Dementia patients often exhibit "weird" behaviors like saying rude things, hiding objects, believing deceased people are alive, experiencing hallucinations, pacing, or having "catastrophic reactions" (overreacting to small issues) because brain changes disrupt normal thinking, memory, and behavior, leading to confusion, disinhibition, and misunderstanding situations, not intentional malice. Common examples include making inappropriate comments, getting lost easily, repeating questions, or unusual sleep patterns like sundowning.
Restlessness and fidgeting
People with dementia often develop restless behaviours, such as pacing up and down, wandering out of the home and agitated fidgeting.
Seroquel is the brand name for quetiapine, an atypical antipsychotic that is used off-label to treat severe behavioral signs of dementia. It can help with bad symptoms, including agitation, aggressiveness, and hallucinations, that other drugs don't help with.
Many people with dementia become restless and may fidget or pace up and down. They may constantly wring their hands, pull at their clothes or touch themselves inappropriately in public. This could be because of pain or discomfort, needing the toilet, a need for more physical activity or problems with their environment.
Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care. Don't argue or try to convince. Allow the individual to express ideas.
It is common for people with dementia to experience delusions (or strongly held false beliefs), which can also take the form of paranoia. Common delusions include theft or believing loved ones are trying to harm them.
The term "sundowning" refers to a state of confusion that occurs in the late afternoon and lasts into the night. Sundowning can cause various behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning also can lead to pacing or wandering. Sundowning isn't a disease.
As Alzheimer's disease progresses, it can lead to significant changes in eating habits, including appetite loss and a behavior known as “pocketing,” where food is held in the mouth without swallowing.
The "2-finger test" for dementia involves an examiner showing a hand gesture (like interlocking index and middle fingers) and asking the patient to copy it, testing motor skills, visual memory, and coordination, as difficulties can signal early cognitive decline, but it's a screening tool, not a definitive diagnosis, prompting further medical evaluation. Other related tests include finger-tapping and finger-to-nose, looking for hesitation or misjudgment in movement.
Smoking, low physical activity, and a poor diet are all lifestyle and environmental influences that have been linked to rapid dementia decline. Physical activity promotes cardiovascular health, which in turn improves brain function. Those who lead a sedentary lifestyle may experience faster cognitive decline.
Meaningful activities are a great way to bring joy, connection, and comfort to a loved one with dementia. Simple things like enjoying a favorite song, moving a little each day, or engaging in familiar routines can make a big difference in their well-being.
When someone gets the diagnosis of dementia, a cure is only very rarely possible (see p2 About Reversible Dementias). In the current issue of Neurology, Sacks and Shulman1 report one of these rare cases of a reversal of dementia involving a patient on steroid medication.
Playing music, having objects to touch and interact with, and hand massage can all help people with dementia in the later stages.
Misplacing things and losing the ability to retrace steps
A person living with Alzheimer's or other dementia may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. He or she may accuse others of stealing, especially as the disease progresses.
Dementia can cause significant changes in a person's mood and behavior. This can include increased irritability, depression, anxiety, agitation, and apathy. Some individuals may also exhibit more pronounced behavioral changes such as aggression or wandering.
Disorientation and Confusion – Dementia can cause patients to feel lost or confused about their environment, leading to disorientation that may result in clothing removal as they try to make sense of their surroundings.
While family caregivers often provide the primary daily support for individuals with dementia, legal responsibility for decision-making and financial management can fall to spouses, adult children (depending on filial responsibility laws), or court-appointed guardians or conservators, especially in the absence of a ...
repetitive behaviour – for example, repeatedly pulling at clothes or asking the same question over and over. following a carer around (trailing) or constantly checking that they are near. disturbed sleep patterns – sleep is particularly disrupted, and in a different way, in a person with dementia with Lewy bodies.
Signs of late-stage dementia
having a limited understanding of what is being said to them. needing help with most everyday activities. eating less and having difficulties swallowing.
The 5-word memory test is a cognitive screening tool. This approach is simple—a person is told 5 words in a specific order, and a few minutes later, they're asked to recall them in the same order. It's often used by healthcare providers to test memory and short-term recall.
When someone with dementia speaks in made-up words that sound like nonsense, it can be confusing and even heartbreaking. But what's really happening isn't stubbornness or random confusion—it's a breakdown in the brain's language system.
Each dementia patient's symptoms and their onset vary, but shadowing usually occurs in the middle stages of Alzheimer's before mobility is seriously limited. Older adults who are prone to shadowing may follow their caregivers around constantly, which can be distressing for both parties.
These include wakefulness at night and problems falling asleep and staying asleep, as well as drowsiness and napping during the day. These sorts of sleep disturbances are associated with many kinds of dementia, most notably Alzheimer's disease.
Nursing homes use many strategies to ensure that dementia patients stay in bed at night. Some of the practices that they employ are monitoring the sleep environment, taking residents to the washroom at regular intervals, and using bed alarms to alert if anyone is getting out of bed.