Symptoms of Dementia (And How Caregivers Can Manage Symptoms)

Caring for a loved one with dementia brings fresh challenges. They may start to feel like a different person than the one you grew up with due to the many symptoms associated with the different types of dementia, such as vascular dementia, frontotemporal dementia, dementia with Lewy bodies, mixed dementia, Huntington’s disease, Creutzfeldt-Jakob disease, and the most common type of dementia: Alzheimer’s disease.

These symptoms can make your role as a caregiver more difficult, but it’s important to remember that it’s not you, it’s the disease causing these behaviors.

In this blog, we’ll help you understand the symptoms of dementia and their associated behaviors, including:

• Cognitive Decline
• Depression
• Anxiety & Agitation
• Aggression & Anger
• Paranoia
• Dietary issues
• Repetition
• Sleep issues (sundowning)
• Hallucinations
• Wandering

As a caregiver, you may experience some or all of these, and they may worsen at different stages of the disease. What’s important to note is that by first understanding the symptom, you can begin to reduce or eliminate the triggering event and ease your loved one’s stress. And we want to help in whatever way we can. Contact St. Andrew’s with any questions, concerns, or to look into your options for Memory Care at one of our communities!

Note: This blog is meant to be a guide and not professional medical advice. There are many other medical conditions that can cause dementia-like symptoms, including some that are reversible, such as thyroid problems and vitamin deficiencies. It’s crucial to have your loved one evaluated by a healthcare professional or neurologist who is able to diagnose the risk of dementia, provide advice, and prescribe medication, as needed. With proper intervention and treatment, early symptoms can often be reduced or eliminated.

Forgetfulness may be a normal part of aging, but problems that arise with cognitive decline and confusion are the first warning signs of dementia and Alzheimer’s. In the early stages of mild cognitive impairment, your loved one may experience difficulty with problem-solving, recalling recent events, making complex decisions, and finding the right word.

In later stages, memory loss becomes far more severe. Your loved one may fail to recognize you, family members, or friends. He or she may forget names or become confused about once-familiar locations, such as room in their home or the passage of time.

The cause: Memory loss and confusion result from progressive damage to brain cells caused by Alzheimer’s disease, but sometimes a change in routine, new living arrangements, or some infections can worsen symptoms.

• Stay calm and show understanding.
• Provide brief, simple explanations; not long or complicated ones.
• Use photos and other items to facilitate memories of people and places.
• Try not to take anything personally and try not to show any hurt feelings if they are starting to lose memory of special details about you.

Experts suggest that 40-50% of people who have received a diagnosis of dementia experience mental health problems—particularly in the early and middle stages of the disease.

Depression can be difficult to diagnose because: (1) symptoms such as personality changes, apathy, loss of interest, mood swings, social withdrawal, isolation, trouble concentrating, and impaired thinking often overlap with Alzheimer’s disease and other forms of dementia and (2) your loved one’s cognitive decline often makes it difficult for him or her to fully express their sadness or other feelings.

The cause: The high incidence of depression in those with Alzheimer’s disease is due to changes in the brain and nervous system from the disease and sometimes the shock of an early diagnosis.

Treating depression in those with Alzheimer’s disease includes therapeutics, counseling, and a gradual return to activities that bring your loved one joy. Work with a physician to develop a plan that includes the following:

• Participating in support groups and/or counseling.
• Setting a predictable daily life routine.
• Increasing the frequency of enjoyable activities that contribute to their quality of life.
• Encouraging regular exercise.
• Validating your loved one’s feelings.
• Celebrating their successes.
• Finding ways for your loved one to contribute to family life.
• Assuring your loved one that he or she is loved, respected, and appreciated.
• Preparing your loved one’s favorite foods or engaging them in relaxing activities.
• Reassuring your loved one that you are there for them.

Your loved one may gradually lose their ability to understand new information and feel anxious or agitated as a result. He or she may become restless, feel a need to pace, or become upset in certain places.

The cause: Anxiety and agitation may be caused by a number of health conditions, side effects of medications, or situations that can affect your loved one’s ability to think clearly, including:

• Moving to a new residence or nursing home
• Environmental changes, such as travel, hospitalization, or the presence of houseguests
• Changes in caregiver arrangements
• Misperceived threats
• Fear and fatigue from trying to make sense of a confusing world

• Remove stressors in order to create a calm environment.
• Avoid environmental triggers, such as noise, glare, or background distractions.
• Ensure your loved one’s comfort by monitoring the thermostat and checking for any pain, hunger, thirst, fatigue, infection, and bladder/bowel issues.
• Simplify tasks and routines so they’re not overwhelming.
• Involve your loved one in activities to distract from any anxiety-producing triggers.
• Reassure your loved one that you are there and that they’re safe.
• Stay calm and do not raise your voice, show offense, or become combative.

Aggressive behaviors may be verbal or physical. They can occur suddenly, with no apparent reason, or result from a frustrating situation. While aggression can be hard to cope with, understanding that your loved one doesn’t intend to behave this way can help.

The cause: Aggression can be caused by many factors, including:

• Physical discomfort: Hunger, thirst, sleeplessness, side effects of medications, or pain associated with urinary tract or other infections can cause your loved one to act out in anger.
• Environmental factors: New environments, unfamiliar people, loud noises, large crowds, feeling lost, and other factors in the environment can overstimulate your loved one and cause them to be aggressive.

Overwhelming communication: Your loved one may be overcome by confusing instructions, too many questions or demands, or your tone of voice (i.e., annoyance, irritability, etc.).

• Identify the triggering event that caused the behavior and refrain from this activity in the future to avoid outbursts.
• Schedule appointments or activities when your loved one is most alert and able to better process information.
• Speak slowly and in a soft, reassuring tone.
• Limit distractions in the environment.
• Soothe your loved one with a relaxing activity, such as music or a movie.
• In severe cases, call 911 if your loved one is unable to calm down and poses a threat to you or themselves.

Your loved one may become suspicious of those around them and may accuse them of theft, infidelity, or other inappropriate behavior. Although not grounded in reality, the situation is very real to the person. Keep in mind that your loved one is trying to make sense of his or her world and that the disease is causing this behavior.

The cause: In mid-to-late-stage Alzheimer’s disease, increasing confusion and memory problems can contribute to your loved one’s delusions (false beliefs) and paranoia.

• Try not to take offense.
• Help others understand your loved one’s changing behaviors and that false accusations are caused by the disease, not them.
• Listen to them and their concerns.
• Reassure your loved one that you care.
• Offer brief and simple explanations.
• Engage your loved one in another activity to switch his or her focus.
• Get outside help if your loved one is having severe delusions and you fear they may be a harm to themselves or others.

Those with Alzheimer’s disease and other dementias may experience difficulty sleeping or increased confusion, anxiety, agitation, pacing, and disorientation beginning at dusk and continuing throughout the night. This is known as “sundowning.”

The cause: Although the exact underlying cause is unknown, it’s believed that these changes result from the disease’s impact on parts of the brain. Other risk factors that may contribute include:

• Mental and physical exhaustion from an unfamiliar environment.
• An upset in the “internal body clock” causes a mix-up between day and night.
• Reduced lighting can increase shadows, causing your loved one to misinterpret what they see.
• Disorientation due to the inability to separate dreams from reality.
• Less need for sleep, which is common among older adults.

• Keep track of what happens before sundowning episodes and try to identify triggers.
• Schedule appointments, trips, and bathing when your loved one is most alert.
• Set up regular times for waking up, eating meals, and going to bed.
• Encourage walks or spending time outside in the sunlight.
• Reduce stimulation (watching TV, doing chores, listening to loud music, etc.) during the evening hours.
• Keep the home well-lit in the evening.
• Find soothing activities that your loved one will enjoy, such as listening to calming music or watching a favorite movie.
• Talk to the doctor about the best times of day to give your loved one medication.
• Limit daytime naps if there are issues with sleeping at night.
• Have them reduce or avoid alcohol, caffeine, and nicotine intake, which can disturb sleep.
• Finally, if your loved one wakes up and is upset, approach in a calm manner, remind him or her of the time, and find out if they need anything.
• Reassure your loved one that everything is alright and, if needed, supervise him or her if they need to get up and walk around or do another activity, etc.

Regular, nutritious meals can become challenging for people in the middle and late stages of dementia. They may become overwhelmed with too many food choices, forget to eat, or believe that they’ve already eaten.

The cause: Possible causes of poor appetite include:

• No longer recognizing the foods on their plates.
• Inability to tell you about their poor-fitting dentures or other dental problems.
• New medications or changes in dosages for existing medications.
• Lack of physical activity or exercise.
• Decreased sense of smell and taste.

• Prepare your loved one’s favorite foods.
• Limit distractions by serving meals in quiet settings.
• Keep table settings simple.
• Use contrasting colors to help distinguish food from the plate or table (e.g., bright-colored food on a white plate).
• Check temperatures to ensure food and beverages are cool enough to eat.
• Offer one food at a time if your loved one has difficulty choosing.
• Allow plenty of time to eat.
• Eat with others as it may encourage your loved one to eat.
• Grind foods, cut them into bite-size pieces, or serve soft foods that aren’t hard to chew or swallow.
• Watch for signs of choking.
• Learn the Heimlich maneuver in case of emergency.

Because people with Alzheimer’s disease gradually lose the ability to communicate, they may do or say the same thing over and over. In most cases of repetition, your loved one is most likely seeking comfort, trying to express a concern, or asking for help. Therefore, it’s important to try to anticipate their needs as best you can.

The cause: Again, deteriorating brain and nerve cells cause a decline in cognitive function.

• Look for a reason behind the repetition (certain times, people, environment, etc.).
• Focus on how your loved one is feeling rather than on what he or she is doing.
• Stay calm and be patient—he or she likely doesn’t remember asking the same question.
• Answer your loved one, even if you have to repeat it several times.
• Reduce boredom by engaging your loved one in an activity.
• Use memory aids as reminders (notes, calendars, photographs, etc.).
• Accept your loved one’s behavior and find ways to work with it.

When a person with Alzheimer’s disease or other dementias hallucinates, he or she may see, hear, smell, taste, or feel something that isn’t there. Some visual hallucinations involve ordinary visions of people, situations, or objects from the past, while others may even be frightening.

NOTE: There are other causes of hallucinations so it’s important to see a doctor to rule out any other issues, such as schizophrenia, infections, pain, substance abuse, side effects of medication, etc.

The cause: Hallucinations are false perceptions of objects or events involving the senses, caused by changes within areas of the brain—often in later stages of the disease.

• Calmly assure your loved one that you’re there and that they’re O.K.
• Try to gently divert their attention by calmly suggesting a walk, moving to another room, starting a conversation, or turning on some music.
• Acknowledge your loved one’s feelings/fear and try to uncover what the hallucination means to him or her.
• Turn on lights to reduce shadows caused by dim lighting.
• Cover or remove mirrors.
• Eliminate any sounds that might be misinterpreted, such as noise from a television or an air conditioner.

It’s common for those living with dementia to become lost or confused about their location—and it can happen at any stage of the disease. Some 60% will wander at least once, while many do so repeatedly. Wandering can be dangerous and even life-threatening, which puts added stress on caregivers and families.

Everyone with Alzheimer’s disease and other dementias is at risk for wandering, but there are early signs to watch for. Take extra care if the older adult:

• Returns from a regular walk or drive later than usual.
• Forgets how to get to familiar places.
• Tries to “go home” even when at home.
• Becomes restless, paces, or makes repetitive movements.
• Has difficulty finding places in the home, such as the bathroom or bedroom.
• Asks the whereabouts of past friends and family.
• Appears lost in a new or changed environment.
• Becomes nervous or anxious in crowded areas, such as stores or restaurants.

The cause: Alzheimer’s disease and other dementias cause people to lose their ability to recognize familiar places and people.

• Set a time each day to check in with each other.
• Review your loved one’s scheduled activities and appointments for the day together.
• Find a companion to sit with your loved one if you’re not available.
• Consider alternative transportation options if driving safely or getting lost becomes a concern.
• Remove access to car keys if your loved one is no longer able to drive.
• Identify the time of day your loved one is most likely to wander and plan activities during this time.
• Ensure basic needs are met, including toileting, nutrition, and hydration.
• Reduce (don’t eliminate) liquids up to two hours before bedtime so your loved one won’t have to find and use the bathroom during the night.
• Avoid places that can cause confusion or disorientation, such as shopping malls or large grocery stores.
• Supervise your loved one if new surroundings cause confusion, disorientation, or agitation.
• Ask friends, family, and neighbors to alert you if they see your loved one wandering, lost, or dressed inappropriately.
• Create a list of places your loved one might wander to (past workplaces, favorite restaurants, places of worship, previous homes, etc.).

Finally, as the disease progresses and/or the risk for wandering increases, assess your loved one’s living environment and take steps to eliminate situations that may present a danger or safety hazard. (See Resources for the Alzheimer’s Association Home Safety Checklist)

St. Andrew's transitional and secure memory care helps older adults experiencing Alzheimer's disease, forms of dementia, and other types of memory loss and cognitive impairment feel fulfilled. Families can rest assured knowing our knowledgeable caregivers help residents feel at ease, understood, and valued throughout the day and night.

Contact us to learn more or schedule a tour.