Dementia and Behavior Problems – Why Do Difficult Behaviors Occur?

We know that an illness like dementia brings with it changes in normal or routine functioning. The deficits that occur in brain function with the onset of various dementias, such as Alzheimer’s disease, vascular dementia, fronto-temporal dementia, or dementia with lewy bodies also increase the possibility of abnormal behaviors. These abnormal behaviors only add to the challenges faced by caregivers, since the verbal or physical outbursts, the inappropriate sexual behaviors, the apathy and withdrawal, the resistance to care, among others, are not intentional or purposeful. Rather, they are the result of behavior controls that weaken and eventually break down with the atrophy of the brain tissue. And with these defective controls, the person with dementia is more vulnerable to minor upsets or frustrations than the average person can tolerate.

In essence, the dementia patient is more sensitive to internal and external stimuli. These stimuli can also be thought of as triggers or causes of the problem behaviors, and can be grouped into four categories:

i. Physical causes include sensory losses (e.g., vision, hearing), acute and chronic illnesses, dehydration, constipation, pain, adverse effects from medications, and anxiety and depression;

ii. Environmental causes include too much or too little stimulation, too little structure, unfamiliar routines, and caregivers who are unfamiliar;

iii. Task-related causes include activities that are too complicated or have too many steps, or rely on previously learned information;

iv. Communication causes include inability to communicate one’s needs, word-finding difficulty, inability to comprehend spoken language.

Many of these causes are outside the control of caregivers but many can be managed or modified. The more caregivers can address potential causes and eliminate or minimize them, the fewer chances there are to tax the person with dementia beyond his capacity. And of course, reducing these potential causes of behavior difficulties can also mean reducing the number and dosages of psychotropic medications needed to control the behaviors. Reducing the need for chemical restraints is always desirable.

See the entire range of educational programs on the CoHealth website, for health care professionals, health care workers, and family caregivers. Two especially useful programs are the courses on differentiating among depression, dementia, and delirium and behavioral approaches for sensory losses in older adults.