If your loved one is living with dementia, you may notice acute and ongoing personality changes that can be jarring—or even frightening.
Whether it’s unexplained verbal or physical aggression, heightened agitation, or depression and anxiety, personality changes in dementia can take many forms, often worsening as the condition progresses.
And despite increased awareness of the symptoms of dementia, behavioural and psychological changes in people with dementia are often misunderstood.
But while these changes may seem random, they’re often triggered by underlying issues such as side effects of medications, disruption to established routines, and even dismay at the toll the condition is taking.
These behaviour changes can be disorienting—for you and your loved one—so it’s important to understand the types of personality changes a person with dementia may experience.
In this article, we’ll explore the most common personality changes associated with dementia and their underlying causes, as well as offer practical tips to help you support your loved one when times get tough.
What causes personality changes in people with dementia?
It’s understandable to assume that behaviour and personality changes in dementia are symptoms of the condition in and of themselves, but that’s not always true.
In many cases, there’s an underlying cause to the changes, often an unmet need, such as hunger, or other environmental factors, such as sensory overwhelm, side effects of medications, or even disorientation caused by changes to familiar spaces.
For example, if your loved one is unusually aggressive—either verbally or physically—at a family gathering, it may be a sign that they’re overwhelmed by the situation.
Similarly, your loved one may find it disorienting if a significant change to their environment, such as moving furniture around or painting the walls.
Routine is hugely important to people with dementia, so disruptions to their familiar schedules may also trigger acute behavioural changes.
Of course, the nature of those disruptions can vary, and they may not be consistent, but common triggers include changes to meal times, television schedules, and bedtimes.
But behaviour changes in dementia aren’t solely caused by disruptions to familiar routines.
In many cases, personality changes can be triggered by dementia itself, as your loved one may feel anxious about the impact the disease is having on them, or frustrated by difficulties engaging with their hobbies.
What are the most common personality changes with dementia?
It’s important to remember that behavioural changes will vary from person to person, based on their personality and preferences—dementia isn’t a monolith.
That said, there are some commonly-reported personality changes, each posing unique challenges.
Loss of inhibition
Loss of inhibition is common in people living with dementia, and may include behaviours such as rudeness, inappropriate speech, or undressing in public spaces.
In some cases, people may experience a loss of sexual inhibition, which may cause them to touch themselves in public.
It’s important to note that a person living with dementia may not view these behaviours as inappropriate and may react with confusion or if confronted.
Agitation
A person living with dementia may become easily agitated or restless, displaying behaviours such as fidgeting, pacing, or obsessively tidying living spaces.
There are several reasons a person with dementia may experience heightened agitation, including the physical changes to the brain caused by the illness and environmental factors such as abrupt changes to their known routine.
Social withdrawal
Social withdrawal is one of the most commonly reported behavioural changes in people living with dementia, and it can take a variety of forms.
For example, your loved one may speak much less than they used to—or even stop speaking altogether. They may also physically withdraw from noisy or busy rooms, preferring to be in a less overwhelming space.
There are several underlying reasons for social withdrawal in dementia, including difficulty communicating with others, increased sensitivity to noise, and even depression and anxiety.
Sundowning
Sundowning is a commonly-reported, yet complex aspect of dementia, referring to changes to a person’s behaviour that occur in the late afternoon or evening.
Sundowning behaviours can include heightened agitation, increased distress, delusions, and even hallucinations.
The exact causes of sundowning aren’t fully understood, but research has identified links between sundowning behaviours and unmet needs (i.e. hunger or tiredness).
Aggressive behaviours
Aggressive behaviours may be physical or verbal, including, but not limited to, shouting, swearing, hitting, or throwing objects.
As with many behavioural issues in dementia, aggressive behaviours are rarely symptoms in and of themselves and are typically caused by an underlying issue.
These underlying issues will, of course, vary from person to person, but may include:
- Physical discomfort
- Distress caused by unfamiliar or dark rooms
- Mental health issues linked to dementia (e.g. anxiety or depression)
- Confusion regarding altered mental and physical capabilities
- Frustration caused by prolonged periods of social contact
If your loved one is behaving in an unusually aggressive way, it’s important to look beneath the behaviour to identify any unmet needs.
Trailing
Trailing refers to the literal act of your loved one following another person—typically someone who makes them feel safe—from room to room or repeatedly asking where that person is.
Also known as shadowing, trailing is caused by a mixture of memory loss and anxiety. Essentially, if your loved one is following you closely, it’s a sign that they’re feeling anxious and seeking reassurance.
Disruptions to sleep patterns
Sleep disturbances in dementia can vary in type, and are typically triggered by an underlying issue, such as physical pain, overstimulation, or emotional struggles.
While there’s no definitive list of sleep disruptions for people living with dementia, common complaints include struggling to drift off, difficulties staying asleep, and repeatedly waking up during the night.
As you can imagine, sleep disturbances can be highly disruptive for people living with dementia, as heightened levels of fatigue can intensify other behavioural changes.
How to deal with dementia-related personality changes
It can be challenging, distressing, or even frustrating if your loved one behaves in a way that’s out of character for them.
And while there’s no one-size-fits-all approach to navigating behaviour changes in dementia, there are things you can do to support your loved one.
And it starts with understanding, in both senses of the word.
Be understanding
It’s important to remember that your loved one isn’t intentionally behaving in a way that feels frightening or inappropriate—it’s a symptom of a condition, so the best thing you can do is offer patience and compassion.
You should also educate yourself on the types of dementia and the stages of dementia, as by doing so, you’ll be able to offer more focused support if your loved one is struggling.
As we explored earlier, most personality changes in dementia are triggered by an underlying cause, such as an unmet need or physical discomfort, so it’s vital that you look beyond the behaviour itself and seek to identify the trigger.
Be patient
It won’t always be easy (or quick) to identify what’s causing your loved one to behave differently, so patience is key.
As you attempt to identify any potential triggers, remember to stay calm and patient, reminding your loved one that you’re there to help and that they’re safe.
If your loved one is agitated or aggressive, avoid arguing or anything that might further escalate the situation, as that’ll add further distress and potentially damage your relationship.
Create a daily routine
Routine is hugely important to people living with dementia; it helps them navigate the often-erratic nature of the illness and provides a sense of stability and comfort.
For example, if your loved one typically goes about activities in a certain order—such as eating breakfast at a specific time—it’s wise to maintain these patterns, as doing so will help them know what to expect, and when.
By sticking to familiar routines, you can help to prevent the anxiety that goes hand-in-hand with uncertainty and is often the source of aggression or agitation.
Routine is also important to ensure your loved one gets enough rest, and by sticking to a regular bedtime, with a familiar wind-down routine, you’ll help your loved one to feel rested and refreshed, which can alleviate symptoms of dementia.
Learn your loved one’s cues
In most cases, behavioural changes in dementia aren’t random. They’re a sign that your loved one is struggling with something, be it physical or emotional.
But communicating with someone with dementia can be challenging, especially if they’re experiencing speech or memory issues.
With that in mind, it’s important to learn your loved one’s cues, both verbal and non-verbal. By doing so, you’ll be able to quickly identify—or even pre-empt—issues and intervene before things can escalate.
For example, if your loved one is fidgeting more, it could be a sign that they’re in physical discomfort. Similarly, if they’re pacing back and forth, it could be a sign that they’re anxious or agitated.
You should also pay close attention to your loved one’s facial expressions—especially if they’re struggling with speech—as from these, you’ll be able to develop a picture of their emotional state in a given moment or scenario.
It may be challenging at first, but by learning your loved one’s cues, you’ll be able to anticipate shifts in behaviour, allowing you to offer the best support.
Dealing with personality changes in dementia can be challenging, but with patience and perseverance, you can learn to identify their underlying causes and offer the support your loved one needs.
Need more advice on supporting your loved one? Check out our help and guidance section, where you’ll find articles on everything from tips for preventing falls to eating and drinking well.
Think your loved one might benefit from a little extra support? Check out our dementia care services, which are delivered in the comfort of home by highly trained care professionals and tailored to your loved one's unique needs.