Dementia can have a huge impact on the family member affected. While almost everyone knows that dementia can result in memory loss, there are other, more subtle changes that can come about as a result of diseases that cause dementia, such as Alzheimer’s disease and Parkinson’s disease.
These diseases cause damage to the brain, which in turn causes cognitive decline or dementia. This does usually come with memory loss, but it also changes the way people with dementia act, and how they see themselves.
A family member with dementia may lose their sense of self or who they are. They may become confused about where they are or what is going on around them, and most troublingly for family caregivers, their personality may change.
Behavior changes in family members with dementia can be extremely hard to deal with. Loved ones may not act in the same way as before, and often can become curt, rude, or even aggressive.
In this article we are going to explore the reasons why behavioral changes occur in people with dementia, as well as looking at what you can do to help, and some strategies for coping with this phenomenon.
Why family members with dementia experience behavioral changes
Dementia is a symptom of damage to brain cells caused by diseases such as Alzheimer’s and Parkinson’s. When brain cells in the frontal lobes of the brain (the area that controls personality) are damaged, significant changes in behavior can occur.
This might just manifest itself in a lack of focus or motivation, or a failure of concentration. But it can also be exhibited through rudeness, insensitivity, or aggression.
Behavioral changes in family members with dementia can also occur due to frustrations with other aspects of the disease. If your loved one can’t follow a conversation, remember who you or they are, or cope with loud noises or crowds, then they can act differently out of anger and frustration. Here we go into a little more detail about the causes of behavior change in people with dementia.
The most common reason behind behavioral change is damage and degeneration in the brain. As brain cells are damaged or lost due to the disease, your loved one’s personality and behavior will change, depending on where the damage has occurred. For example, damage to the parietal lobe might result in a loss of language ability, or a change in reaction to touch. Damage to the temporal lobe might cause a change in emotional control, alongside a decrease in learning ability.
Damage or loss in the frontal lobe restricts impulse control
Damage to the frontal lobe is probably the most common explanation for behavioral change, particularly when it manifests as rudeness or aggression. This is because the frontal lobe is the part of the brain that controls most aspects of someone’s personality, including ability to focus and concentrate, ability to think, and impulse control. Damage to or loss of brain cells in the frontal lobe can restrict a dementia sufferer’s ability to control their impulses and instincts, which in turn can result in rude behavior.
Alteration to response to the environment
Brain damage caused by dementia can mean that your loved one finds it more difficult to cope with stimuli from the world around them. Crowds, bright lights, and loud noises, for example, can often lead to confusion, desperation, and unhappiness. This alteration can mean that things that seem ordinary to you might provoke significantly different responses in your loved one.
Frustration at memory loss
Stepping away from the physical symptoms of brain damage, there are plenty of emotional responses that can cause changes in behavior in family members with dementia. The most common of these is frustration caused by memory loss. For a loved one with dementia, the simplest interactions can be incredibly frustrating. Not being able to remember small details, plans, dates, faces, or family members, or sometimes even key aspects of their own personality, can cause deep irritation, anger, and even despair. It is easy to understand why this might result in a significant personality change.
Similarly, dementia can often lead to confusion about all sorts of basic aspects of day-to-day life, or even just generalized incomprehension or uncertainty, which itself can have a significant impact on behavior and personality. Being confused can lead to frustration, or misunderstanding things that they see or hear. Ordinary verbal or physical cues might be missed, or they might just be less able to follow conversations. All of this can lead to troubling personality alterations.
As people with dementia become less able to think clearly for themselves, they often begin to mirror or mimic the behavior of others, taking their cues on how to behave, or react to certain circumstances or stimuli, from those around them. Family members with dementia can be surprisingly perceptive and sensitive to the emotions of others, and as a result your own emotional state, and your own behavior, may have a significant impact on them.
Medical issues, pain, or infection
In the shorter-term, behavior can also be affected by medical issues like pain or an infection. Loved ones with dementia are often less able to articulate how they feel, and can struggle to pinpoint or describe specific aches, pains, or discomforts. Instead, they may behave in a different way, becoming easily irritable or angry, or being unable to sleep, eat, or be active. Certain medications can also have this effect, again often because the person with dementia finds it hard to make the connection between the medication and how they are feeling.
A loss in cognitive abilities
Dementia can cause severe damage to a person’s cognitive abilities, which in turn can have a significant impact on their personality and general behavior. For some, making the link between cause and effect can become difficult, meaning that your loved one may stop being able to analyze the link between their actions and their consequences. Similarly, dementia can mean that sufferers find it hard, or are unable to follow a sequence of events, leading to confusion, frustration, annoyance, and anger. Finally, people with dementia are sometimes unable to understand which tasks are important, and struggle to prioritize. This can mean that their decision-making becomes erratic, and their behavior changes as a result.
What can you do to help family members going through behavioral changes?
As a family caregiver there is not a lot that you can do to prevent these changes in personality, or stop unusual or negative behavior from a loved one with dementia. However, as is almost always the case with dementia, there is plenty that you can do to help your family member cope with the changes better, and by making life easier for them you may in turn find that you can have a positive impact on their behavioral changes as well. Here are some of the steps you should take if you notice significant changes in your family member’s behavior or personality.
Evaluation by medical provider
The first step should always be to seek an evaluation with a medical provider. It is easy to assume that behavioral changes are due to dementia, but as mentioned above these changes are often a result of a pain, an infection, or even a response to medication. Your loved one’s doctor will be able to examine them and ascertain if they are suffering anything physical which might explain the alteration. If this is the case, it is often fixable, and once the source of the pain and frustration is removed, your loved one’s behavior will return to normal.
Medication, but in moderation
Medication can help ameliorate certain personality alterations, but it is not always wise to rush to medicate your family member. There are plenty of behaviors that come about as a result of dementia that cannot be cured (for example pacing or wandering), and the best thing to do in these cases is to work out how to ensure that they aren’t problematic, rather than trying to fix them. In fact, in some cases reducing medication may actually help, as the side effects of certain medications may actually be responsible themselves for changes in behavior.
When it comes to dementia, confrontation is almost always a waste of time, and can actually be extremely counter-productive. Understanding the behavior of your loved one, and working hard to appreciate what they are going through, is a far more helpful and positive reaction. Irritability, anger, even aggression can be forms of communication, and trying to understand what your family member might be trying to say rather than merely reacting to the behavior change can be enormously helpful.
Following on from this, educating yourself on why dementia causes anger is immensely important, and can be incredibly helpful. Taking the time to understand the causes of behavioral or personality change not only helps family caregivers know how best to respond, it also increases empathy, which can be an important part of the care process in itself. Additionally, developing this understanding will make coping with new behaviors easier for carers, as they will know that it is not personal. Ensuring that you can deal with a family member with dementia is a vitally important part of the caregiver role.
Identify what is causing the change
While there is rarely a way to fix or cure changes in personality, it is possible to avoid certain behaviors, if you know what you are looking for, and what to avoid. If you can identify what causes unusual behavior or acting out, whether it is a change in environment or some other trigger or pattern, you can take steps to avoid this, and hopefully help to prevent the stimulus that causes anxiety, confusion, or anger in your loved one.
When you notice signs of behavioral change in a loved one with dementia, it is important to take a step back and assess the behavior itself before deciding to take any action. In many cases, the change may be minimal, and any mitigating action you take may be more trouble than it is worth, or even have a negative impact. While coping with personality alterations may be difficult for carers, sometimes the best policy is to just leave them be. After all, annoying and frustrating behavior might be difficult to deal with, but it is a very different prospect to behavior that presents risks or could be hazardous.
Routine is enormously important in dementia care. People with dementia usually respond best to steady, set routines, and changes to the everyday order of things may be a part of why your loved one is acting differently. Ensuring that they continue to have a structured routine, and feel comfortable and certain about their environment and their day-to-day lives, can go a long way towards avoiding negative behaviors.
People with dementia are often extremely perceptive, empathetic, and sensitive to the moods and emotions of others, particularly other members of their family. Therefore one of the best ways to help them is to move towards acceptance of their condition, and understanding that personality changes are a result of real issues, not down to difficulty or aggressiveness on the part of the sufferer. Making them feel accepted and loved regardless of their behavior can help.
Be calm and patient
As mentioned above, confrontation is almost always a self-defeating tactic when it comes to caring for people with dementia. Being calm and patient, even in the face of difficult behavior, is far more likely to result in positive outcomes. Pointing out behavioral and personality shifts is most likely to result in defensiveness, whereas suggesting positive actions like exercise, self-care, respite care, and meditation will likely produce better outcomes, and potentially better behavior.
What can you do to cope with behavioral changes in a family member?
Dealing with behavior changes in family members with dementia is not just about helping them. It is also vital that caregivers find ways for themselves to cope with the difficulties of looking after a loved one with dementia. Here are a few tactics to help you deal with personality changes in family members with dementia.
Talk to a professional
Talking to someone with the expertise required to aid family caregivers in looking after aging parents is a great first step. Aging life care professionals (previously geriatric care managers) and senior care advisers can provide advice and guidance that will help you cope, as well as offering practical support where necessary.
Online or in person support groups
There are a wealth of resources both online and in-person that can provide support and comfort for family caregivers looking after loved ones with dementia. Online support forums such as AgingCare.com put you in touch with other people in a similar situation, to share experiences and tips, or just as a place to vent. The Alzheimer’s Association is also a fount of information and resources, including in-person support groups.
Read good books on the topic
There are plenty of good books written about the challenges of coping with family members with dementia, and several that focus on the specific issue of coping with behavioral change. Coping With Behavior Change: A Family Caregiver’s Guide is one of the best.
Mindfulness and exercise
Self-care is vital for family caregivers, and ensuring that you don’t neglect your mental and physical health is important. Remember to take regular exercise (even just a daily walk will help), continue to eat healthily, and try breathing exercises and mindfulness practices.
The DICE method
DICE is a tool for understanding and responding to behavior, and can be immensely helpful for caregivers looking after parents with dementia. The method follows a structured path where you (D)escribe the issue, (I)nvestigate the possible causes, (C)reate a plan, and (E)valuate the plan. This process can help make coping with the challenges of care easier, or at least more structured and routine.
Coping with behavior changes in family members with dementia can be challenging and upsetting, but there are a number of things that you can do and resources to take advantage of that can help. Additionally, it is important to remember that you don’t have to do everything by yourself! Senior Helpers can provide a huge range of services for family members with Alzheimer’s, Parkinson’s, and other forms of dementia, to help you care for and cope with loved ones suffering from dementia. By providing exceptional in-home care and offering a genuine connection, you can significantly reduce the burden of care that falls on you, and give them the absolute best quality of life for longer.
To find out more about what Senior Helpers can do, and what services we offer in your area, get in touch today!