The Center for Brain/Mind Medicine > Support & Education
Why Is My Person Acting Differently?
As dementia progresses, a person can feel increasingly vulnerable and struggle to communicate their needs. It’s important to remember that individuals with dementia are not choosing to participate in unwelcome behaviors. Often these behaviors communicate a need.
When trying to problem-solve behavioral changes, consider what is going on for the person with dementia and in their environment, and what you, as the caregiver, might bring to the situation. Below are some helpful considerations and information on potential behavioral changes associated with dementia. (Please note: Not all people with dementia will experience all of these behaviors.)
Please BREATHE Mnemonic
This mnemonic can be a helpful tool for caregivers to identify factors that may be contributing to the person’s behavioral changes:
Pain – Or other medical issue, like a recent change in medication or a Urinary Tract Infection (UTI)?
Bored –Social or cognitive stimulation level today? This week?
Restroom – Do they need to go to the bathroom? Are they constipated? Have they had an episode of incontinence?
Exhausted – Physical activity today? This week? Quality of sleep—overnight and napping?
Anxious – Scared? Worried? Chronic mental health condition worsening?
Thirsty – How much have they had to drink? Could they be dehydrated?
Hungry – Last meal or snack? Do they need more frequent but smaller meals?
Environment – Sensory issues, such as visual issues, clutter, too hot, too cold, lighting? Need for more medical equipment, like grab bars or a walker to feel secure?
Behaviors can be triggered or complicated by the way caregivers approach or react to the person with dementia:
- Emotional reactions or relationship dynamics (fear)
- Expecting more than what the person with dementia can do (ambiguous loss/grief)
- Stress and mood symptoms
Caregivers will be confronted with an overwhelming number of situations and behaviors that need to be addressed. One caregiving pearl of wisdom is learning the art of “choosing your battles” and “letting go.”
Behaviors & Strategies
What It Is
Behaving in a forceful way that doesn’t fit the situation:
Behaving in a way that is uncharacteristically stubborn, uncooperative, hard to handle, or resistant to care:
Signs of feeling nervous, worried, or frightened, such as:
Apathy or Indifference
Exhibiting decreased motivation and symptoms that may include:
Having strong beliefs that are not true, such as:
Persistent (lasting more than two weeks) signs of sadness and hopelessness, such as:
Acting impulsively or inappropriately, such as:
A sensory experience of seeing, hearing, smelling, feeling, or tasting things that don’t exist outside of the mind, such as:
Acting cranky, overly critical, or impatient, such as:
Doing things over and over, such as:
Changes in sleep habits, such as:
Behaviors that worsen in late afternoon into the evening, including increased confusion, anxiety, agitation, pacing, and disorientation. Factors that may aggravate late-day confusion:
Additional Caregiver Tips
Behavioral changes are expected symptoms of the dementia process. Continuing to learn more can help you feel supported and give you tools for the dementia journey. Here are some additional pointers:
- Go back to the basics—the 4Rs: Reassure, Reconsider, Redirect, and Relax.
- Talk with your person’s neurologist if behaviors are acute so you can rule out medical causes.
- If social or public outings are difficult, consider discreetly giving others these printable cards or making your own variation specific to your person.
- Still feeling stuck? Join a support group, speak with a social worker, call the Alzheimer’s Association 24/7 Helpline 1-800-272-3900.