Dementia & Difficult Behaviors: Part 1-Understanding the Problem

Albert Einstein once said, “If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.” In part one of this Dementia & Difficult Behaviors blog post, we will delve into understanding the difficult behaviors associated with brain disease. In part two, we will address ways to respond to difficult behaviors.

Understanding Dementia & Difficult Behaviors

Dementia is really an umbrella term used for over 100 types of brain disease including Alzheimer’s, Parkinson’s, Lewy Body, and Frontal Temporal Lobe dementia. It is not uncommon for individuals to have even more than one type of dementia. Our brain is an incredible muscle that controls language, decisions making, memory, behavior, emotions, etc. As the brain disease progresses, its symptoms arise from chemical and structural changes occurring in the parts of the brain that control these functions. The result is often a range of difficult behaviors that can be disorienting and challenging for family caregivers to understand and address. Common examples include:

  • Repeating questions
  • Bursts of anger/ aggression
  • Swearing
  • Hyper-sexuality
  • Restlessness
  • Disrobing
  • Hoarding
  • Wandering
  • Resistance/ non-compliance
  • Sleep difficulties
  • Incontinence

Loved One Gone Wild

One of the biggest questions that families ask about these difficult behaviors is, “Is it the person or is it the disease?” We are used to judging people based on their behavior because we know people can control their behavior. In fact, we tend to value people’s behaviors far more than their words. Those parts of the brain that control behavior are what are impacted by dementia. As loved ones and caregivers it is important to make a mental shift to start looking at difficult behaviors as symptoms of a disease not expressions of a person. It can often feel like actions are directed at caregivers in retributive ways: “Mom threw out the grocery list I made her for the third time this week and I know she is just getting back at me for not visiting more often” At other times, it may feel disorienting and embarrassing: “Dad started cursing out the waitress in public. That is not like him. I can’t believe he would humiliate me like that.” These scenarios may seem familiar, especially during shifts into different stages of the disease. The key to remember is to not take behaviors personally. It is not about you. Difficult behaviors are symptoms of dementia not an expression of the loved one with the disease.

Causes of Difficult Behaviors

While the dementia itself can cause difficult behaviors, it is important to note that multiple factors can amplify or change behavior in a loved one and it is important to pay attention to behavior the way you would pay attention to changes in any other type of symptoms. Common factors that cause difficult behaviors are:

  • A combination of dementias: structural and chemical changes in the brain
  • Medication side effects/ dosages off
  • Depression/ Decline in emotional or mental health
  • Fatigue
  • Chronic illness, pain, and decline in physical health
  • Acute illness such as a urinary tract infection(UTI)
  • Environmental factors
  • Over complicated tasks
  • Miscommunication/ lack of understanding
  • Impaired visions, hearing or other senses
  • Dehydration
  • Constipation or other bowel imbalances 

The Emotional Brain

Emotions are an important way that we gauge and learn about the world around us. Emotions tell us when we are enjoying something; they alert us when we are in danger and signal to us our first impressions of a situation or person. The limbic system which includes the hippocampus in the brain regulates our emotions. When these emotional control centers of the brain are affected by dementia it is common for individuals with disease to exhibit behaviors such as: outbursts of anger or other strong emotions, disorientation, perceived danger, anxiety and clinging, accusations of theft, etc.

Alphabet Soup

The temporal lobes of the brain are on either side of the temple just behind the eyes. These are language centers where vocabulary, speech patterns, memory, as well as mood stability are housed. Along with the limbic system, changes in this part of the brain can account for rapid changes in mood, temper, and aggression. Most commonly you will see difficulty with communication such as an inability to recall words, lack of comprehension, and unintelligible or repetitive attempts at communication.    

The Unfiltered Brain

While much of language is lost such as vocabulary and sequencing it is common to have automatic language preserved. Examples of automatic language are: swearing, racial slurs, sexual language, other forbidden words, pledges, music and song lyrics. Without a filter for language, if the thought occurs, it gets communicated. Even individuals who were proper and reserved may begin to swear like a sailor, which can be both embarrassing and disorienting. This is distinctly a symptom of the disease.  

The Sexual Brain

The pre-frontal cortex is the front part of the brain and is responsible for controlling our impulses, planning, judgment, reasoning and insights. It is the logical break to automatic behaviors. When the executive control center of the frontal lobes is affected, sexually disinhibited behaviors are quite common in both men and women with dementia.   

Now that we understand the ways in which the brain is affected by dementia and how difficult behaviors arise as a symptom of that disease, click here to read part 2 of our blog series to learn how you can best respond and address these difficult behaviors.  


Memory Care

When it comes to finding quality Alzheimer’s Care or Dementia Care for your loved one, you have Sound Options. As a Geriatric Care Management firm and In-Home Care provider, we believe that aging safely at home is possible for those diagnosed with a wide variety and stages of dementias. This disease demands our creativity and customized care means providing caregivers equipped to understand and respond appropriately to difficult behaviors and unique needs of an individual with the brain disease. We are helping families plan for the future and find the memory care they need today. To find out more about our holistic elder care services, give us a call at 800.628.7649. 

Published on July 23, 2014.