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Much has been written about the confusion and memory loss that can occur with Alzheimer’s. However, some of the most challenging symptoms are behavioral ones. Unpredictable and erratic behaviors can develop as the disease progresses.

Some of these symptoms are personality and character changes that can be very alarming and disturbing, while others may be subtle. A once gentle tone of voice may become mean and sarcastic. Facial expressions may change, going from a scowl to disdain to a blank stare.

There is little you can do to alter the changes wrought by Alzheimer’s. By understanding them, you can better accept and adjust to these changes.

Three Difficult Behavioral Changes from Alzheimer’s

  1. Anger and aggression. A once docile person with Alzheimer’s may suddenly get mad, even furious. The anger may be totally unwarranted and irrational but it’s real to the person. When severe, this anger can even manifest itself with violent outbursts, screaming, hitting and biting. Sometimes it is less intense and the person may simply be irritable and unhappy.
  2. Anxiety and agitation. Even Alzheimer’s patients who were previously calm and stress-free can get very upset and worried. They may get worried to the point of being terrified. The more anxious and scared they get, the more they break down emotionally and psychologically. This anxiety can result in agitated behavior such as restless pacing, hand-wringing and insomnia.
  3. Suspicions and delusions. People in the later stages of Alzheimer’s can get very mistrustful. This could manifest itself in many different ways. Maybe they don’t believe anything you say or suspect everyone of trying to trick them or hurt them. They could believe that other people are stealing from them or hiding their things; sometimes they start hiding things themselves. In short, this behavior is marked by paranoia, fear, accusations and suspicion of everything. As the disease progresses, reality can get distorted and people can grow delusional. They may start hallucinating and imagining things that aren’t there. My mother often thought my sister-in-law was sitting on the piano bench in the living room and asked me if I saw her.

What Causes these Behavioral Changes in those with Alzheimer’s?

These difficult behaviors are what doctors call “noncognitive neuropsychiatric symptoms” (NPS). They are a result of damaged brain cells, caused by dementia and Alzheimer’s. Not surprisingly, an impaired brain loses its ability to function properly. As a result, it can dramatically change how a person will act.

Physiological changes caused by the disease are primarily what trigger shifts in behavior. However, disturbing behavior can also be caused by certain environmental conditions. These can aggravate and complicate the situation for a person with Alzheimer’s. Examples include:

  • A noisy restaurant
  • A crowded room
  • A large party where everyone is talking at once
  • A loud television

All of these situations can make it more difficult for someone to cope with the changes going on in their brain. Behavioral difficulties may also be a result of true physical discomfort and someone with Alzheimer’s may not be able to communicate this. Make sure their anger and anxiety aren’t stemming from bad arthritis, constipation, cramps or some other physical pain. Make sure their clothes aren’t bothering them and that they aren’t too hot or too cold.

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10 Strategies for Dealing with Alzheimer’s-Related Behavior Changes

Sometimes prescription drugs can be helpful in treating these behavioral changes. There are medications for anger management, depression and anxiety. Non-drug therapies have also proven to be successful in mitigating and managing behavior issues associated with Alzheimer’s.

Caregivers can’t do much to prevent Alzheimer’s-related changes in personality and behavior, but there are ways to cope. Try the following strategies:

  1. Establish daily routines. Routines build confidence and familiarity for those struggling with the disease. Getting into the car in the morning instead of the usual routine of walking the dog and having breakfast can completely disrupt the day. The simplest changes to routine can be unsettling.
  2. Ensure proper nutrition and exercise. A nutritional diet and regular exercise can also help keep the brain engaged and focused throughout the day.
  3. Keep daily tasks as simple as possible. Someone with Alzheimer's may get easily confused. Choosing what to wear and getting dressed can be baffling. Find ways to reduce your loved one’s stress in a way that works for them. Try picking out their clothes for them or presenting them with two options to choose from instead of the whole closet.
  4. Be compassionate. Alleviate aggression caused from dementia by staying calm. Understand why it’s easy for them to snap due to frustration and anger. How would you feel if you always forgot what you were going to say and couldn’t communicate or function as you once did? These behaviors are reactions to the many symptoms of the disease they are facing.
  5. Do not argue or try to reason. Don’t disagree or deny their experience. Accept the delusions, agree with them and try to pacify them. Be positive. Don’t say, ”You’re crazy, mom! There’s no one sitting at the piano!” Say something like, “I don’t see anyone at the piano mom. What are they doing? How does it make you feel?” Use validation theory with dementia to affirm their reality without lying.
  6. Engage them in activities. Whether it’s helping set the table or doing a jigsaw puzzle, it will keep them distracted and occupied. Getting them involved in activities can also make them feel they still have control over their life. A sense of contribution and worth can do wonders.
  7. Redirect them. Try playing music they enjoy or singing and dancing together. Music can be a powerful tool in calming those with dementia. A movie can also be a pleasant distraction from what is frightening or bothersome.
  8. Reassure them that they are safe. When dealing with paranoia from dementia, let your loved one know they are not alone. Explain that you and their other caregivers are there to help. Keep photos of loved ones and favorite objects close at hand for them.
  9. Respect their need for solitude. While social interaction can be very beneficial, if they want to retreat, let them. Give them a safe space. Try reconnecting later with a cup of tea or their favorite drink.
  10. Employ the healing power of humor whenever you can. My mother wouldn’t shower because she insisted that there was always a large man in her bathtub. Respond with something like, “That man in the bathtub? Let’s get the garden hose and spray him off! Maybe he wants a bubble bath?!” You can’t change what they see but you can change the context.

The most difficult advice to follow is to not get angry or frustrated. It will only make the situation worse and won’t accomplish anything worthwhile. When you feel overwhelmed, take a time-out if possible by leaving the room or catching your breath. Nurture your own physical, mental and emotional well-being, and you will be able to provide better care for your loved one.

Learn more about how professional caregivers can support those with Alzheimer’s and dementia here:


Management of Neuropsychiatric Symptoms of Dementia

How to Respond When Dementia Causes Unpredictable Behaviors

Managing Personality and Behavior Changes in Alzheimer’s

Coping with Agitation and Aggression in Alzheimer’s Disease

About the Author(s)

An accomplished freelance writer and editor, Cheryl is passionate on how to bolster our resilience in old age and reshape the course of decline. Her compassion and understanding for caregiving stems from acting as a caregiver for her mother, who struggled with dementia, and her father, who suffered from Parkinson’s.

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