Expert advice on understanding changes in behaviour

Dementia can change the way someone feels and behaves, leading to them saying or doing things that are very out of character.

These changes in behaviour can be distressing for the person experiencing them as well as for their families and carers.

We spoke to Dementia Australia Honorary Medical Advisor Professor Henry Brodaty AO to understand why people living with dementia can sometimes experience changes in behaviours and what to do to manage these changes.

What drives changes in behaviour?

Professor Brodaty said there are many types of behavioural changes a person living with dementia may exhibit.

They include agitation, aggression, anxiety, calling out, delusions or hallucinations, depression, irritability and wandering, and there are a variety of reasons for these changes.

“There is usually a reason for a person’s behaviour to change so it’s important to try to work out what the person is trying to communicate,” Professor Brodaty said.

He said causes for most behavioural changes fall into four categories:

• Biological: Are there things happening inside the brain or body driving this behaviour? For example, is the person experiencing pain that they are unable to communicate about? Do they have a urinary tract infection?
• Psychological: Are there behavioural triggers? For example, are they bored? Is their familiar family member no longer visiting?
• Interpersonal: Is the person living with dementia unable to comprehend or make their needs known to others? Are there strained relationships with another person?
• Environmental: Is there too much or too little stimulation? For example, lights in a room may be too bright or the space unfamiliar. Are other people intruding or calling out?

How can I prevent changes in behaviour?

Professor Brodaty said recording how often the behaviour occurs, and what happens before, during and after can help to understand what might be causing it and how it can be prevented.

“We don't treat blood pressure without readings and we can’t treat behaviours without measuring their frequency and severity,” Professor Brodaty said.

“When it comes to helping to prevent or lessen changes in behaviour in a person living with dementia the message is simple – don't blame the person, try to understand the person.”

What can I do when my loved one has a changed behaviour?

National Dementia Helpline Advisor Jennifer said that carers often felt overwhelmed when managing behavioural changes.

Jennifer shared that empathy & validation are important strategies to use when supporting a person living with dementia.

“If you can, move to a quiet or safe space to take some time to calm down together – especially if you’re out in the community or in unfamiliar space,” she said.

“It can also be helpful to create a list of things to try to minimise triggers that can lead to changes in behaviour, as well as positive ways to respond to changes in behaviour.”

Jennifer said that triggers for changes in behaviour may change over time. 

“If the strategies you use become ineffective, try something else,” she said. “It is worth persevering. 

“What does not work today may work tomorrow.” 

Where can I go for help?

If changes in the mood or behaviour of someone close to you or someone you care for who lives with dementia are causing them or you distress, there is help available:

• Contact the free, confidential National Dementia Helpline on 1800 100 500 or via webchat, available 24/7 for information, advice and support.
• Learn more about changes in behaviour on our website, or view Professor Brodaty’s webinar on changed behaviour.
• Call the Dementia Behaviour Management Advisory Service on 1800 699 799.