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Managing behavioral problems in people with dementia - focus on the caregiver


A person with dementia may experience changes in personality and behavior that can be very distressing for them and others. These changes can include agitation, anxiety, aggression, frustration, anger, suspicion and hallucinations.

Caring for someone with dementia can be a challenging and sometimes overwhelming task. It is easy to neglect your own physical, mental and emotional needs, but doing do may put your own health at risk.

If you need help

Information on caring for people with dementia can be found at the Alzheimer's Disease Educational & Referral Center of the National Institute on Aging:

Caregiver guides are available at:

Assessing behavioral problems

When assessing behavioral problems in people with dementia, think 'ABC':

  • Activators: what are the triggers for the behavior?
  • Behavior: what is the nature of the behavior?
  • Consequences: what impact does the behavior have on the patient and others?

Causes of behavioral problems

Sometimes behavioral problems can be caused by:

  • pain
  • depression
  • delirium
  • side effects of medications
  • infection
  • lack of sleep
  • drowsiness
  • constipation
  • worsened thought process.

A person's environment can also cause behavioral problems, e.g. poor lighting or heating, excessive noise, disruption to normal routines, and boredom.

Treatments

Unwanted drug effects are one of the most reversible conditions in the elderly. Simply stopping the offending drug or lowering the dose can produce a cure. This has led to the recommendation that "any new symptom in an older patient should be considered a possible drug side effect until proven otherwise."

If you think that a medicine might be causing an unwanted effect, don't stop it suddenly. Please contact your doctor to talk about it.

Even if you are not sure what has caused the behavioral problem, you should contact your doctor. Identifying and treating a medical condition or an unwanted side effect of medication can help fix the problem.

Non-drug approaches can be effective in a shorter time, and with less overall risk and cost than using drugs. For example:

  • Ensure that the person has a comfortable environment.
  • Spend some time preparing for any changes to routine and avoid rushing.
  • Make sure that the person has useful things to do and does not get bored.

Remember that dementia is generally progressive and not reversible. It is important to try the steps suggested in this brochure, but these will not always solve the problem or prevent recurrence in the future.

Medicines for behavioral problems in dementia

Sometimes medicines can help improve behavioral disturbances. However:

  • They are not always needed, and non-drug measures can often be effective.
  • They may cause unpleasant or dangerous side effects.
  • They are often unhelpful. Non-drug measures can be effective, with fewer side effects.
  • They need to be reviewed regularly.
  • They are often needed for a short time only.

If you think the medicine is not helping or is causing an unwanted side effect, talk to your doctor or other primary care practitioner.

More information

Brochures on behavioral problems in dementia can be found at: