Hebrew SeniorLife created the word ReAge to reflect the breadth and depth of services we offer: providing world-class health care; building innovative senior communities; funding groundbreaking research; and teaching future generations of geriatricians.

ReAge, a combination of “redefine” and “aging,” means to question everything about the aging process. Through ReAging, we are challenging conventions in order to create and implement new standard-of-care approaches that will positively impact the lives of older adults.

View ReAge Videos

Understanding Behavioral Changes Caused by Dementia

Eran Metzger, M.D.'s picture
Understanding Behavioral Changes Caused by Dementia
Understanding Behavioral Changes Caused by Dementia

Behavioral changes can be one of the most difficult aspects of caring for someone with dementia. Up to 90% of people with dementia exhibit some form of upsetting behavior over the course of their illness. Examples of these dementia behaviors, known collectively as Behavioral and Psychological Symptoms of Dementia (BPSD), include:

  • Disinhibition, or poor impulse control. The person with dementia may be rude or tactless, act out sexually or remove his clothing at an inappropriate time or place.
  • Mood swings, which tend to happen later in someone who has Alzheimer’s disease than other types of dementia. These moods can include anger, which is also a symptom of depression (particularly in older men, who are less likely to be sad and tearful than women who are depressed).
  • Apathy, or loss of motivation or interest. The person with dementia may seem content to spend the day staring at the TV or into space. Apathy is also a symptom of depression — the main difference is that dementia-related apathy has no other depression symptoms.

Typically, one or more of these behaviors will appear after other signs of dementia, like memory problems. One exception is a type of dementia called behavioral variant frontotemporal dementia, in which behavior changes are usually the first noticeable symptom.

Medical assessment is important with any behavior changes. There are other possible causes in addition to dementia, including:

  • Medication side effects
  • Thyroid disease
  • Dehydration
  • Infection
  • Brain tumor

How do you deal with upsetting behavior? If dementia is the cause, look for triggers and try to change them. For example, if being left alone seems to be a trigger, consider having someone keep your loved one company, or sign her up for social activities or adult day care.

If behavioral changes put your loved one’s health or safety at risk, there are practical ways to help protect him. For example, if he tries to wander, you can install an alarm on the door (most home security systems offer a chime). There are also a number of tracking devices available.

Caring for someone with dementia can leave you prone to emotional or physical illness. Sometimes caregivers don’t realize that they’re over the limit until they're hospitalized for a problem. A caregiver support group, either online or in person, can be an extremely helpful way to deal with the stress.

At some point, you may have to think about moving your loved one into an assisted living or long-term care facility. There’s no right answer about when to do that – it’s a very individual choice, and it’s not an easy one. Feeling guilty is completely normal, but it’s important to remind yourself that if you get ill, you won’t be able to help your loved one.



Director of Psychiatry

Eran D. Metzger, M.D., is director of psychiatry at Hebrew Rehabilitation Center. Board certified in psychiatry, neurology and forensic psychiatry, Dr. Metzger's clinical interests focus on the interfaces between medical illness and emotional disorders, as well as medical ethics. He is a graduate of the Pennsylvania State University College of Medicine and completed his internship at Brockton Hospital and his residency and fellowship at Beth Israel Deaconess Medical Center. An assistant professor of psychiatry at Harvard Medical School, Dr. Metzger's research interests include...

More about this blogger

Follow us:


Comments (17)

my husband never smiles at us

my husband never smiles at us but to others he is happy..forgets he gives things to boys n gets mad....Thinks i am the one who is ill...i feel lonely....he is 72 n i am 53..help i think he has alzeimers or something.. How could we be married 20 years two kids 9 n 11 and he shows no emotion to me.....but to others he does..hurt feeling..ps- when if even once a year we go state fair i see him smile n talk to strangers n wish he was that way with me..if i talk he ends up hurting my feelings n says he wished i wouldn't tlak to him..help....

Rita-there is 20 years

Rita-there is 20 years between my husband and I. He will be 80 soon and I am 60, 2-1/2 years ago his MRI had shown that we would see signs of dementia. Needless to say it is challenging. I sometimes question myself, is it all in my head? He talks to everyone, which he did before, but he forgets, shuffles, always has his tongue out to the corners of his mouth. He gives other attention but I am treated like the maid. It is hard for me to remember this is not the man I married.

I'm a cna caring for a

I'm a cna caring for a dementia client, she is sometimes nice to me but for the most part she dont want my assistant. she called me name. How can I make this client calm and less combative toward me. I love what I do, but it's get so overwhelming at time. She dont want me to help her and at the same time I have to protect her. Help me make this situation.

My dad has been diagnosed

My dad has been diagnosed with unspecified dementia and delusional disorder. He tells stories and creates problems within the family. His siblings don't make things easy for us for believing his stories. His anger burst are getting worse. Sometimes I don't want to answer my phone because all he wants to do is yell or is very negitive. How do I deal with this? It seems to me that he keeps the arguing going within the family.

My husband is showing signs

My husband is showing signs of dementia. He also has CIDP and a type one diabetic for 57 yrs. He also has to cath in order to urinate. I have been his caregiver for 3 and a half yrs. now. I never get a break and need some kind of help. We have Medicare and Atena Ins. We live on Long Island. Is there anyway I can get some help. He is 73 and I am 75. He sometimes lets me help him but most of the time no. Protecting him against himself is the difficult part. I do not know where to turn.

I care for my mother with

I care for my mother with dementia and type II diabetes, Lately she's been hateful when I try to help her with her shots and testing. I try to fix things she likes but the more I do the angrier she gets.

MY wife was diagnosed with

MY wife was diagnosed with dementia eight years ago at the Mayo clinic. I have had her to approximately ten for medical and mental help, with tinnitus being a major factor. its along story that I have a diary on that tells me I wont be able to keep her after 65 years of marriage

My 84-year-old mother fell

My 84-year-old mother fell and hit her head about 4 months ago; she now has dementia due to her fall. I don't know what to say to her when she wants to do things which do not make sense. For example, she wants to cut down every tree on the property (not a good idea!) and wants to know where her checkbook is (I have it because I am paying her bills for her) so she can write a check to a tree guy. Reasoning her does not work. What do I say to her? Any suggestions are appreciated.

Did you like this post? Tell us your story!