Book: Later Stages Symptoms

Changes in behaviour can be one of the most difficult aspects of living with dementia, both for the person with the condition and those around them.

It’s important to see beyond the behaviour itself and think about what may be causing it. There may be specific reasons why the person with dementia is behaving differently, such as:

• difficulties relating to dementia (such as memory loss, language or orientation problems)

• Distress or agitation – this may be because the person is confused about where they are, who they are with or what they are meant to be doing. They may be in pain or feel threatened, they may not understand what is going on (for example, if a carer tries to change their clothes without explaining why) or because of frustration brought about by not being able to communicate a need.

• Sundowning – some people may become more agitated and confused in the late afternoon and early evening. There are a number of theories as to what can cause this predicable pattern;  it may be caused by a range of factors including disturbance to the body clock, too much or too little sleep, or medication. It may help to give the person something meaningful to do at this time of day and make sure the environment is suitable (more peaceful and less light). Going outside during the day (if possible) can help.

• Repetition – the person may repeat certain behaviours (for example, carrying out the same activity or making the same gesture over and over). This may be because they feel anxious or want comfort.
  

• Hallucinations and delusions – some people with dementia experience hallucinations, in which they see, hear, smell, taste or feel things that are not really there. Others may develop delusions, where they strongly believe things that aren’t based on reality but feel real to them (for example, they may be convinced that someone is stealing from them). Talking calmly to the person, offering reassurance and meaningful activity (such as going for a walk or doing something around the house) can help. If you think the person is experiencing hallucinations or delusions and its upsetting them you should speak to a GP.

• Restlessness – This could be for a range of reasons such as pain or discomfort, needing the toilet, a need for more physical activity or problems with their environment (for example if they are just sitting in the same place with no stimulation for much of the day).