Scientific Explanations
Changing Lives Together: Dementia and Personality
There are moments in all our lives; a look, a word, or a habit that makes our loved ones uniquely “them.” A cup of tea our mothers silently make, our fathers’ jokes we’re used to, our partners’ smiles... But when dementia enters the picture, it’s often these familiar cornerstones that slowly change or fade away. And this kind of transformation deeply shakes not just the patient but everyone who walks alongside them—family, friends, caregivers.
What is Dementia? The Brain’s Journey and Its Process of Change
Dementia refers to a group of diseases caused by the progressive deterioration of brain cells, manifesting with symptoms from memory loss to impaired judgment, behavioral, and personality changes. Alzheimer’s is the most common type, but there are others such as Lewy body dementia, vascular dementia, and frontotemporal dementia. According to the World Alzheimer Report 2023, there are more than 55 million people living with dementia globally. (World Alzheimer Report 2023)
This number is expected to double by 2050. The effects are profound not only for patients but also for their families and caregivers; one of the most complex and challenging aspects of dementia is the changes in personality and behavior.
What is a Personality Change?
Personality encompasses our emotions, thought patterns, and ways of relating to the world—the set of traits distinguishing us from others. Personality traits are partly innate, partly shaped by the environment, and remain mostly stable over a lifetime. However, in progressive and neurodegenerative diseases like dementia, marked changes in personality can occur. For relatives, this often triggers a sense of ambiguous loss: the person they knew seems to “change” and become someone else.
Why and How Does Personality Change in Dementia Patients?
Changes in personality begin with the damage and deterioration in the brain caused directly by the disease. For example:
Damage to the frontal lobes (which control behavior, impulses, and decision-making) can lead to increased spontaneity, impatience, or inappropriate behaviors.
Damage to the temporal lobes weakens emotional processing, language, and the recognition of social cues.
The nature of the change depends on which brain regions are most affected. For example, in Alzheimer’s, the first impact is usually on the hippocampus and surrounding areas—responsible for processing memories—so memory loss comes first. As the disease progresses, behavioral and personality changes become more prominent.
How Do Personality Changes Manifest?
The most frequent signs of personality change include:
Withdrawal or social isolation: Previously sociable people may become more withdrawn, avoiding activities.
Excessive suspicion or paranoia: They may believe that calls are from enemies, accuse others of stealing, or think the caregiver is intentionally causing harm.
Lack of emotion or inappropriate emotionality: Formerly affectionate people may become indifferent or unexpectedly angry, or sometimes laugh inappropriately.
Changes in sexual behavior and social norms: Especially seen in frontotemporal dementia; they may tell inappropriate jokes or behave out of context.
Anxiety and agitation: Excessive anxiety and restlessness can result from even small changes in routine, with strong responses to minor issues.
Passivity or loss of motivation (apathy): Someone previously active may lose all interest, including in hobbies, appetite, or personal hygiene.
The Reflection of Brain Changes on Personality
Scientists associate personality changes with microscopic pathological processes in the brain (for example, amyloid plaques and tau protein accumulation). These biological disturbances disrupt communication between neurons and cause fluctuations in fundamental behavior and characteristics.
The cause-and-effect relationship can be summarized as follows:
Cell death and loss of connections → Specific brain area loses function → That area’s control over mood, empathy, or social norms declines.
Some types of dementia cause personality changes earlier or more intensely. In frontotemporal dementia (FTD), changes in personality and behavior, sometimes even before memory loss, are most noticeable.
Who Is Affected and To What Extent?
More than 80% of dementia patients experience “behavioral and psychological symptoms” (BPSD) at some stage of the disease (Source). Personality changes are among the most frequently reported complaints. The progression rate, type of dementia, and the person’s baseline personality help shape this process:
For instance, apathetic attitudes may be more pronounced in generally introverted individuals, while extroverted or leader-type individuals may show more aggression or improper behaviors.
Close relatives (spouse, children, siblings) usually notice these changes earlier and more painfully.
A Challenging Journey for Family and Friends
Observed personality changes undermine the basis of care, communication, and emotional bonds. Caregivers often feel as if they are “losing” the person they once knew. According to medical sources, over 60% of those close to people with dementia report emotional difficulties and a sense of loss during this time (Source).
As a caregiver, you may often experience feelings such as:
“It doesn’t feel like them anymore... Don’t they understand me?”
“We never saw them like this before... How did they change?”
“They say and do things they never would have before. Am I doing something wrong?”
Remember: These changes are part of the disease and outside the patient’s control. No caregiver is responsible for these changes. The person you love is still there at their core—they only seem more subdued as dementia casts its shadow over that core.
Scientific Research and Statistics
A comprehensive meta-analysis conducted in 2015 identified specific deviations in the personalities of dementia patients:
Increase in emotional instability (35–55%)
Decrease in conscientiousness and reliability (over 50%)
Decline in sociability (around 54%)
Decrease in openness
Source shows that these rates are valid across nearly all types of dementia. For some patients, personality change may be the very first sign of illness.
Accompanying Your Loved One in Their Changing World
Many relatives describe these changes by saying things like, “They’re angry at me now,” “They’ve become impatient,” or “They blame me.” It’s normal to grieve, feel anger, or guilt. But remember: The person you love is still there; their world is simply shaken by the disease they are experiencing.
Personality changes often make communication more difficult, but they can be met with love and patience. A gentle touch, shared memories, your reassuring presence... These are still ways of saying to your loved one, “I’m here.”
So, Why Do We Face These Changes?
There are essentially three main reasons:
Deterioration of brain function: Damage to the neural circuits regulating emotions and controlling impulses.
Biochemical changes: Neurotransmitter imbalances, especially in acetylcholine and dopamine systems, leading to mood fluctuations or loss of empathy.
Environmental and psychosocial factors: Loss of independence, lack of social activity, and communication difficulties can also accelerate personality changes.
Key Points in Diagnosis and Follow-Up
Some personality changes can resemble other psychiatric illnesses (such as severe depression or chronic schizophrenia). Therefore, it’s important to consider whether the changes are persistent or temporary, and how different they are from the person’s baseline temperament. Physical illnesses, medication side effects, or sudden environmental changes can also cause temporary fluctuations in personality.
Practical Tips for Caregivers: Stronger Than You Think
Stay Calm: It’s natural to feel hurt or angry in response to personality changes. However, avoid arguments or taking things personally.
Use Familiar Rituals and Memories: Offer familiar music or objects from the past; remind them of favorite activities. The brain may retain these “automatic” emotional patterns a bit longer.
Avoid Judgment: Be aware that negative words or behaviors are products of the disease.
Seek Emotional Support: Don’t suppress your own feelings; reach out to a professional (psychologist, support group) if you need to.
Remember, you are also exploring the limits of your own personality and patience. The love, understanding, and devotion you show during this period will offer hope not only to your loved one but also, years from now, to yourself.
Can Personality Changes Be Managed?
Medical treatments (such as antidepressants, antipsychotics, anxiolytics) may be necessary for some behavioral changes. However, what’s most important is using behavioral approaches and offering an environment that meets the patient’s changing capacity. Preventing personality change is rarely possible, but we can help our loved ones use their remaining abilities and feel safer and more at peace.
Conclusion: More Than Loss—Transformation
Dementia may seem to erase not just memories, but the delicate patterns of personality. But above all, the meaning of your love and patience can never be overshadowed by any disease. Even as your loved one changes, what you can give—understanding, embrace, a peaceful presence—will be reshaped by your own personality.
While personality change may feel like a loss, sometimes discovering preserved emotions or accepting and understanding your loved one in their new way opens doors to a renewed relationship. Because love can reach the core of the disease. Remember, you are not alone on this journey.
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