over again. This is partly explained by short-term memory loss. It is essential to be aware that the person may not remember asking the question or receiving an answer from you.

Repetitive behaviour Some people with dementia repeat the same actions over and over again. They may pack and unpack their bag, repeatedly fold napkins or walk around in circles. If there is damage to the frontal lobe of the brain, impulses will be disrupted and instead of a person moving on to a new action they will become caught repeating the same action. 

Clinging and following behaviour It is common for people with dementia to constantly follow people around from one room to another, or to call out all the time to check who is there. The person with dementia is experiencing living in a world where nothing makes sense anymore and where anything could happen. They are seeking reassurance and comfort from another person.

Looking for a place from their past As dementia progresses, the memory of recent events is usually affected first. The long-term memory usually stays intact until the dementia is more advanced. As the short-term memory becomes affected, they may not remember where they currently are and constantly search for places from their past which are familiar such as their school, a pub or previous homes.

Searching or asking for deceased relatives Many people with dementia live in the past and therefore look for relatives, friends or loved ones that died many years ago. This may be because the individual has forgotten that the person has died and their memory of the person is stronger than the memory of the death.

Restlessness and agitation There are many reasons why a person with dementia may become restless or agitated. They may be hungry or thirsty, in pain or feel unwell, bored, distressed or anxious. 

Feelings of entrapment Sometimes people with dementia may feel trapped within their own bodies as well as feeling hemmed in within their environment and may vent feelings of anger and frustration. 

Insults People with dementia may use inappropriate language and may direct insults at you.  This may be in the form of swearing, or using language which some people may find offensive. 

Losing and Hiding things There may be occasions when a person with dementia will accuse you or others of stealing, or attempting to steal their personal belongings. This may be because the person with dementia may be experiencing delusions or simply forget where they have put something. These accusations can be upsetting and distressing for the person who has been accused and must not be taken personally.

Lack of inhibitions For most people their sex life is an intimate area that they wish to remain private and not many people feel comfortable talking about their sex life or sex in general. A person with dementia may have reduced sexual inhibitions and this may lead to exposure of their private thoughts and behaviours. There may be displays of inappropriate sexual behaviour such as undressing in public places, exposing themselves or fondling their genitals, urinating in public or touching someone in an inappropriate way.

Anger and aggression Not all people with dementia will display angry or aggressive behaviour but there may be times when some behave in an angry or aggressive manner. Aggressive episodes may be caused as a result of a number of reasons and if a person is being cared for in their own home, then this anger is usually directed at those closest to them. 

Remember that all behaviour is an attempt to express how the person is feeling.

Read our Top Tips to help you communicate with a person with dementia. 

Next Steps

For more information about caring for a loved one at home join our discussion in our Facebook group Care Begins at Home for ongoing advice and support from our care experts.