Neurological Awareness
A Silent Cry: Dementia and Changing Behaviors
Ayşe looked into her mother's eyes. The usual peaceful expression was gone, replaced by an incomprehensible restlessness mingled with emptiness. Last night, her mother had failed to recognize Ayşe for the first time; and by early morning, she had tried to leave the house. The loving mother who was always gentle now acted rudely toward her, this once cheerful woman who never showed anger was now throwing food on the floor and shouting for no reason. These changes can deeply shake almost anyone. Sometimes with anxiety, sometimes with deep sadness, we ask: "What is happening, why is she behaving this way?"
Dementia and Behavioral Changes: A Common Scenario
Dementia is not only about memory loss. Affecting an estimated 60-70 million people worldwide, dementia is a major social challenge. While the most well-known form is Alzheimer’s disease, other types include vascular dementia, Lewy body dementia, and frontotemporal dementia. In all these types, behavioral changes can be among the most striking and often most challenging symptoms of the disease.
Approximately 80% of those living with dementia will develop noticeable behavioral or psychiatric symptoms at some point (NIH). These symptoms can appear long before cognitive loss, and often manifest in much more dramatic ways.
What is a Behavioral Change? Where Do We Draw the Line?
Classically, a "behavioral change" refers to alterations in a person’s prior attitudes, reactions, and social interactions as a result of declining health. In dementia patients, these changes often develop unexpectedly, suddenly, and quite dramatically. But how do we recognize these changes and what are their causes?
Sudden outbursts of anger
Anxiety, restlessness, suspiciousness
Withdrawal or apathy
Stubbornness, increased obstinate behavior
Restless wandering (such as wandering constantly around the house)
Socially inappropriate behaviors
Developing obsessions (like repeatedly asking the same question or about the same event)
Hallucinations or delusions
The Effects of Dementia on the Brain and Their Reflection in Behavior
At the root of behavioral changes lies the biological alteration dementia causes in the brain. The frontal lobe (front part of the brain) is especially responsible for personality, social awareness, and emotional regulation. As dementia affects this region, a person’s threshold for reaction drops, and their empathy and sense of reality may deteriorate.
Elsewhere in the brain, as structures like the hippocampus (memory center) and amygdala (emotional responses) are damaged, the patient may feel threatened or like they are in a foreign environment. This often sets the stage for behavioral crises.
Frontotemporal dementia in particular can lead to dramatic personality and behavior changes early on, while Alzheimer’s disease tends to manifest behavioral symptoms in later stages. According to the Alzheimer's Association, changing behaviors are seen in 90% of Alzheimer’s patients. Agitation, restlessness, aggression, and insomnia may intensify as the condition progresses.
Beyond Biological Causes: Dementia, Fear, and Incomprehension
Behavioral changes often reflect the confusion the patient is experiencing. Refusing a simple meal may be because they don’t recognize the food or have forgotten its taste; an attempt to escape the home may be a desire to flee from an environment that feels unfamiliar. The core issue is that, even when cognitive capacity is damaged, emotions and core human feelings often persist. It’s understandable: Your loved one looks at you and asks, “Who are you?” — probably because, at that moment, they feel lost, helpless, or afraid.
Common Behavioral Changes
Agitation/Restlessness: Among the most frequent behavioral symptoms. The patient may constantly fiddle with objects, pace, or show unexplained bursts of anger.
Depression and Anxiety: About 40% of people with dementia develop depression. Worries they cannot otherwise express are reflected in their behavior.
Aggression: Seemingly unprovoked, sudden outbursts of anger, yelling, throwing objects, or even physical violence may occur—typically when patients feel threatened.
Social Withdrawal: Interest in meals or family gatherings may wane. Mental fatigue is one of the main reasons.
Hallucinations and Delusions: Especially common in Lewy body dementia. Patients may see and converse with people who aren’t there.
Unfounded Suspicions: Accusations like “They stole my wallet!” or “You’re poisoning me!” These paranoid thoughts can be very disruptive to relationships.
Repetitive Behaviors and Obsessions: Examples include repetitive hand washing or persistently asking the same question.
From an Emotional Perspective: The Caregiver’s Experience
“I feel like I’m losing my father. He was always so cheerful; now he blames me. I know it’s not really him, but the disease talking, yet my heart still aches...”
Just as those diagnosed with dementia, their loved ones can also become victims of the process. Studies show that 40% of caregivers experience moderate to high levels of emotional burden and burnout (PMC). Especially when behavioral changes begin, accepting these shifts in personality can become emotionally draining. For many, witnessing their loved one gradually become a stranger initiates a process of mourning.
Main Causes of Behavioral Changes
Brain injury and deterioration in neural communication: As neurons die, the regulation of thoughts and emotions is disrupted.
Physical pain or discomfort not understood by the patient: Even minor issues like a toothache, urinary tract infection, or constipation can cause major behavioral changes.
Medication side effects or improper drug use: Some behavioral symptoms can also be direct side effects of medications.
Environmental factors, uncertainty, and new surroundings: Changes in routine or moving to a new environment can trigger crises in Alzheimer’s and other dementias.
Emotional causes: Fear, loneliness, difficulty making sense of situations.
Scientific Approach to Behavioral Changes
Modern science advocates viewing behavioral changes not as "loss of identity," but as symptoms of disease. Rather than a new identity or personality emerging, the existing networks and mechanisms are deteriorating. Dementia patients do not act deliberately; every response reflects the changes happening in the brain. This perspective can make it somewhat easier to accept the changing face of our loved ones.
Practical Ways to Cope with Behavioral Changes
Approach with empathy: Don’t blame yourself or succumb to anger. The cause is the disease, not the person.
Communicate compassionately: Use simple, clear sentences; maintain eye contact and use a gentle tone of voice.
Maintain daily routines: Minimize changes. A planned and predictable environment offers comfort.
Investigate the reason for behaviors: Before a behavioral crisis emerges, check if anything has changed in the environment or with the patient—rule out hunger, need for the bathroom, or pain.
Avoid physical touch during crises: Especially if aggression is escalating, step back and focus on calming the environment.
Seek professional help when needed: Sometimes medication or psychiatric support may be necessary. Don’t hesitate to speak with your doctor.
Remember: Every behavior has a reason. Instead of being angry and asking, "Why are they doing this?" try asking, "What might they be experiencing?"
Are Dementia Behaviors Permanent or Changeable?
Behavioral changes can come and go over time. Depending on the course of the disease, certain behaviors may intensify while others fade. A patient may be quite agitated for a period, then calmer for a few weeks. However, in general, as dementia progresses the persistence of behavioral changes increases.
What Caregivers Need
Join support groups: Talking with other caregivers and sharing experiences can boost your motivation.
Allow yourself breathing space: Don’t neglect your own well-being; take short breaks when needed.
Stay informed: Keep up with the latest research, new care approaches, and available support resources about dementia.
Don’t hesitate to seek professional help: Tolerating behavioral changes can be challenging. Getting help from a specialist is not just beneficial for the patient, but for you as well.
Behavioral Symptoms – Comparison: Alzheimer’s vs. Frontotemporal Dementia
Symptom | Alzheimer’s | Frontotemporal Dementia |
|---|---|---|
Personality change | Later onset | Very early |
Loss of empathy | Rare | Common |
Anger outbursts | Occasional | Frequent, severe |
Obsessive behaviors | Rarely | Common |
Hallucinations, delusions | Advanced stage | Rare |
Scientific Guide: Advanced Approaches in Managing Dementia Behavioral Changes
Personalized care approaches: Studies show that considering an individual’s past habits and personal preferences is effective for managing behavioral symptoms (BMJ).
Innovative non-pharmacological approaches: Non-drug interventions such as music therapy, movement therapy, and environmental modifications have proven to have positive effects.
Importance of early intervention: Getting psychological support for both patient and family when initial symptoms emerge can reduce the severity of behavioral changes later on.
Common Misconceptions
“Behavioral changes result from poor care.” This is incorrect. Good care can reduce the severity of these symptoms, but not eliminate them.
“Medications fix everything.” Medications are only helpful for some behavioral symptoms and are not always needed. Wrong medications can worsen the condition.
“The patient is being deliberately rude.” These behaviors are largely involuntary and the result of the disease’s impact on the brain.
Conclusion: Understanding, Patience, and Knowledge Are Your Greatest Assets
Behavioral changes seen in dementia patients are not just a symptom; they’re an emotional trial that stands between us and our loved ones. The way through this challenge lies in empowering yourself with knowledge, approaching the situation with understanding, and seeking help as needed. You’re doing your best; keep going without falling into unjustified guilt for yourself or your loved ones. Remember, the love and patience you show may be the only hand they can hold onto in the world they’re losing.
References
Bir Sonraki Okuma
