Understanding Why Behaviours Change with Dementia

The Person Behind the Behaviour

When dementia affects someone’s brain, it dramatically changes how they experience and interact with the world. What might appear as difficult or challenging behaviour is usually their way of trying to communicate something important – perhaps that they’re frightened, uncomfortable, frustrated, or simply can’t understand what’s happening around them.

The person you knew is still there. Their core personality, feelings, and need for love and respect haven’t disappeared. What’s changed is their ability to process information and express themselves in familiar ways.

The behaviours that families find most challenging include:

• Agitation and aggression
• Wandering and restlessness
• Repetitive questions or actions
• Resistance to personal care
• Sleep disturbances

Common Triggers That Lead to Difficult Moments

Understanding what triggers challenging behaviours is like being a detective. Once you identify the cause, you can often prevent the behaviour or reduce its intensity significantly.

Physical discomfort is one of the most overlooked triggers. The person might be in pain but unable to express this clearly. They could be too hot, cold, hungry, thirsty, or need the toilet.

Environmental factors play a huge role too. Loud noises, bright lights, crowded spaces, or unfamiliar surroundings can be overwhelming for someone with dementia. Changes in routine can be particularly unsettling – people with dementia often find comfort in predictability.

Practical Strategies That Really Work

Creating the Right Environment

Your surroundings can either support calm behaviour or contribute to agitation. Think of your home environment as a tool that can help reduce challenging behaviours before they start.

Lighting makes an enormous difference. Harsh fluorescent lights can be agitating, whilst dim lighting can increase confusion. Natural light during the day helps maintain normal sleep patterns.

Key environmental improvements:

• Use natural light during the day where possible
• Remove trip hazards and ensure good lighting on stairs
• Keep spaces calm and organised, reducing clutter
• Use familiar photographs and personal belongings for comfort
• Consider the volume of televisions and radios

Visual cues can provide reassurance and reduce confusion. Clear signs on doors (perhaps with pictures as well as words), a large clock and calendar, and familiar objects can help someone feel more oriented and secure.

Communication That Connects

How you communicate can either escalate a difficult situation or help defuse it. The goal isn’t just to get your message across, but to help the person feel heard, understood, and respected.

Keep your language simple and clear. Long, complex sentences can be confusing. Your tone of voice and body language often matter more than your actual words. A calm, warm voice can be soothing even if the person doesn’t fully understand what you’re saying.

Effective communication techniques:

• Approach from the front where they can see you
• Get on their eye level rather than towering over them
• Use simple, short sentences with one instruction at a time
• Allow plenty of time for responses
• Don’t argue or correct them when they’re upset

When someone becomes agitated, resist the urge to argue or correct them. If they insist their long-deceased mother is coming for tea, rather than explaining that this isn’t possible, you might ask what they’d like to prepare for her visit. This validates their feelings without reinforcing confusion.

Responding to Specific Challenging Behaviours

When Someone Becomes Agitated or Aggressive

Aggression is often a sign that someone feels threatened, cornered, or overwhelmed. Your first priority is keeping everyone safe, but try to do this without escalating the situation.

Stay calm yourself – easier said than done, but your emotional state will affect theirs. Take a deep breath, lower your voice, and try to project a sense of peace and control.

Steps to manage agitation:

• Look for what might have triggered the behaviour
• Check if they’re in pain or need the toilet
• Reduce noise or chaos in the environment
• Try distraction with favourite activities or music
• Give them space if they need it

Sometimes simply addressing the underlying cause can quickly resolve the situation. Distraction and redirection often work better than confrontation.

Managing Repetitive Questions and Actions

Repetitive behaviours can be exhausting for carers, but try to remember that from the person’s perspective, they’re asking each question for the first time. Their short-term memory problems mean they genuinely don’t remember asking before.

Rather than saying “You’ve already asked me that ten times,” try to respond with the same patience you showed the first time. Consider writing down the answer so you can show it to them instead of repeating yourself verbally.

Sometimes the question isn’t really about the information – it’s about seeking reassurance. “When is Mary coming?” might really mean “I’m feeling anxious and need to know someone cares about me.”

Dealing with Wandering and Restlessness

Wandering isn’t always problematic – sometimes people just need to move around. The key is making sure they can do so safely whilst addressing any underlying needs driving the behaviour.

Create safe spaces for walking, both indoors and outdoors if possible. Clear pathways of obstacles, ensure good lighting, and consider whether they might enjoy a secure garden area where they can walk freely.

Managing wandering safely:

• Provide regular exercise and meaningful activities
• Use ID bracelets with your contact details
• Consider door alarms for peace of mind
• Look for patterns – are they searching for something specific?

Handling Resistance to Personal Care

Personal care can become a battleground, but it doesn’t have to be. Resistance often comes from fear, embarrassment, loss of independence, or not understanding what’s happening.

Timing matters enormously. Some people are more cooperative in the morning, others in the evening. Pay attention to when the person seems most relaxed and receptive.

Making personal care easier:

• Time care when the person is most relaxed
• Play their favourite music or chat about memories
• Ensure the room is warm and comfortable
• Use their preferred products when possible
• Don’t force care if resistance is strong – try again later

Supporting Yourself as a Carer

Recognising the Impact on You

Dealing with challenging behaviours day after day can be emotionally and physically exhausting. It’s normal to feel frustrated, sad, angry, or overwhelmed sometimes. These feelings don’t make you a bad carer – they make you human.

The stress of caring for someone with dementia can affect your own health, relationships, and wellbeing. Social isolation is common among carers. Friends might not know what to say or how to help, and you might find it difficult to maintain relationships when your focus is constantly on caregiving.

Building Your Support Network

You don’t have to manage challenging behaviours alone. Building a support network isn’t just helpful – it’s essential for sustainable caring.

Professional support is available through your GP, local authority social services, and organisations like the Alzheimer’s Society. They can provide advice about specific behaviours, arrange respite care, and connect you with other services.

Key sources of support:

• Your GP for medical concerns and referrals
• Community mental health teams with dementia specialists
• Alzheimer’s Society support groups across the UK
• Family and friends – be specific about what help you need
• Online carer communities and forums

Family and friends often want to help but don’t know how. Be specific about what would be useful – perhaps someone could sit with your loved one while you go to the shops, or help with household tasks that have become overwhelming.

When Professional Help is Needed

Some situations require professional intervention. If behaviours are putting anyone’s safety at risk, if they’re significantly impacting quality of life, or if you’re feeling unable to cope, it’s time to reach out for additional support.

Your GP should be your first port of call for medical concerns. They can check for underlying health problems that might be contributing to challenging behaviours, review medications, and refer to specialist services if needed.

When to seek immediate help:

• Behaviours putting safety at risk
• Sudden changes in behaviour or health
• You’re feeling unable to cope
• Significant impact on quality of life for everyone

In crisis situations, don’t hesitate to contact emergency services or NHS 111. Many hospitals have psychiatric liaison teams who can provide advice and support during acute situations.

Moving Forward with Confidence

Accepting That Some Days Will Be Harder

Caring for someone with dementia isn’t a steady journey – it’s more like a series of ups and downs. Some days will be good, with moments of connection and relative calm. Others will be difficult, with behaviours that challenge your patience and leave you feeling drained.

This unpredictability is part of the condition, not a reflection of your caring skills. Even with the best strategies and support, challenging behaviours can still occur. What matters is how you respond and how you look after yourself through the difficult times.

Learn to celebrate the small victories. A peaceful morning, a moment of recognition, a successful personal care session – these might seem insignificant to others, but they’re precious when you’re dealing with challenging behaviours regularly.

Building Resilience for the Long Term

Remember that seeking help isn’t giving up – it’s being realistic about the challenges of dementia care. Whether it’s asking family to take over for an afternoon, accessing professional respite care, or eventually considering residential care, these decisions are about ensuring the best possible care whilst preserving your own wellbeing.

Your role as a carer, though challenging, makes an enormous difference to the person you’re supporting. Your patience, creativity, and love in managing challenging behaviours helps maintain their dignity and quality of life. This is valuable, important work, and you should feel proud of your commitment and care.

Every person with dementia is unique, and every caring relationship is different. Trust your instincts, be kind to yourself, and remember that doing your best is enough – even when your best looks different from day to day.