Common dementia behaviors and how to manage them

When a loved one has dementia, acclimating to their needs and behaviors comes with a significant learning curve. Some behaviors are easier to adapt to, like no longer liking previously enjoyed meals or needing reminders to use the bathroom. But others, like increased wandering and new aggression, can feel dangerous and confusing.

Caring for someone living with dementia can be both rewarding and incredibly challenging, but being informed about dementia and common behaviors can make a big difference, says Jessica Corona-Irwin, a registered nurse, certified dementia practitioner and support group facilitator and the head of nursing at Remo Health. 

“When caregivers are well-informed about the disease progression and strategies available, they are better equipped to respond calmly and navigate difficult situations,” she explains. “Caregivers are also important when it comes to shared decision-making during various treatment options, especially during the mid to latter stages of the disease.” Keep reading to learn more about common dementia behaviors, why they change and how to handle each one with care and compassion.

Understanding dementia behaviors — and why they happen

Each type of dementia has a distinct pattern of brain cell damage, which leads to different symptoms for different individuals, notes Dr. Joel Salinas, a neurologist and the co-founder and chief medical officer of Isaac Health. 

For example, “in Alzheimer’s disease, the earliest neurological changes often involve abnormal buildup of proteins…which disrupt brain networks critical for memory, orientation and language,” he explains. “In contrast, other dementias — like frontotemporal dementia or Lewy body dementia — affect different brain regions first, leading to earlier changes in behavior, movement, speech or attention, rather than memory.”

Some common dementia behaviors that often challenge loved ones and caregivers include:

• Aggression.
• Agitation.
• Sundowning, or late-day behavior escalations.
• Verbal or physical outbursts.
• Wandering.
• Delusions.
• Obsessive behaviors.
• Visual hallucinations.
• Resistance to care.

Salinas says the behaviors that surface in the aftermath of dementia-related brain shifts aren’t intentional; they’re signs of the brain struggling to process the surrounding world.

“Damage to parts of the brain that regulate mood and impulse control — like the frontal lobes — can increase the likelihood of distress-related behaviors such as agitation, sundowning and even verbal or physical outbursts, ” he says. “These behaviors are often triggered by confusion, overstimulation or unmet physical or emotional needs.”

How to respond to common dementia behaviors

It’s vital for dementia caregivers to learn how to recognize different behavior patterns and learn how to respond safely and compassionately. Below, Corona-Irwin offers examples of the most common dementia behaviors and tips to help you respond. As always, it’s important to consult with medical professionals to determine the best strategies to address each individual’s needs.

Aggression and agitation

Aggression and agitation in individuals with dementia can often be expressed through verbal outbursts or restlessness. This can signal unmet needs, confusion or discomfort.

Corona-Irwin recommends that caregivers and loved ones help someone with dementia-related agitation by using the following strategies:

• Identify triggers, like confusion, discomfort or sensory overload. 
• Rule out pain. 
• Simplify the environment.
• Use calm communication.
• Provide redirection. 

Additionally, she adds, it’s crucial to seek professional help for potential medication adjustments and/or therapeutic support.

Read more:

Dementia and anger: What’s the connection and how to cope

Wandering and getting lost

When individuals living with dementia walk off without a set plan or destination, it’s called wandering. 

Corona-Irwin says safety-proofing the home by adding difficult-to-open locks and alarms is an essential consideration when caring for someone who is experiencing wandering. She also suggests providing close supervision, especially during peak wandering times, and using identification and monitoring systems, like a GPS tracker, while maintaining a consistent daily routine with physical activity.

Repetitive questions and actions

Repeatedly asking the same question or performing the same action is a behavior often stemming from anxiety, discomfort and confusion, Corona-Irwin says. Responding with patience, simple answers and offering reassurance rather than lengthy explanations is most helpful in these circumstances. 

“Don’t correct [them],” she adds. “Gently redirecting their attention to engaging activities that are tailored to their preferences can help reduce the repetition.”

Hallucinations and delusions

Hallucinations and delusions refer to when people living with dementia see, hear or believe things that are not real, and then get scared or upset as a result. “This can be very real and frightening to the person experiencing it,” Corona-Irwin says. 

“When they experience these episodes, caregivers should avoid arguing [with them] and instead reassure and validate their feelings,” she explains. “It’s crucial to consult a doctor, as these symptoms can indicate underlying medical issues or medication side effects.”

“Identifying underlying reasons for resistance, such as pain or discomfort, and being flexible with timing are crucial strategies. Professional guidance can also offer valuable support.”

— Jessica Corona-Irwin, registered nurse and certified dementia practitioner

Sundowning

When a person with dementia experiences increased confusion, agitation and restlessness — typically starting in the late afternoon or evening and continuing into the night — it’s called sundowning. 

To prepare for this, Corona-Irwin says, caregivers should:

• Maintain consistent daily routines
• Maximize daytime light exposure.
• Minimize evening stimulation.
• Offer calming activities.
• Ensure the person’s comfort.
• Secure the environment.

If symptoms are severe, she adds, it’s vital to consult a doctor.

Refusing care or assistance

“People with dementia may refuse help with daily activities like bathing or eating, often due to a loss of control, fear or confusion,” says Corona-Irwin. She notes that caregivers should be gentle, offer limited choices, breaking down tasks and using distraction to encourage cooperation. 

Environmental modifications and daily routine adjustments can also help reduce agitation and refusal of care in home settings. “Identifying underlying reasons for resistance, such as pain or discomfort, and being flexible with timing are crucial strategies,” she says. “Professional guidance can also offer valuable support.”

How to create a supportive environment for dementia care

Many things are out of our control when caring for someone with dementia, but one thing you can do is control the person’s environment to help reduce the expression of symptoms. 

Corona-Irwin says soft and consistent lighting, using natural cues to signal routines (like playing calming music before bedtime) and repeating daily steps in the same order can help seniors feel more grounded and secure. She also recommends scheduling demanding activities during times when they are most alert, cooperative and calm.

To eliminate or reduce environmental triggers, Dr. Macie P. Smith, gerontologist, has found the following modifications most successful in home settings:

• Reduce and/or eliminate distractions in the person’s space, including floor and wall coverings.
• Ensure the temperature is comfortable.
• Avoid hosting large groups of people in the person’s space.
• Follow a familiar daily routine — for example, always washing their face and brushing their teeth before getting dressed, if that is their preference, or always saying their prayers before lying down for bed.

“Dementia behaviors are often how the brain communicates when it can’t use words. Recognizing that these behaviors have meaning — and that help is available — can make a major difference.”

— Dr. Joel Salinas, neurologist

When to seek professional help with dementia behaviors

While there is no cure for most dementias, early and comprehensive care can make a meaningful difference, Salinas says. Medical treatments and therapies may slow decline, he says. “Equally important are non-drug approaches — such as maintaining a routine, minimizing environmental stress and providing meaningful activities — that help reduce behavioral symptoms and improve quality of life.”

Each expert we spoke to uplifts the importance of professional support and knowing when it’s time to seek more help or adapt an individual’s care plan. Corona-Irwin suggests watching for:

• New responses to old stimuli.
• Increased aggression or violence.
• An increase in agitation or confusion.
• New safety risks, such as unsafe driving.
• Medication errors.
• Increased wandering. 
• Ongoing sadness.
• New hallucinations, false beliefs or delusions.
• Sudden incidents of falls or accidents.
• Noticeable weight loss or signs of poor nutrition.
• Sudden mood changes.

Very sudden changes in behavior — especially increases in confusion, agitation or withdrawal — could be red flags related to either the dementia diagnosis or another medical issue, Salinas notes. “Infections, untreated pain, dehydration or new medications can all mimic or worsen dementia symptoms,” he says. “When a person with dementia seems ‘off,’ it’s important to think medically, not just neurologically.”

Testing and treatment should always be guided by a doctor’s full evaluation, Corona-Irwin adds. This can ensure prompt treatment and help eliminate the possibility of misattributing symptoms. Above all, she says, listen to yourself and seek support when anything seems concerning. “If something feels ‘off’ or different, trust your instincts. You don’t have to wait for a crisis to get support.”

Support and resources for dementia caregivers

Learning how to manage different behaviors isn’t the only challenge dementia caregivers face. If you’re looking for more specific guidance as you care for someone with dementia, the following resources and care items can support you on your journey:

• Contact The National Council on Aging for information about mental health resources, financial planning and more. 
• Read books about caregiving to find valuable wisdom, camaraderie and support.
• Find virtual and in-person support groups through the Alzheimer’s Association or the Caregiver Action Network.

If you’re a caregiver for a family member or you have a loved one with dementia who lives alone, consider additional care options or seeking higher levels of care as needed. This might include hiring an in-home caregiver to support the comfort, safety and health of a loved one with dementia, or even seeking assisted living or memory care to help with daily tasks and offer specialized support.

“Dementia behaviors are often how the brain communicates when it can’t use words,” says Salinas. “Recognizing that these behaviors have meaning — and that help is available — can make a major difference.”