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Dementia is more than memory loss. It affects how a person thinks, feels, and behaves. As brain cells degenerate, the person’s ability to manage emotions and social judgment weakens. This often leads to changes in mood, personality, and daily conduct. Family members may find these behaviours confusing or distressing, but they are part of the disease process.
Statistics and trends
Globally, more than 55 million people live with dementia, with 10 million new cases diagnosed yearly (World Health Organization, 2023). In Singapore, about 1 in 10 seniors aged 60 and above have dementia, and this number is expected to triple by 2050 as the population ages. Behavioural and psychological symptoms affect up to 90% of those with dementia at some stage of the illness. These symptoms are a leading cause of caregiver burnout and institutionalisation.
Types of behavioural changes with dementia
Common behavioural changes include:
Agitation and aggression
May occur from frustration, pain, or unmet needs.Apathy
Loss of interest or motivation in daily activities.Wandering
Moving aimlessly, sometimes due to confusion or restlessness.
- Sundowning
Increased irritability or confusion during late afternoon or evening. - Disinhibition
Socially inappropriate remarks or actions due to reduced impulse control. - Repetitive behaviour
Repeating questions or actions due to memory loss. - Hallucinations and delusions
Seeing or believing things that are not real, common in later stages.
Implications of behavioural changes
When behavioural changes are ignored or left unmanaged, the consequences can be serious for both the person with dementia and their caregivers.
Health deterioration
Agitation and wandering can lead to accidents, falls, or injuries. Refusal to eat or take medication can cause dehydration, malnutrition, or infection.Rapid cognitive decline
Persistent stress and poor emotional control worsen brain function. Studies show that unmanaged behavioural symptoms accelerate dementia progression.Caregiver burnout
Constant aggression, shouting, or sleepless nights often cause severe emotional fatigue among family members. Burnt-out caregivers are more likely to resort to restraints or institutionalisation.Institutional impact
In nursing homes, untreated behaviours can disrupt other residents, lower staff morale, and increase medication use or hospital transfers.Social isolation
Families may withdraw from social gatherings due to embarrassment or exhaustion, causing both the patient and caregiver to lose social support.
Clinical and non-clinical treatments
Treatment involves a person-centered approach combining medical and psychosocial care.
Clinical management:
Antipsychotics for severe agitation or psychosis.
Antidepressants for mood symptoms.
Cholinesterase inhibitors to slow cognitive decline.
Non-clinical interventions:
Consistent routines and familiar environments to limit confusion.
Validation therapy and gentle redirection to reduce distress.
Caregiver education on communication techniques and triggers.
Side effects of medications
Clinical management requires careful monitoring due to potential risks, especially in frail elderly patients.
Antipsychotics
Used to control aggression, hallucinations, or delusions. Side effects include drowsiness, increased fall risk, stroke, and higher mortality in older adults with dementia.Antidepressants
May cause low sodium levels, dizziness, and gastrointestinal issues.Sedatives
Short-term use may calm agitation but can lead to dependence, confusion, or worsening cognition.Cholinesterase inhibitors
Used to slow decline but may cause nausea, vomiting, or bradycardia.
Due to these risks, non-drug interventions are always preferred first. Medications are prescribed only when behaviours threaten safety or cause extreme distress. Regular review is essential to ensure benefits outweigh side effects.
How to understand and accept these behaviours
A person with dementia behaves differently because the brain is losing its ability to process information and control emotions. Understanding this helps caregivers respond with compassion instead of frustration.
Do not take behaviours personally
Aggression, accusations, or withdrawal are symptoms of disease, not intent.Stay calm and validate feelings
Acknowledge the emotion behind the behaviour instead of correcting facts. For example, say “You seem upset, I’m here to help,” instead of arguing about what is true.Modify the environment
Reduce noise, avoid clutter, and maintain familiar settings to prevent agitation.Preserve dignity
Always address the person respectfully, maintain eye contact, and offer choices when possible.Seek support
Caregiver support groups or respite services reduce stress and improve coping.
Conclusion
Behavioural changes in dementia signal a decline in brain function, not a loss of character. They represent how the disease reshapes thought, emotion, and response. Resistance often leads to frustration, while acceptance allows understanding and empathy to guide care. Society must view these behaviours through a compassionate lens. Acceptance does not mean giving up; it means adapting care and expectations to the person’s reality. When caregivers embrace these changes with patience and respect, the person with dementia experiences greater comfort, dignity, and peace in their remaining years.