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The Key to Understanding the Challenging Behaviors of Dementia

Written by Sherry Christiansen
 about the author
4 minute readLast updated April 10, 2023

Caregivers to parents and senior loved ones with dementia already know that it can be difficult to care for a loved one as the disease progresses. Dementia can make a person exhibit challenging behaviors and psychological symptoms that are upsetting for everyone involved. Although we can’t prevent these behaviors or changes, there are ways to better understand and deal with them. Read our tips for handling the challenging behaviors associated with dementia.

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Challenging Behaviors Associated With Dementia

Some of the most common challenging behaviors and personality changes that dementia brings include:
  • Anger
  • Apathy or disinterest
  • Changes in personality
  • Communication problems
  • Following another person around the house all day (sometimes called shadowing)
  • Mood swings
  • Nighttime waking
  • Pacing or wandering
  • Violent behavior
  • Restlessness
  • Verbal Abuse

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Handling and Understanding Challenging Dementia Behaviors

Fortunately, the following tips have been proven to help caregivers handle challenging behaviors associated with dementia.

Tips for Dementia Caregivers

  1. Ask for help from others. Getting input from experts and fellow caregivers can help you find a new solution, take a new course of action, or better understand the underlying cause of challenging behaviors.
  2. Attempt to accommodate the behavior if possible. Trying to control a difficult behavior often backfires.
  3. Be aware that the underlying cause of some symptoms can be a physical problem. Always report behavioral symptoms to a health care provider.
  4.  Be prepared to be flexible. What works today may not work tomorrow.
  5. Change your perspective. The best way to do something different is to first attempt to see it differently. Changing how you see and react to a situation will oftentimes enable the person with dementia to exhibit different behavior.
  6. Develop coping strategies in advance. There are good days and bad days in dementia care. It’s best to be prepared.
  7. Disrupt patterns that may contribute to negative behavior. For example, try a different way of asking a person with dementia to do something.
  8. Employ compassion, flexibility and patience.
  9. Keep in mind that although you cannot change your loved one’s behavior, you can always change your own.
  10. Remember that behaviors are motivated by something. Although it may not seem like it, a person with dementia is usually making a statement, even when performing repetitive actions. They may be acting out of a sense of needing to do something meaningful or productive.
  11. Try to anticipate the person with dementia’s underlying needs. This will allow caregivers to redirect many negative behaviors. For example, a person who is bored can be redirected to help with simple household chores (with supervision, of course).

How to Handle Agitation and Anxiety

There are several potential sources of agitation and anxiety in people with dementia, including confusion, fatigue, and overstimulation.
Tips for handling agitation include:
  • Addressing any chaos in the environment by reducing noise levels and the number of other people nearby
  • Avoiding moving household objects whenever possible (familiar objects located in the same places can provide a sense of security)
  • Changing the immediate environment when the person with dementia becomes agitated
  • Playing soothing music
  • Safety-proofing the environment to allow for as much autonomy as possible

How to Handle Communication Problems

Many people with dementia have communication problems, including forgetting words, using repetitive phrases, and more.
Tips for handling communication problems include:
  • Giving reassurance
  • Limiting outside distractions when attempting to communicate (turn off the radio and television)
  • Listening for the meaning of the feelings behind their words
  • Speaking clearly and loud enough to be heard
  • Using non-verbal means of communication (such as body language, facial expressions, and touch)

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How to Handle Delusions, Hallucinations and Paranoia

Along with anxiety, delusions, hallucinations, and paranoia are common behavioral issues in people with dementia, which may occur as a result of changes in the physical health of the brain.
Tips for handling delusions, hallucinations, and paranoia include:
  • Avoid arguing or trying to impose a sense of truth or reality onto the person with dementia
  • Consult with a health care provider to find out if medication may be needed
  • Reassure the person by saying things like: I am sorry you are getting upset by this.
  • Redirect the person with dementia to divert their attention to something more appropriate

How to Handle Sleeplessness and Sundowning

Insomnia and sleeplessness, also known as sundowning, are common behaviors in people with dementia. It occurs due to a combination of factors and can be worsened by being exhausted after a day’s events.
Tips on how to handle sleeplessness and sundowning include:
  • Avoid giving your loved one alcohol, caffeine or sugar
  • Hiring help at night so you can get enough sleep without having to leave your loved one with dementia unattended
  • Discouraging long naps during the day
  • Talking to a health care provider about natural sleep-inducing medication, such as melatonin
  • Turning the lights on and closing the curtains well before sunset to eliminate confusion about the time, particularly in the winter months

How to Handle Wandering

It’s not always easy to find out why a person with dementia is wandering, but caregivers can use these insights to help them more effectively deal with the problem.
Tips on how to handle wandering include:
  • Adding “child-safe” plastic covers to doorknobs
  • Considering a GPS tracking device
  • Keeping a current photo on file, just in case the person with dementia goes missing
  • Installing door alarms and set them to go off if the door is opened
  • Installing locks that require a key (keeping safety issues in mind for all people in the home)


Meet the Author
Sherry Christiansen

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader.  Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site.  Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.