The Center for Brain/Mind Medicine > Support & Education

Behavioral Changes

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?

Caregiver Considerations

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:

  • Verbal—screaming, cursing, threatening, or loud, repetitive sounds.
  • Physical—hitting, kicking, biting, scratching, throwing objects at others or oneself.
  • Verbal aggression can escalate into physical aggression. De-escalating at the verbal stage can be preventive.


  • Ensure safety and remove potential triggers.
  • Focus on feelings, not facts.
  • Try to be positive and reassuring.
  • Shift the person’s focus to another activity.
  • Take a break after ensuring safety.
  • Observe patterns for triggers.
  • Try to incorporate music.
  • Call 911 if the person or your safety is at risk.
  • Speak with the person’s medical team.

Behaving in a way that is uncharacteristically stubborn, uncooperative, hard to handle, or resistant to care:

  • Repetitive questioning, fidgeting, nervous pacing, and hiding or hoarding objects
  • Arguing, complaining, being overly critical, or becoming easily upset
  • Inappropriate screaming or disruptive noises
  • Resistance to bathing, dressing, or taking medications
  • Leaving home on purpose



  • Look for a reason or trigger.
  • Turn action or behavior into an activity (for example, turn noises or yelling into music or turn on music; if person is rubbing their hand on the table, provide a cloth for dusting).
  • Offer reassurance and approach the person in a calm manner.
  • Take a short break from the task/activity if faced with resistance.
  • Try to understand where the person’s frustration is coming from.
  • Provide an answer and/or write down the answer and put in prominent location.

Signs of feeling nervous, worried, or frightened, such as:


  • Shortness of breath or panting, sighing, being unable to relax, jumpy. or tense
  • Easily startled by light touch or noise
  • Asking repeated questions about what they should be doing or where they are going
  • Shadowing or following you around wherever you go; nervous pacing
  • Create a calm and soothing environment.
  • Talk about worries or fears.
  • Learn triggers or causes for their anxiety.
  • Consider ways the person found comfort before cognitive changes.
  • Stay active—physical activity can reduce anxiety and help with sleep.
  • Maintain a healthy diet.
  • Talk with the person’s doctor if anxiety is new.
Apathy or Indifference

Exhibiting decreased motivation and symptoms that may include:

  • Less interest in or trouble with initiating usual activities or activities and plans of others
  • Difficulty engaging in conversation or doing chores
  • Lack of emotion




  • Introduce a range of different activities, including art, cooking, Montessori methods, exercise, multisensory stimulation, pet therapy, music, reminiscence.
  • Break tasks into simple steps.
  • Gently prompt the start of activities.
  • Avoid blaming the person for being lazy.
  • Try to remain calm; take a break.
  • Consider hiring help or enrolling in a day program.

Having strong beliefs that are not true, such as:

  • Believing others are trying to steal from or harm them
  • Believing their house is not actually their home
  • Believing their significant other is having an affair




    • Remain calm.
    • Don’t argue or try to convince.
    • Try to understand their reality and provide reassurance, care, and concern.
    • Investigate for any environmental triggers.
    • Replace any lost items.
    • Try not to take offense.
    • Use distraction with an enjoyable activity or topic of conversation.
    • Talk with a doctor to evaluate for medical causes.

    Persistent (lasting more than two weeks) signs of sadness and hopelessness, such as:

    • Feeling like a failure, stupid, or useless
    • Feeling like a burden to family and loved ones
    • Periods of tearfulness or sobbing
    • Sleep and appetite changes
    • Loss of pleasure in usually fun activities
    • Acknowledge the frustration and sadness, while continuing to express hope.
    • Establish a predictable daily routine.
    • Find ways they can contribute to family life.
    • Make a list of activities, people, or places the person enjoys.
    • Exercise regularly, particularly in the morning.
    • Provide reassurance of love and respect.

    Acting impulsively or inappropriately, such as:

    • Talking to strangers as if they know them
    • Saying things that may hurt people’s feelings
    • Talking openly about very personal matters not usually discussed in public
    • Behaving in a way that is socially inappropriate for the situation (e.g., talking in church or singing at mealtime)
    • Try to react with patience and gentleness, even though behaviors may be embarrassing.
    • Give plenty of physical contact such as stroking, hugging, and rubbing.
    • If behavior is sexually inappropriate, gently remind them their behavior is inappropriate and guide them to a private place or try to distract.
    • Carry companion cards you can give to others to help them understand that your person has dementia.

    A sensory experience of seeing, hearing, smelling, feeling, or tasting things that don’t exist outside of the mind, such as:

    • Auditory—hearing voices, sounds, or music from inside or outside the person’s mind; the voices may be talking to each other or to the person
    • Visual—seeing something no one else can see, such as people, animals, bugs
    • Olfactory—smelling an odor that is not present
    • Tactile—feeling insects, touch, or pinpricks on or under the skin that are not there
    • Gustatory—sensing an odd taste in food or liquids that is not there
    • Determine if the hallucination is bothering the person.
    • Stay calm and avoid contradicting them.
    • Respond in a calm, supportive manner (e.g., “I’m here, I will protect you. I will take care of you.”).
    • Listen intentionally to what they are saying so you can better understand what they are experiencing.
    • Check the environment and remove any triggers.
    • Focus on feelings (e.g., “You seem really scared.”).
    • Talk to a doctor to rule out medical causes.
    • Distract and redirect.

    Acting cranky, overly critical, or impatient, such as:

    • Being argumentative or having sudden angry outbursts
    • Frequently complaining
    • Crying unpredictably or having sudden mood changes
    • Allow the person to keep as much control in their life as possible.
    • Build in routine and quiet time.
    • Reduce noise and clutter.



    Motor Disturbance

    Doing things over and over, such as:

    • Opening and closing drawers or doors
    • Putting on and removing clothing
    • Fidgeting, pacing, tapping fingers or bouncing feet a lot
    • Repeatedly handling buttons or picking at things
    • Wandering (repeatedly walking away without any purpose)
    • Turn action or behavior into an activity (turn noises or yelling into music or turn on music; if person is rubbing their hand on the table, provide a cloth for dusting).
    • Identify the time of day the person is most likely to wander and plan things to do during that time.
    • Involve the person in daily activities.
    Nighttime/Sleep Behaviors

    Changes in sleep habits, such as:

    • Waking up during the night
    • Walking around the house at night
    • Getting up earlier than usual in the morning
    • Taking excessive naps during the day



      • Maintain regular times for meals and bed.
      • Seek morning sunlight exposure.
      • Schedule regular daily exercise.
      • Avoid alcohol, caffeine, and nicotine.
      • Provide nightlights and security objects.
      • Discourage watching television during periods of wakefulness.

      Behaviors that worsen in late afternoon into the evening, including increased confusion, anxiety, agitation, pacing, and disorientation.  Factors that may aggravate late-day confusion:

      • Fatigue (mental or physical)
      • Low lighting/increased shadows
      • Disruption of the body’s “internal clock”
      • Difficulty separating reality from dreams
      • Presence of an infection such as UTI


      • Try to keep a predictable daily routine.
      • Encourage activities during daylight.
      • Make early evening a quiet time of day.  Play soothing music, read, or go for a walk.
      • Limit daytime napping and caffeine.
      • Have a family member or friend call during this time.
      • Close curtains or blinds at dusk to minimize shadows, which can cause confusion. Turn on lights.
      • Distract with a favorite snack, object, or activity.


      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.