Understanding Dementia and Challenging Behaviors: Types, Causes, and Behaviors
Dementia is a progressive disease that causes cognitive decline and can lead to challenging behaviors, such as depression, agitation, and wandering. However, it’s important to note that changes in the brain associated with dementia occur long before a person starts exhibiting symptoms. In fact, in the early stages, dementia without challenging behaviors is common. Read on to learn about the types of dementia with and without challenging behaviors and how they can impact seniors.

Dementia with Challenging Behaviors

Many types of dementia can cause mood and behavioral changes, with up to 90% of patients experiencing one or more dementia-related challenging behaviors, including verbal or physical aggression, incontinence, agitation, wandering and pacing, paranoia, hallucinations, and delusions, sexual disinhibition, sleep disturbances, changes in appetite, and hoarding. Mood changes are also common, including apathy, depression, anxiety, and fear.
These challenging behaviors are caused by cognitive decline due to the progressive deterioration of brain cells and a lack of stimulating activities or stressors like pain, sleep problems, and feelings of loss of control. Dementia patients often become increasingly sensitive to their surroundings, so specific environmental triggers, such as excessive noise or sudden changes in routine, can also play a part in behavior problems.

Dementia Without Challenging Behaviors

Dementia can occur without behavioral symptoms, particularly in the earlier stages. However, as dementia progresses and a person’s disease severity increases, changes in mood and behavior associated with progressive damage to brain cells become more likely. Unfortunately, less than 10% of patients experience dementia without challenging behaviors.

Unspecified Dementia with and without Challenging Behaviors

Several conditions may cause dementia, and sometimes confusion or mild cognitive impairment can’t be clearly diagnosed as a specific type of dementia. This is known as unspecified dementia. Unspecified dementia can occur with or without challenging behaviors. People with unspecified dementia with challenging behaviors may experience some of the same changes in mood and behavior as those with other types of dementia. In addition, people with unspecified dementia without challenging behaviors may have mild cognitive symptoms that may progress over time.

Challenging Behaviors by Dementia Type

Challenging behaviors may vary depending on the type of dementia a person has. For example, patients with Alzheimer’s disease may experience wandering and pacing, increased anxiety or agitation, depression, hiding things or believing others are hiding something, hallucinations, delusions, paranoia, unusual sexual behavior, hitting others, misunderstanding things they see or hear, and wearing the same clothes every day. Patients with vascular dementia may experience wandering, sleep disturbances, apathy, depression, agitation, and anger. Common challenging behaviors in patients with Lewy body dementia may include sleep disturbances, depression, apathy, anxiety or fear, agitation or restlessness, hallucinations, delusions, and paranoia. Finally, patients with front-temporal dementia may experience acting impulsively or inappropriately, apathy, and repeating the same activity or speech.

Managing Challenging Behaviors in Dementia Patients

Challenging behaviors in dementia patients can put a great deal of strain on family and caregiver relationships. While you may have a good handle on your loved one’s behavioral symptoms at first, taking breaks for your health and well-being is still necessary. Consider adding an in-home caregiver to your care team or enrolling your loved one in an adult daycare program. The extra support can help prevent caregiver burnout and allow you to maintain a healthy relationship with your loved one.
As dementia progresses, extreme behavioral symptoms can become difficult to cope with alone. Memory care training techniques and person-centered approaches may be necessary to handle more severe challenging behaviors. If you struggle to manage a loved one’s care at home, consider transitioning them to a memory care community, where around-the-clock staff is trained.