Alzheimer’s and Sleep Problems

( People with Alzheimer’s disease go through many changes, and sleep problems are often some of the most noticeable.

Most adults have changes in their sleep patterns as they age. But the problems are more severe and happen more often for people with Alzheimer’s.

You might notice that your loved one:

  • Sleeps a lot more than usual, including taking naps during the day. This is common for people in the early stages of the disease.
  • Has trouble falling asleep or wakes up a lot at night. When he does sleep, he might doze on and off.
  • Wants to sleep more during the day and stay awake at night. This becomes more common as Alzheimer’s gets worse.
  • Gets restless or agitated when the sun sets, a condition called sundowning. He might pace or wander during the night, too.

Scientists aren’t sure why people with Alzheimer’s tend to have problems sleeping. It may be because the disease damages the brain and changes the way it controls the sense of when to get shut-eye and when to be awake.

But even when sleep patterns change, you can make it easier for your loved one to rest and get some Zzz’s yourself.


Most doctors say it’s best to start with changes to lifestyle and behavior to fix sleep problems. There are medications that can aid sleep, but they can be harmful for people with Alzheimer’s, causing confusion and making them more likely to fall.

Here are some tips to get started:

  • Help your loved one keep a regular 24-hour schedule. Eat meals, wake up, and go to bed at the same time each day.
  • Discourage naps during the day, or at least limit them to 30 minutes.
  • Move him into sunlight soon after he wakes up and keep the lighting low as bedtime approaches. This helps set his internal clock closer to normal.
  • Make sure he exercises every day, although not within 4 hours of going to bed.
  • Encourage him to avoid nicotine, alcohol, caffeine, and large meals, especially at night.
  • Make sure his bedroom is comfortable, with the temperature not too warm and not too cold.
  • Check with your loved one’s doctor about other health conditions he might have that can cause sleep problems, such as restless leg syndrome, sleep apnea, or urinary tract infections. There may be treatments that can help.
  • Some Alzheimer’s drugs, like donepezil (Aricept), can cause trouble sleeping. If your loved one takes this medication, avoid giving it to him at night.

A mix of changes may help if one tactic doesn’t work.

Sleep Medications and Alzheimer’s

If your loved one’s doctor prescribes medicine to help him rest, he’ll probably start at the lowest dose possible and stop the drugs as soon as sleep patterns improve.

Medications include:

  • Sleeping pills such as zaleplon (Sonata) and zolpidem (Ambien)

Doctors also sometimes prescribe drugs called antipsychotics such as risperidone (Risperdal). They can be helpful, but they also might increase the risk of death in some people with dementia. You’ll want to talk carefully with your loved one’s doctor about this medicine before he takes it.

Just as Alzheimer’s sleep problems can change over the years, so do the ways you can handle it. Always talk to your doctor about which options are best.

How You Can Get Rest, Too

As a caregiver, it’s just as important for you to get enough shut-eye, so you can take better care of yourself and your loved one.

Many of the same things recommended for people with Alzheimer’s can work for you, too:

  • Keep a regular schedule.
  • Don’t smoke, and cut down on caffeine, alcohol, and large meals, especially at night.
  • Have a comfortable bedroom and use it only for sleeping.
  • If your loved one takes a short nap during the day, take the chance to lie down and rest as well.
  • Connect with other caregivers for support. You might feel better talking to others about your situation and hearing their advice.
  • Aim to get 7-9 hours of sleep a night.
  • Try to relax before you go to bed. Muscle relaxation exercises, writing in a journal, or soft music can help.

WebMD Medical Reference Reviewed by Richard Senelick, MD on June 22, 2015

© 2005 – 2017 WebMD, LLC. All rights reserved.


Alzheimer’s or Depression: Could it be Both?

(Mayo Clinic) Alzheimer’s and depression have some similar symptoms. Proper treatment improves quality of life.

Early Alzheimer’s disease and depression share many symptoms, so it can be difficult even for doctors to distinguish between the two disorders. And many people with Alzheimer’s also are depressed.

One important difference between Alzheimer’s and depression is in the effectiveness of treatment. While Alzheimer’s drugs can only slow the progression of cognitive decline, medications to treat depression can improve a person’s quality of life dramatically.

People who have both Alzheimer’s and depression may find it easier to cope with the changes caused by Alzheimer’s when they feel less depressed.

Similar Symptoms

Some of the symptoms common to both Alzheimer’s and depression include:

  • Loss of interest in once-enjoyable activities and hobbies
  • Social withdrawal
  • Memory problems
  • Sleeping too much or too little
  • Impaired concentration

With so much overlap in symptoms, it can be hard to distinguish between the two disorders, especially since they so often occur together. A thorough physical exam and psychological evaluation can be helpful in determining a diagnosis. However, many people with moderate to severe Alzheimer’s disease lack both the insight and the vocabulary to express how they feel.

Signposts for Depression

To detect depression in people who have Alzheimer’s disease, doctors must rely more heavily on nonverbal cues and caregiver reports than on self-reported symptoms. If a person with Alzheimer’s displays one of the first two symptoms in this list, along with at least two of the others within a two-week period, he or she may be depressed.

  • Significantly depressed mood — sad, hopeless, discouraged, tearful
  • Reduced pleasure in or response to social contacts and usual activities
  • Social isolation or withdrawal
  • Eating too much or too little
  • Sleeping too much or too little
  • Agitation or lethargy
  • Irritability
  • Fatigue or loss of energy
  • Feelings of worthlessness, hopelessness or inappropriate guilt
  • Recurrent thoughts of death or suicide

Alzheimer’s Disease with Depression is Different

People with Alzheimer’s may experience depression differently from that of people without Alzheimer’s. For example, individuals diagnosed with Alzheimer’s disease:

  • May have symptoms of depression that are less severe
  • May experience episodes of depression that don’t last as long or recur as often
  • Talk of suicide and attempt suicide less often

Scientists aren’t sure of the exact relationship between Alzheimer’s disease and depression. Some research has found that the biological changes caused by Alzheimer’s may intensify genetic predisposition to depression. Other studies suggest that the presence of depression may increase your chances of developing Alzheimer’s disease.

It’s clear that depression has a strong effect on quality of life for people with Alzheimer’s disease. Depression can lead to:

  • Faster cognitive decline
  • Earlier placement in nursing homes
  • Greater disability involving daily living skills
  • Increased dependence on caregivers

Treatment Options

Several options are available to treat people diagnosed with Alzheimer’s disease and depression:

  • Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — for example, citalopram (Celexa) and sertraline (Zoloft) — are the first line antidepressants used for people who have depression and Alzheimer’s because of the low risk of side effects and drug interactions. Other antidepressants, such as venlafaxine (Effexor, Effexor XR) or bupropion (Wellbutrin), also may be used.
  • Physical exercise. Regular physical exercise, particularly in the morning, seems to ease the symptoms of depression.
  • Support groups and counseling. Support groups and professional counseling may help people with depression in the early stages of Alzheimer’s disease, before their communication skills deteriorate.
  • Electroconvulsive therapy. Some people with depression and dementia don’t respond to other treatments. In many of these cases, electroconvulsive therapy can help relieve symptoms of severe depression. The procedure delivers electricity to the brain for a few seconds, to trigger a seizure. Electroconvulsive therapy is used more frequently for older people than for younger people — perhaps because older people may have more side effects from antidepressants or have more severe complications from severe depression.

Making the right diagnosis and getting appropriate treatment can help make life easier and more enjoyable for both the person with Alzheimer’s and his or her caregivers.


By Mayo Clinic Staff

© 1998-2017 Mayo Foundation for Medical Education and Research. All rights reserved.


Understanding Behavioral Changes in Dementia

(Lewy Body Dementia Association) Most people with dementia undergo behavioral changes during the course of the disease. They may become anxious or repeat the same question or activity over and over. The unpredictability of these changes can be stressful for caregivers. As the disease progresses, your loved one’s behavior may seem inappropriate, childlike or impulsive. Anticipating behavioral changes and understanding the causes can help you deal with them more effectively.

Click here to download a PDF of this document.

What is the behavior telling you?
Persons with dementia often lose their ability to express themselves before they lose their ability to understand. Behavior becomes a means of communication. Ask yourself why your loved one is behaving this way. Then you can take steps to manage the behavior.

Tips for managing behavioral changes
When your loved one exhibits an undesirable behavior, your reaction may be to try to stop or change the behavior. But remember, you can’t reason with or teach new skills to a person with dementia. Instead, try to decrease the intensity or frequency of the behavior. Consider these approaches:

  • Remember that your loved one isn’t acting this way on purpose. Try not to get angry or upset or take it personally.
  • Speak calmly and softly to the person.
  • If the behavior is aggressive, back away. Give your loved one space. Then calmly approach him or her. Don’t argue.
  • Consider the potential cause of the behavior. Is your loved one tired, hungry, in pain, frustrated, lonely, bored? Could it be a side effect of medication?
  • Respond to the emotion, not the behavior. If your loved one keeps asking about a certain family member, he or she may need reassurance that this person is healthy and safe. Avoid trying to reason with the patient, this may often lead to frustration for both of you, because he or she may be unable to follow lengthy explanations.

If a behavior continues, keep a journal to identify patterns (time of day and possible triggering events), and this may provide clues regarding ways to intervene.

Validate, Join and Distract
One effective method for managing a difficult or annoying behavior is to validate, join and distract. For example, if your loved one constantly heads to the door asking to go home, efforts to try to distract him may not work. By simply interrupting the behavior, you don’t gain an understanding of why the behavior is occurring.

A more effective approach is to try to validate the emotion that you think is underlying the behavior. For example, say something like, “I know you miss your family.” Then sit down and look through family photo albums. This way, you haven’t just distracted the person but you’ve first joined in and validated the person’s emotions. Validating, joining and then using distraction may be most effective with people who are in the early to middle stages of the disease.

You know your loved one best
Let your knowledge of your loved one who has dementia guide your choices for distractions. For example, if she was a homemaker, stirring cookie dough or folding laundry may be meaningful activities. Responding to challenging behaviors takes creative solutions, patience and a willingness to be flexible.


Although persons with dementia typically lose recent memory skills, habits are a part of a different memory structure in the brain that tends to remain intact longer. By sticking to the same routine, your loved one doesn’t have to stop and think about what to do next. The routine becomes automatic. Components of a routine may include eating breakfast before getting dressed, sitting in the same recliner in the living room each morning, attending elder care in the afternoon and taking a bath in the evening.

Although organizing your own day may take little conscious effort, giving structure to the day of a person with dementia may pose special challenges. Thinking for two takes sensitivity, ingenuity and patience.

Using routine as a tool
As a caregiver, you know your loved one’s daily rituals better than anyone else. And, you’re in a unique position to customize and refine your loved one’s routine so that it includes meaningful activities for as long as possible. These daily activities, which may seem insignificant, honor the life of your loved one and provide him or her with a sense of purpose.

Keep in mind that just because your loved one is changing doesn’t mean other things must change. Where objects are located in your home, and when and where routine activities happen can stay the same even as your loved one’s disease progresses.

Other aspects of daily life should remain the same and be strengthened. These may include:

  • Personal hygiene routines
  • Mealtime routines such as preparation, serving, eating and cleanup
  • Household chores such as doing laundry, sweeping and dusting

You can use each one of these activities to reinforce routine and capitalize on your loved one’s strengths and interests.

These daily tasks also take advantage of procedural or habit memory. By capitalizing on the memory your loved one retains the longest, namely habit memory, you can involve him or her in meaningful, purposeful activities for longer.

The progressive nature of LBD, Alzheimer’s, and other forms of dementia requires that you re-examine your routine frequently — especially if you notice your loved one is agitated, unsettled or depressed. There will come a time when you can’t sustain even basic routines. At this point, flexibility is important. Maybe your loved one used to read the paper each morning but no longer can read. He or she may still be able to hold the paper and turn the pages, and if this is an activity that he or she enjoys and is meaningful to them, then it should be allowed to continue.

It is important for caregivers to step down expectations as the disease advances. Routine is a tool. Because no two people respond the same to a routine, it’s up to caregivers to decide what works best for them and the loved ones in their care.

Here are some tips for maintaining a routine:

  • Identify the routine. Routine tasks are those performed on a daily basis. Dressing for the day or walking the dog are routine tasks. Taking an annual trip to a cabin with extended family is not, and your loved one may now find it unsettling.
  • Retain important rituals. Maybe your wife preferred to eat the evening meal at a television tray in the living room. By continuing this habit in the same environment, you may cue your wife to eat and serve as a bridge to positive memories.
  • Remove distractions and limit choices. This may mean narrowing the clothing choices in the closet, offering two possible outfits to wear (or asking if your loved one would care to wear one particular outfit). It also may mean relocating an item in the house that may otherwise cause your loved one to lose interest in the task at hand.
  • Recognize that change may be necessary. Maybe your husband always helped set the table. As the disease advances, you can continue this routine with some changes. Perhaps your husband can continue to just put the spoons on the table, or maybe he can hold the spoons for a while before you put them on the table yourself. Educate your family and friends about the disease. Too many people visiting at one time may overwhelm your loved one and upset your routine. Before your friends visit, give them communication tips, such as not asking your loved one too many questions. (See “The Importance of Maintaining a Support Network.”)
  • Stay flexible. You can’t schedule every activity and event in advance. When an unexpected or unforeseen change occurs in the routine, just restart your routine the next day.


As a person’s condition progresses, his or her ability to communicate diminishes. Understanding the effects of the disease will help you communicate as effectively as possible for as long as possible

Your loved one may:

  • Be unable to remember names, thoughts or memories
  • Use the wrong words or invent words
  • Mispronounce or repeat words
  • Have difficulty organizing thoughts
  • May be easily distracted
  • Use more nonverbal gesture
  • Lose ability to reason and understand
  • Use language that is more direct or accusatory
  • May become withdrawn and speak very little

Medications and other health problems also may affect communication. If you notice significant or abrupt changes in your loved one’s ability to communicate, talk to his or her physician.

Tips for better communication Although you may find these changes frustrating and even alarming, you can counter them. Consider using these tips to improve communication with your loved one:

  • Make the effort. When communicating becomes difficult, your first response may be to stop. Recognize that communicating effectively may take more time and energy. Making the effort will help you sustain this vital aspect of your relationship with your loved one as well as preserve your loved one’s dignity.
  • Try to understand. Rather than correcting mispronunciations or inaccurate statements, recognize that your loved one may no longer be able to consistently come up with the right words, or may have trouble comprehending what you’re saying. Be patient and use phrases such as “I’m sorry, could you repeat that?” or keep the flow of conversation going by providing the elusive word.
  • Speak slowly, calmly and quietly. This will allow the person time to process what you are saying. People with dementia often watch our non-verbal cues (facial expression, body language, tone of voice) to interpret what we are saying and may mirror our mood.
  • Avoid quizzing, testing or trying to teach the person to remember. These techniques won’t work and will only serve to embarrass and humiliate. Imagine the feelings associated with not being able to recall a child’s name during such a test. Instead of saying, “Do you know who this is?”, try “Here is your granddaughter Susan who has come to visit.”
  • Reassure and comfort. Do not reality orient. The person may be worried about the children, parents, going “home” even if living at home or going to work even if long retired. Trying to convince them of the truth is generally fruitless and can be frustrating or even frightening. Jump into their world and help to make it less frightening by providing lots of reassurance. For example, if your loved one is worried because the children are not home from school yet, provide an explanation that might be acceptable and reassuring such as, “the children are staying at a friends house tonight, they are having a nice time”. If your loved one does not recognize you, go along with it or try stepping out of the room and announce your identity upon your return.
  • Be aware of your nonverbal communication. Speak slowly, calmly and in a normal volume. People with dementia can be sensitive to changes in mood, voice, posture or facial expression. You can do wonders to ease tension by smiling at a frustrating moment. If you have difficulty understanding what your loved one is saying, listen for the feelings behind what he or she is trying to communicate and validate those feelings. For example, say, “I know that you’re frustrated right now” or “I’m glad you’re so happy today.”
  • Forgive yourself when you don’t always respond appropriately. You may find it difficult to communicate with as much understanding and patience as you’d like to. Keep in mind that because of the memory loss, your loved one is unlikely to remember everything you say.
  • Simplify your communication. Stand directly in front of your loved one and make eye contact. Communicate one idea at a time and use simple instructions. Try breaking even simple tasks into one-step commands. If you’re helping with a task, let your loved one know what you’re going to do next. If possible, demonstrate what you want your loved one to do — such as brushing teeth or putting on a jacket. If you must repeat things, try to use the same words. If your loved one doesn’t understand a second time, then try rewording. Avoid abstract concepts, which your loved one may find difficult to grasp. For example, phrases such as “jump into bed” can be confusing. Instead, use direct statements such as “it’s time to get into bed.”
  • Validate the feeling behind the words. Even if you are unable to understand what is being communicated, look at the non-verbal signs of emotion. Is she upset? Joyful? Afraid? Respond accordingly providing lots of affection and comfort.
  • Reminiscence can be very useful and validating. Persons with dementia usually retain their memories from long ago. Discussing these memories and prior accomplishments often provide a sense of security.
  • Do not try to argue or reason with the person. Their ability to reason is no longer there, and the person will not be able to remember your reasoning or rationally weigh your points. Do not argue with the person over what they see, hear or feel. If the person is seeing things you don’t see, reassure him and respond to his or her feelings about it. Remember that these ideas or hallucinations are very real to the person who is experiencing them. Rather, offer reassurance and validation (e.g., “I know this is troubling for you, let me see if I can help”).
  • Reduce clutter, extraneous noises or confusing aspects in the environment. Check out any real basis to the person’s fear. For example, the person may “hear people” in the next room because the TV is on.
  • If the person misplaced something and thinks you or someone else “stole it,” offer to help look for the item. Keep track of frequent hiding places, and if possible keep duplicates of the item.
  • Accept changes. Keep in mind that the changes you see and hear in your loved one are a result of the disease, not of your loved one trying to be difficult or hurtful. When your loved one says inappropriate things, remember it’s the disease talking. Try not to take it personally.

Even when your loved one no longer responds in the way he or she once did, your efforts to communicate will help to keep him or her engaged in life for as long as possible.


People with dementia are likely to walk or pace aimlessly at some point during the disease. This wandering behavior can occur both indoors and outdoors, and it may have several causes. It may be the result of memory loss and disorientation. It may be a sign of curiosity, restlessness or boredom. Or it may be an attempt to express an emotion, such as fear or loneliness, or basic need, such as hunger or thirst. Here are some tips to help cope with this challenge, determine which ones work best for you and adapt them to your specific situation.

To help reduce or manage your loved one’s tendency to wander:

  • Understand the disease process. People with dementia often have deteriorating communication skills. When language is gone, behaviors may be the only way your loved one can communicate. By wandering, your loved one may be trying to share feelings of fear, isolation, loneliness or confusion. Provide comfort with a hug and a reminder that he or she is safe and in the right place.
  • Make sure your loved one is getting enough food, drink, rest and opportunities to use the bathroom. If your loved one has trouble expressing wants, wandering may be the only way he or she can tell you that these basic needs aren’t being met.
  • Take a daily walk or engage in excercise with your loved one, if possible. This may reduce anxiety, agitation and restlessness and reduce the tendency to wander.
  • Allow your loved one to wander in safe areas, such as a fenced yard or looping set of hallways, with supervision. This can be a natural way to explore and adapt to surroundings.
  • Maintain a quiet environment. Wandering can occur when there’s too much stimulation, such as multiple conversations or a loud television.
  • Keep your loved one engaged in daily chores and activities. Restlessness and boredom can lead to wandering.
  • Make your living space safer by removing throw rugs, moving electrical cords and possibly rearranging furniture. Use night lights and install gates at stairwells in case your loved one wanders at night.
  • Install childproof doorknobs or latches mounted high on doors or post a stop sign on your home’s exit doors. This may deter outdoor wandering.
  • Keep a family photo album handy. Your loved one’s wandering may indicate a desire to look for family members or something familiar.
  • Post signs that say “Bathroom,” “Bedroom” and “Kitchen” on the corresponding doors in your home. Your loved one may forget where he or she is and may have difficulty finding these rooms without guidance.
  • Keep car keys out of sight. Wandering doesn’t always occur on foot.
  • If your loved one tries to leave the house, do not stop him. Forcefully trying to restrain a person set on leaving can result in injury and a catastrophic reaction (severe distress). Rather, go with him or her for a “walk”, go on an outing (even if it just for a drive around the block), or let them go and then follow them to ensure safety. Even if it is the middle of the night, the few minutes you go for a walk is better then the hours of distress (and possibly injury) associated with trying to stop a person with dementia from leaving
  • Enroll your loved one in the Alzheimer’s Association’s “Safe Return” program. This is a nationwide identification system designed to assist in the safe return of people who become lost when wandering. Caregivers pay about a $40.00 registration fee. In return, they receive an ID bracelet, name labels for clothing, ID cards for a wallet or a purse, registration in a national database with emergency contact information, access to a nationwide alert system and a 24-hour toll-free number for reporting lost persons. To register someone, contact a local chapter of the Alzheimer’s Association or call 800-272-3900.


When people with dementia become frustrated, scared or unable to communicate, they may become irritable or angry. Sometimes a person may experience a catastrophic reaction. This may occur in response to variety of occurrences including: loud noise (radio, TV, person), multiple questions, “why” questions, feeling insecure, feeling left out, small accidents, being reprimanded, arguments, a tense or irritable caregiver, or tasks that are too difficult. Try to see the situation from the patient’s point of view.

  • Make sure your loved one gets enough sleep. Fatigue can cause combativeness.
  • Reduce loud noises and physical clutter in your home. Loud noises and clutter can over stimulate your loved one. Limit guests to one or two at a time, and use television sparingly.
  • Don’t expect too much. Don’t try to teach new information or ask your loved one to perform tasks he or she has been unable to complete in the past. This only results in frustration.
  • Include exercise and light housekeeping chores in your loved one’s daily routine. This may reduce the restlessness that can lead to agitation and aggression.
  • Don’t argue with or quiz your loved one to test his or her memory. This can lead to agitation. If you need to ask your loved one questions, make them easy to understand and ask them one at a time.
  • Keep your loved one’s routine and environment consistent and simple. Changes — even small ones — can cause agitation. If you need to make changes, make them gradually.
  • Try to be pleasant. If you’re feeling angry, stressed, irritated or impatient, try not to let it show. Respond to your loved one in a calm, reassuring way. That doesn’t mean you should deny your feelings, however. Just try to deal with them at a later time, and it may be be a cue that it is time to obtain additional assistance, so you can have some respite from caregiving responsibilities.
  • If your loved one becomes frustrated, provide reassurance and distract him or her with another activity. After some time has elapsed, you can return to the original activity if necessary.
  • Don’t panic. If your loved one becomes agitated or aggressive, don’t resort to physical force. Try instead to soothe your loved one by holding hands, gently patting his or her back. Some people do not like to be touched when they are feeling agitated, and for those individuals it may be best to leave the room or to sit quietly a safe distance from him or her.
  • Consider the 5 “R”s in handling catastrophic reactions: Remain calm, respond to feelings, reassure the person, remove yourself, return later.
  • Check out the reality of a situation; maybe what the person says or thinks is true.
  • Remember that whispering or laughing around the person may be misinterpreted.
  • Consult a physician. Sometimes agitation is caused or aggravated by physical symptoms of pain, discomfort, physical illness or a co-occurring depression.


Exercise may not be high on your list of caregiving priorities. But you should consider it. There are many well-documented benefits of exercise for people who have dementia — benefits that also may make it easier for you to cope.

Benefits of exercise

Helping your loved one stay active may:

  • Improve strength, endurance and cadiovascular health
  • Reduce risk of falls and fractures
  • Improve energy, circulation, stamina and mood
  • Improve sleep
  • Promote regular bowel and bladder function
  • Help maintain flexibility and balance, reducing the risk of serious injury from falls
  • Help sustain the ability to perform self-care activities, such as grooming and dressing
  • Impart a sense of belonging, purpose and contribution
  • Create a calming effect through familiar activity

Getting started:

If you’re interested in making exercise part of your loved one’s daily routine, consider these tips:

  • Consult your loved one’s doctor first. Other medical conditions that your loved one may have, such as high blood pressure or heart disease, may affect the type of program you can establish.
  • Offer support and encouragement but not pressure. Pushing your loved one beyond what he or she is comfortable doing may cause frustration.
  • Go with the familiar. Plan safe, supervised activities your loved one has enjoyed in the past, such as walking, swimming, golf or tennis. These offer the best chances for success.
  • Exercise with your loved one. This may even help you manage the stress of caregiving.
  • Adapt activities to your particular situation. If your loved one was once an avid golfer, for example, hitting chip shots in the backyard still may provide enjoyment.
  • Establish a regular routine. Exercise at the same time each day, if possible, and keep the sequence of activities the same each time. If you and your loved one walk together, for example, use the same walking path each time to minimize confusion. When it rains, walk inside a mall or in your home.
  • Ask your loved one to follow your lead while exercising. Offer simple instructions or directions. Or use an exercise videotape as a guide for some light stretching or calisthenics.
  • Look to outside resources. If your loved one enjoys exercising with others, contact your local senior citizen’s center for information about group exercise programs.
  • Look for creative options. Walk outdoors and watch birds as you go, or dance to music that your loved one enjoys. If outdoor gardening is no longer an option, plant and tend an indoor container garden or take a walk in a local nursery.
  • Wear loose-fitting clothes and comfortable shoes. If you’re exercising outdoors in cool weather, wear layers of clothing appropriate to the temperature. This is especially important if your loved one has lost the judgment required to solve everyday problems, such as knowing what to do if he or she gets too cold.
  • Remember to warm up. Before any activity, walk for a few minutes and then do gentle stretching exercises for the upper and lower body.
  • Watch for changes in your loved one’s capacity for exercise. As dementia progresses, his or her capacity for exercise decreases. If you see this happening, cut back or try less strenuous activities so that your loved one can stay active as long as possible.
  • Never ignore comments about pain, dizziness or shortness of breath. Consult a doctor if your loved complains of these symptoms.

Keep it fun

When factoring exercise into your care giving goals, aim to help your loved one remain as independent as possible while providing exercise options that offer purpose, meaning, pleasure and fun. In the process, exercise may even enhance your relationship.


Nearly 90 percent of adults older than 65 who live at home have complaints about sleep. However, among people with dementia, the problem is even more severe. In fact, sleep problems are one reason people with dementia end up in nursing homes.

Stress, alcohol use, poor sleep habits, certain medications and an additional illness can all contribute to disturbed sleep among people with dementia, as can an underlying sleep disorder.

What is “sundowning”?

Many people with dementia experience periods of increased agitation, confusion and restlessness beginning at dusk and continuing through the night. This late-day phenomenon has sometimes been called sundowning. Nighttime agitation can make it impossible for the person under your care to get the sleep he or she needs to function well. How to cope To help prevent nighttime agitation in your loved one with dementia, try these tips:

  • Don’t serve your loved one alcohol. It contributes to confusion and can increase anxiety. If the person insists on having a drink, try serving a nonalcoholic drink in a familiar cocktail glass, or serve nonalcoholic beer or wine.
  • Limit caffeine-containing foods and beverages (sodas, coffee, chocolate) to mornings only. Consuming caffeine later in the day can cause sleeplessness.
  • Plan to go outside, or have your loved one sit near natural light. Exposure to sunlight helps to set the body’s internal clock and may also improve mood.
  • Plan days to include plenty of interesting activities. Involvement in daytime tasks, such as walks, car rides or exercise help to keep the day filled with meaningful activities. However, avoid overstimulation. This can lead to exhaustion and disorientation. Taper activities off as the day winds down.
  • Establish set times for getting up and going to bed. Try not to deviate from those times. If possible, set the same sleep and wake schedule the person maintained during his or her working years. If you feel your loved one is sleeping too late, wake him or her up earlier.
  • Limit daytime napping. If your loved one needs a nap, make sure it’s short and not too late in the day. Have him or her take the nap on the couch or in a recliner rather than in bed. Reserve the bed for nighttime sleep.
  • Feed your loved one a light snack before bed. If he or she awakens during the middle of the night, try warm milk or herbal tea.
  • Establish a bedtime routine of relaxing activities, such as listening to soft music or giving your loved one a backrub. Do the same things in the same way every night (including using the bathroom before bed). The structure and routine may be comforting to the person with dementia.
  • Avoid upsetting activities near bedtime. If bathing or dressing for bed is difficult, do it earlier in the day. Let your loved one use the couch or recliner if he or she refuses to go to bed.
  • Create a comfortable, familiar place for sleeping. Make sure the bedroom is cool and quiet. Have extra blankets available, if needed, especially a favorite blanket, pillow or soft object. Make sure that the person’s bed linens and pajamas aren’t too restrictive or full of uncomfortable wrinkles and folds. Use a night light in the room.
  • Make sure the bedroom is safety-proofed. Keep the area around the bed uncluttered, and make sure the path to the bathroom is clear and softly lit.
  • If your loved one has a tendency to act out his or her dreams, make sure there are no breakable objects nearby and check with your doctor about treatment.
  • If your loved one awakens during the middle of the night and is upset, stay calm. Ask what he or she needs, and reassure that everything is all right. A reminder of the time of day may be helpful. Don’t argue or demand explanations. If you find your loved one wandering in the house, gently guide him or her back to bed or ask if there is a need to go to the bathroom or a desire for a drink of water, and then a gentle reminder that it is time to go to bed.
  • Your doctor can help. If these tactics don’t work, call your doctor. Physical ailments such as bladder or incontinence problems could be interfering with your loved one’s sleep. Your loved one may have an underlying sleep disorder, such as Sleep Apnea or Periodic Limb Movement Disorder that may benefit from evaluation and treatment. Your doctor may also be able to prescribe medication to help the person relax at night or may be able to change a medication if it’s disturbing sleep.


Moving from one house to another can spur anxiety in almost anybody. For people with dementia, however, changes in routine and an unfamiliar environment can be especially stressful. Here’s some advice for making the transition to a new home or care facility as comfortable as possible for the person with dementia.

Add familiar touches

Even before you bring a loved one to a new home, it’s important that the room or space where the person will be is made to look and feel as familiar as possible.

When your loved one sees his or her own things, it triggers that it’s your loved one’s own space — which is important. Some things you can do before the person moves in include:

  • Add a favorite quilt or piece of furniture, such as a chair, perhaps a shelf with special items, and other meaningful possessions belonging to the person.
  • Bring pictures of family and friends, memory books or photo albums. These are particularly important.

Reminiscing about the past is especially important for people with dementia, and items that enable them do this help create comfort and reduce anxiety. Label the pictures so staff will know the names of the people in them and can talk more knowingly about them.

Make a moving day plan

Plan for the day that you will have to move your loved one. Talk to your loved one — while he or she can still make choices — about what he or she wants. Where does your loved one want to live? Explore all your housing options. Start talking before a move is imminent.

On the actual day, move your loved one during the “best” time of his or her day — whether morning or afternoon. This can also make the transition go more smoothly.

In addition, spend time during moving day reminiscing with your loved one, looking at photo albums or memory boxes. This activity is helpful not only for relieving anxiety in the person with the disorder but also for you.


As primary caregiver for your loved one with dementia, you know what an overwhelming and time-consuming job it can be. Even with help from extended family, you may reach a point where you need to enlist the help of others — whether church volunteers or home health aides — to allow you to take short breaks or to provide ongoing help.

It’s important to know what options are available in your community for caregiving assistance. The key is to identify these options before you need them because it may take some time to implement them. Here’s how to get started.

Consider what kind of help you need

As primary caregiver, you know your loved one’s routines, medical concerns and personality. Does your loved one need:

  • Consistent companionship and socialization?
  • Supervision during certain hours of the day for safety reasons?
  • Help with dressing, bathing or eating?
  • Medical assistance with injections, a catheter or a medical device, such as an oxygen tank?

Also, take into consideration your own needs. Do you need regular help with certain household chores or short breaks from your caregiving responsibilities? Your answers to these questions will help guide you to the appropriate individuals and agencies.

Examine your options for help

Depending on your need, you have several options for help:

  • Volunteer assistance. You may find willing volunteers in your neighborhood, church or workplace. Volunteers can provide companionship for your loved one as well as assist you with tasks such as running errands, driving to and from doctor’s appointments or making meals. The Area Agency on Aging’s Elder Locator may be able to help you find a volunteer. Call 800-677-1116 to find the agency nearest you.
  • Homemakers. They provide home management services, including vacuuming, grocery shopping, laundry and meal preparation.
  • Home health aides and personal care attendants. These people assist with personal care, such as bathing, dressing and grooming. They work under the supervision of a professional nurse or physical or speech therapist.

Your local Alzheimer’s Association chapter can help you identify volunteer programs, trained individuals and the names of agencies that provide other supportive and health care services. To locate your local chapter of the Alzheimer’s Association, call 800-272-3900.

To help you narrow your caregiving-assistance options, consider the following:

  • Specialized skills required. Does your loved one have difficulty communicating or walking, have safety concerns or need help in the bathroom?
  • Time needed. How much help do you need? A few hours a week, a couple of days a week, every day, overnight or weekends? Also, factor in your own need for time to do errands and to rest.
  • Best location. Where can care be provided? At home or at an elder care facility, a residential setting or a medical care facility?
  • Payment options. How will you pay for the care? Check what your loved one’s insurance will cover. Consult with physician for prescriptive in-home help, such as visiting nurses. Contact an elder attorney for assistance with determining what your state allows for financial assistance and medicare/medicaid assistance. Does your loved one qualify for government assistance? If you’re planning to pay out-of-pocket, how much are you able to spend?

Hiring help

Develop a list of questions to guide your inquiries and interviews with job candidates. Here are several questions to get you started:

  • What training have you had?
  • What past in-home care experience have you had?
  • What is your past experience working with someone who has dementia?
  • Why are you interested in this type of work?
  • What special skills do you have, such as singing, playing the piano, doing activities?

Some additional tips:

  • Ask the candidate to respond to a particular hypothetical situation. For example, “If my father insists that he can leave the house and drive the car, what would you do?”
  • Get recommendations and check references. You can get recommendations from local home health care agencies, your local Office on Aging, the American Association of Retired Persons or your local Alzheimer’s Association chapter. Always check the candidate’s references.

Entrusting your loved one to the care of others is a big step. But don’t be afraid to ask for help when you need it. By taking the time to pinpoint your needs and identify the appropriate type of help, you can rest assured that you’re doing the best thing for yourself and your loved one.


As a caregiver, it is very important that you make sure your own needs are met and that you take care of yourself as well.

  • Identify the stressors in your caregiving role. What tasks or behaviors are most frustrating or anxiety-producing? Think through and plan your responses to these stressful situations.
  • Access all the information you can about the disease and educate yourself as much as possible about its progression.
  • Get adequate rest.
  • Try to keep incidents in perspective.
  • Write feelings or thoughts in a journal. Writing things down will often help put them into better perspective and will be a way of releasing emotions.
  • Set realistic goals regarding what and how much you can do for your loved one.
  • Be good to yourself. Give yourself frequent praise and rewards for your patience and endurance. Continue to find ways to have fun.
  • Use your sense of humor – it relieves stress and is a positive emotional release for both of you.
  • Identify and be willing to use your support system. Avoid isolation. Have someone available to vent.
  • If family or friends offer help, accept it.
  • Set aside certain days or parts of certain days for yourself, and find a companion or day program for your loved one for that period of time.
  • Forgive yourself for not being perfect and stop trying to be perfect. Don’t be hard on yourself when you experience impatience, frustration, sadness or anger.
  • Take care of yourself physically and emotionally. Eat well balanced meals, get regular checkups and exercise.
  • Find sources for personal satisfaction.


Caring for a person with dementia can be an overwhelming experience. The physical demands can be exhausting. In addition, there is the emotional stress of trying to balance caregiving with your job, family and other relationships. It’s not uncommon to feel angry, guilty, frustrated, discouraged, worried, grief-stricken, isolated and taken for granted.

A dementia support group provides you with an opportunity to share these feelings, learn new caregiving techniques and identify resources.

Benefits of support groups

  • Provide you with up-to-date information and ongoing education about dementia and caregiving
  • Provide practical suggestions regarding challenging behaviors
  • Allow you to verbalize your thoughts and feelings about caregiving
  • Teach you various methods of coping with the stress of caregiving
  • Identify additional caregiving options and resources
  • Help prepare you for future planning and decision making
  • Give you the opportunity to meet other people who can empathize with your situation

Do you have to join a group?

Support groups aren’t for everyone. Some people find that friends and family are sufficient. However, support groups can be beneficial if you find you’re emotionally drained in spite of support from your family and friends. You may feel less alone when talking with others who face similar dementia challenges.

Types of groups

In general, support groups fall into two main categories: those led by professional facilitators (doctor, nurse, social worker) and those led by group members, which are often called peer or self-help groups.

Some groups are more educational and structured. Members may invite a doctor to talk about a specific challenge of dementia or a new experimental treatment. Other groups emphasize emotional support and shared experience.

In addition to traditional support groups, the Internet offers virtual dementia support groups and communities. There are LBD support groups listed on the Lewy Body Dementia Association website

The Alzheimer’s Association’s caregivers’ community allows youto connect with other caregivers and share artwork, poetry and short stories related to your experience.

Finding a group

To find a dementia support group near you:

  • Visit the Lewy Body Dementia Association website for local and online LBD support groups.
  • Visit the Alzheimer’s Association website. Type in your ZIP code or search by state.
  • Contact the Area Agency on Aging in your area.
  • Ask a health care provider for assistance. A doctor, nurse, social worker, clergy member or psychologist may be able to refer you to a local dementia support group.
  • Check your local telephone book and newspaper for a listing of dementia support resources.
  • Contact community centers, libraries, churches or synagogues in your area. Some offer support groups.
  • Ask others you know for suggestions.

Most support groups are free, collect voluntary donations or charge only modest membership dues to cover expenses.
Choosing a support group

Choosing a group that’s right for you depends on several factors. The key is finding one that matches your needs – and personality.

You may find that you prefer a structured, moderated group. Or you may feel more at ease meeting less formally with a small group of people. The anonymity of going online may be appealing, but the trade-off may be that you don’t know who else is online with you or whether you can believe everything you read.

If you decide to take part in a group (real or virtual), try it out a few times. If you don’t find it useful or comfortable, you don’t have to continue. Trust your gut feeling. If you’re nervous or hesitant about sharing personal issues with a group of people you don’t know, consider attending one meeting. You don’t have to talk, and you may gain from just listening.

You may have to experiment with different kinds of support groups before you find one that meets your needs. But keep at it. You may learn new things and form new friendships. And you just might find that a support group helps you cope more effectively with the demands of dementia caregiving in your everyday life.


© 2016 Lewy Body Dementia Association, Inc.


Tips for Managing Common Symptoms and Problems in Dementia Patients

(HelpGuide) As a caregiver for a loved one with Alzheimer’s or dementia, it can be extremely worrying to experience behavior problems such as wandering, aggressiveness, hallucinations, or sleeping and eating difficulties. Many behavior problems are made worse by a poor environment and an inability to deal with stress. By learning how to make changes in the caring atmosphere, you can increase the quality of life for both the patient and yourself.

Identify the Causes of Alzheimer’s or Dementia Behavior Problems

One of the major challenges of caring for a loved one with Alzheimer’s or dementia can be coping with the troubling behavior and personality changes that often occur. It’s important to remember that the person with dementia is not being deliberately difficult. Your loved one’s sense of reality may be different to yours, but it’s still very real to him or her. As a caregiver, you can’t change the person with dementia, but you can employ strategies to modify or better accommodate any problem behaviors. Both the environment you create at home and the way you communicate with your loved one can make a huge difference.

The patient’s behavior can often be a reaction to stress or a frustrated attempt to communicate. If you can establish why the patient is stressed or what is triggering any discomfort, you should be able to resolve the problem behavior with greater ease. Remember, the patient responds to your facial expression, tone of voice, and body language far more than the words you choose. Use eye contact, a smile, or reassuring touch to help convey your message and show your compassion. Try not to take problem behaviors personally and do your best to maintain your sense of humor.

While these caregiver tips are directed at those caring for Alzheimer’s patients, the same behavior problems are also common in other types of dementia.

Some ways to help identify the causes of problem behavior:

  • Try to put yourself in the person’s situation. Look at your loved one’s body language and imagine what he or she might be feeling and what they might be feeling or trying to express.
  • Ask yourself what happened just before the problem behavior started? Did something trigger the behavior? Try a different approach to see if that changes the reaction.
  • Are the patient’s needs being met? Is the patient hungry, thirsty, or in pain?
  • Does changing the environment or the atmosphere help to comfort the person?
  • How did you react to the problem behavior? Did your reaction help to soothe the patient or did it make the behavior worse?

Create a Calm and Soothing Environment

The environment and atmosphere you create while caregiving can play a large part in helping an Alzheimer’s patient feel calm and safe.

  • Modify the environment to reduce potential stressors that can create agitation and disorientation in the Alzheimer’s patient. These include loud or unidentifiable noises, shadowy lighting, mirrors or other reflecting surfaces, garish or highly contrasting colors, and patterned wallpaper.
  • Maintain calm within yourself. Getting anxious or upset in response to problem behavior can increase the patient’s stress or agitation. Respond to the emotion being communicated by the behavior, not the behavior itself. Try to remain flexible, patient, and relaxed. If you find yourself becoming anxious or losing control, take a time out to cool down.

Manage stress in an Alzheimer’s patient

Different stress-reducing techniques work better for some Alzheimer’s patients than others, so you may need to experiment to find the ones that best help your loved one.

  • Exercise is one of the best stress-relievers for both the Alzheimer’s patient and you, the caregiver. Consult with your loved one’s physician to make sure it’s safe to participate in light exercise. Regular walking, movement, or seated exercises can have a positive effect on many problem behaviors, such as aggression, wandering, and difficulty sleeping. Indoor shopping malls are vast walking opportunities protected from the weather. Or you may even consider singing and dancing.
  • Simple activities can be a way for the patient to reconnect with their earlier life. Someone who used to enjoy cooking, for example, may still gain pleasure from the simple chore of washing vegetables for dinner. Try to involve the person in as many productive daily activities as possible. Folding laundry, watering plants, or going for a drive in the country can all help to manage stress.
  • Remembering the past may also help soothe the Alzheimer’s patient. Even if your loved one can’t remember what happened a few minutes ago, he or she may still clearly recall things from decades ago. Try asking general questions about the person’s distant past.
  • Use calming music or play the person’s favorite type of music as a way to relax them when agitated. Music therapy can also help soothe the person during mealtimes and bath times, making the processes easier for both of you.
  • Interacting with other people is still important. While large groups of strangers may only increase stress levels for an Alzheimer’s patient, spending time with different people in one-on-one situations can help to increase physical and social activity.
  • Pets can provide a source of positive, nonverbal communication. The playful interaction and gentle touch from a well-trained, docile animal can help soothe an Alzheimer’s patient and decrease aggressive behavior. If you don’t have a pet of your own, see Resources section below for organizations that offer pet visits.

Take time to connect with the Alzheimer’s patient

Taking the time to really connect with the person you’re caring for can release hormones that boost the patient’s mood and reduce stress. And it can have the same effect on you, too.

Even if the person you’re caring for can no longer communicate verbally, it’s important to take a short time when you’re at your calmest to focus fully on him or her. Avoid all distractions—such as the TV, cell phone, and computer—make eye contact (if that’s possible), hold the person’s hand or stroke his or her cheek, and talk in a calm, reassuring tone of voice. When you connect in this way, you’ll both experience a process that lowers stress and supports well-being.

Managing Alzheimer’s Symptoms: Wandering

While wandering around the house may be irritating to you as the caregiver, it’s not necessarily unsafe for the patient. However, some wandering can be dangerous: going into areas of the house such as stairwells, decks, hot tubs, or swimming pools; leaving the house alone via a window or door; or leaving your yard or property.

Two characteristic precursors to wandering are restlessness and disorientation. An Alzheimer’s patient may exhibit signs of restlessness when hungry, thirsty, constipated, or in pain. They may also become disoriented, pace, or wander when bored, anxious or stressed due to an uncomfortable environment or lack of exercise. To address this you can:

  • Make time for regular physical exercise to reduce restlessness
  • Immediately redirect pacing or restless behavior into productive activity or exercise
  • Reassure the person if they appear disoriented
  • If wandering tends to occur at a particular time of day, distract the person at that time with another activity
  • Reduce noise levels and confusion. These can disorient the person. Turn off the TV or radio, close the curtains, or move the person to quieter surroundings.
  • Acclimate ahead of time if you move the patient to a new environment by making several visits
  • Consult the doctor if disorientation is becoming a problem. Disorientation can be a result of medication side effects, drug interactions, or over-medicating.

Practical ways to prevent wandering

You may be able to prevent wandering by:

  • Installing child-safety devices in your home to keep doors and windows secured
  • Hiding items like purses, shoes, or glasses that the person would always take with them if they left the house
  • Acquiring comfortable chairs that restrict movement, making it difficult for the patient to stand up without assistance

Planning for when the Alzheimer’s patient does wander

In case an Alzheimer’s patient in your care does wander, it’s a good idea to have a plan in place.

  • Notify neighbors and local police about the Alzheimer’s patient’s tendency to wander, and make sure they have your phone number.
  • Have your loved one wear an ID bracelet or ID labels in clothing. New digital devices using GPS or cellular technology can track the patient’s location if he or she wanders off.
  • If a police search becomes necessary, you’ll need a recent photo of the person’s face. Also keep on hand some unwashed clothing to help search-and-rescue dogs. (To do this properly, place the clothing in a plastic bag with plastic-gloved hands, and replace the clothing monthly.)
  • In the U.S., sign up for the Alzheimer’s Association’s Safe Return Program, an identification system to help rescue lost Alzheimer’s patients who have wandered away (see Resources section below).

How to find a missing Alzheimer’s patient

A person with dementia may not call out for help or answer your calls, and often won’t leave many physical cues. He or she may get trapped somewhere, leaving them at risk for dehydration and hypothermia.

  • Check dangerous areas near the home, such as bodies of water, dense foliage, tunnels, bus stops, high balconies, and heavily traveled roads.
  • Look within a one-mile radius of where the patient was before wandering.
  • Look within one hundred feet of a road, as most wanderers start out on roads and remain close by. Especially look carefully into bushes and ditches, as the person may have fallen or become trapped.
  • Search in the direction of the wanderer’s dominant hand. People usually travel first in their dominant direction.
  • Investigate familiar places, such as former residences or favorite spots. Often, wandering has a particular destination.
  • If you suspect that the person used a car or public transportation, you’ll need to consider likely places that are farther afield.

Managing Alzheimer’s Symptoms: Rummaging and Hiding Things

Caring for a patient who rummages around or hides things in the home is a challenge, but not an insurmountable one.

Protecting your property

  • Lock certain rooms or cabinets to protect their contents, and lock up all valuables.
  • Have mail delivered out of reach of the Alzheimer’s patient—perhaps to a post office box.
  • If items do disappear, learn the person’s preferred hiding places.
  • Restrict access to wastebaskets and trashcans, and check all wastebaskets before disposing of their contents in case objects have been hidden there.

Protecting Alzheimer’s patients from harming themselves

  • Remove or prevent access to unsafe substances, such as cleaning products, alcohol, firearms, power tools, sharp knives, and medications.
  • Prevent electrical accidents by blocking unused electrical outlets with childproofing devices. Hide stove knobs so the person can’t turn on the burners.
  • Lower the temperature on water heaters.
  • Designate a special drawer of items that the person can safely “play” with when keen to rummage.

Managing Alzheimer’s symptoms: Belligerence, Anger, or Aggressive Behavior

While creating a calm environment can have a large impact on managing the stress that often results in aggressive behavior, there are also some things you can do during an angry outburst.

  • Don’t confront the person or try to discuss the angry behavior. The person with dementia cannot reflect on unacceptable behavior and cannot learn to control it.
  • Do not initiate physical contact during the angry outburst. Often, physical contact triggers physical violence.
  • Let the person play out the aggression. Give him or her space to be angry alone. Just be sure that both you and the patient are safe.
  • Distract the person to a more pleasurable topic or activity.
  • Look for patterns in the aggression. Consider factors such as privacy, independence, boredom, pain, or fatigue. Avoid activities or topics that anger the person. To help find any patterns, you might keep a log of when the aggressive episodes occur. If the person gets angry when tasks are too difficult, break down tasks into smaller pieces.
  • Get help from others during the activities that anger the patient.
  • Don’t take the aggressiveness personally. It, too, is just part of the dementia.

Managing Alzheimer’s Symptoms: Hallucinations and Suspicion

Hallucinations can be the result of failing senses. Maintaining consistency and calmness in the environment can help reduce hallucinations. Also, violent movies or television can contribute to paranoia, so avoid letting the patient watch disturbing programs.

When hallucinations or illusions do occur:

  • Don’t argue about what is real and what is fantasy.
  • Respond to the emotional content of what the person is saying, rather than to the factual/fictional content.
  • Seek professional advice if you are concerned about this problem. Medications can sometimes help to reduce hallucinations.

Alzheimer’s and suspicion

Confusion and the loss of memory can also cause Alzheimer’s patients to become suspicious of those around them, sometimes accusing their caretakers of theft, betrayal, or some other improper behavior.

  • Offer a simple answer to any accusations, but don’t argue or try to convince them their suspicions are unfounded.
  • Distract the patient with another activity, such as going for a walk, or by changing the subject.
  • If suspicions of theft are focused on a particular object that is frequently mislaid, such as a wallet for example, try keeping a duplicate item on hand to quickly allay the patient’s fears.

Managing Alzheimer’s Symptoms: Sleep Problems

Brain disease often disrupts the sleep-wake cycle. Alzheimer’s patients may have wakefulness, disorientation, and confusion beginning at dusk and continuing throughout the night. This is called “sundowning.”

There are two aspects to sundowning. First, confusion, over-stimulation, and fatigue during the day may result in increased confusion, restlessness, and insecurity at night. And second, some Alzheimer’s patients have fear of the dark, perhaps because of the lack of familiar daytime noises and activity. The patient may seek out security and protection at night to alleviate this discomfort.

Ways to reduce nighttime restlessness

  • Improve sleep hygiene. Provide a comfortable bed, reduce noise and light, and play soothing music to help them get to sleep. If the person prefers to sleep in a chair or on the couch, make sure they can’t fall out while sleeping.
  • Keep a regular sleep schedule. Be consistent with the time for sleeping and keep the nighttime routine the same. For example, give the person a bath and some warm milk before bed.
  • Keep a night light on. Some people with dementia imagine things in the dark and become upset. Stuffed animals or a pet may also help soothe the patient and allow them to sleep.
  • Place a commode next to the bed for nighttime urination. Walking to the bathroom in the middle of the night may wake the person up too much, and then they can’t get back to sleep.
  • Increase physical activity during the day to help the person feel more tired at bedtime.
  • Monitor napping. If the person seems very fatigued during the day, a short rest in the afternoon can lead to a better night’s sleep. But keep naps short—too much daytime sleep can increase nighttime wakefulness.
  • Limit the patient’s caffeine, sugar, and junk food intake during the day.

Dealing with nighttime wakefulness and pacing

If the patient paces during the night, make sure that the primary daytime caregiver can sleep. This requires either a very safe room for the patient to pace in, or else another caregiver who takes over at night. You need your rest, too. Do not restrain the patient in bed, but consider a hospital bed with guardrails in the later stages of Alzheimer’s. If night wakefulness has gotten too hard for you to manage, consult with a doctor if you wish to try administering sleeping pills.

Bright Lights, Better Sleep?

Often, people who have dementia find it harder to respond to day and night transitions, which can make it difficult to get to sleep or stay asleep. A recent study found that adding daytime bright light exposure to the use of melatonin supplements improved sleeping patterns in dementia patients. They enjoyed longer uninterrupted sleep, fewer episodes of getting out of bed at night, and less agitated behavior.

Adapted with permission from A Guide to Alzheimer’s Disease, a special health report published by Harvard Health Publications.

Managing Alzheimer’s Symptoms: Eating Problems

Ensuring someone with Alzheimer’s eats and drinks enough can be a challenge for any caregiver. These tips may help:

  • Encourage exercise – Exercise can make a person feel hungrier: The hungrier the person feels, the more likely he or she is to eat.
  • Monitor medications – Some medications interfere with appetite. Others may cause dry mouth, so make sure that the patient gets enough liquids with food. Discuss eating problems with your loved one’s doctor to see if medication needs to change.
  • Make mealtimes pleasing to the patient – Add flowers to the table or play soothing music. Make the patient’s favorite food and serve it on dishes that contrast highly with food colors. Reduce distractions in the eating area. Also, avoid foods that are too hot or too cold, as these may be unpleasant to the patient.
  • Feed the patient like a baby – Try giving the patient little spoonfuls, and sing short, funny rhymes to get him or her to eat. Get the person to smile so that the mouth opens, and then slip a little food in. Provide finger foods and children’s sipper cups, as the person may have trouble using utensils and normal cups.
  • Monitor chewing and swallowing – Chewing and swallowing difficulties can develop as Alzheimer’s progresses. If necessary, give instructions on when to chew and when to swallow. Keep the person upright for 30 minutes after eating to avoid choking.
  • Transition into providing only puréed or soft foods – In the later stages of Alzheimer’s, the person can no longer swallow food and may choke on food. Swallowing problems can lead to pneumonia because the patient may inhale food or liquid into the lungs. Begin a liquids-only diet when the time is right.

Don’t Forget to Take Care of Yourself

Caregiving for a loved one with dementia can be extremely demanding and stressful. Each day can bring more challenges and higher levels of anxiety, often without any signs of appreciation from the person you’re taking care of. Unfortunately, when you’re stressed and fatigued, you lose the ability to remain calm and soothing, and the patient will inevitably pick up on those negative feelings. This in turn can add to the patient’s own levels of stress and increase their problem behavior.

Taking care of yourself and getting help and support is essential for both your well-being and your loved one’s quality of life. Respite care can provide a break to help you relieve stress and restore energy. Make use of any services available to you and don’t be afraid of asking for help from other family members. It can make all the difference to your success as a caregiver.

More Help for Alzheimer’s Behavior Management

Alzheimer’s Disease and Dementia Help Center: Educate yourself about Alzheimer’s disease and dementia and make important decisions early to help you feel more in control.

Memory loss

Caregiving support

Resources and References

Managing Alzheimer’s behavior problems

Dealing with Behavior Problems – Links to detailed materials on agitation/anxiety, aggressiveness/combativeness, delusions/paranoia, apathy/depression, screaming/vocalization, sexual behavior problems and sleep disorders. (Alzheimer’s Association)

Managing Agitation Behavior in Alzheimer’s Patients – Demented patients show a variety of different behavioral problems, including anger, agitation, depression, suspiciousness, paranoia, wandering, sexual inappropriateness, hallucinations, and delusions. (

The “Challenging Behaviors” Index – An A-Z directory of how to care for and respond to the difficult behaviors of a person with Alzheimer’s Disease or other dementia. (Alzheimer’s Outreach)

Caring for Someone with Dementia: Unusual Behaviour – Provides tips for dealing with unusual behaviors such as repetitive questions, phrases, or motions; following; calling out; lack of inhibition; laughing or crying uncontrollably; pacing; fidgeting; and suspiciousness. Links to articles on more common behaviors like wandering and aggressiveness. (Alzheimer’s Society of the UK)

Hands-On Skills for Caregivers – Gives practical, insightful tips for how to physically approach a difficult patient; how to talk to them respectfully; and how to get them to co-operate with you, both physically and mentally. (Family Caregiver Alliance/National Center on Caregiving)

The Dartmouth Memory Handbook – Digital copy of the 4th Edition edited by Robert B. Santulli, M.D, associate professor of psychiatry at the Geisel School of Medicine at Dartmouth. Includes chapters on dealing with behavior problems. (Caldwell Law)

Pet therapy for managing Alzheimer’s behavior problems

Animal Therapy Group Listing – Offers an international directory of organizations that offer assisted animal therapy. (Land of Pure Gold Foundation)

Management of home safety; safe return program

Home Safety Behavior-By-Behavior – Ways to make your home safe for the Alzheimer’s patient who wanders, who rummages or hides things, who hallucinates; tips for social occasions at home and for adjusting the home environment to compensate for failing senses. (ADEAR: Alzheimer’s Disease Education & Referral Center)

Safe Return Program – A nationwide U.S. program where you enroll the patient for help with wandering: includes identification products, a network of local chapters, a 24-hour emergency crisis line, and a photo database. (Alzheimer’s Association)


Authors: Melinda Smith M.A., Doug Russell, L.C.S.W., and Monika White, Ph.D.



Alzheimer’s Disease: Managing Eating, Drinking, and Swallowing Problems

(Alzheimer’s Australia) Meal times provide us with an opportunity to spend time with our family and friends, as well as sharing food together. When caring for someone with dementia meal times can sometimes become stressful. Loss of memory and problems with judgment can cause difficulties in relation to eating and nutrition for many people with dementia. There are many ways to improve the situation.

Loss of Appetite

Forgetting how to chew and swallow, ill-fitting dentures, insufficient physical activity, and being embarrassed by difficulties can all result in a loss of appetite.

What to try

  • Check with the doctor to make sure that there are no treatable causes for loss of appetite, such as acute illness or depression
  • Offer meals at regular times each day
  • Allow the person to eat when hungry
  • Encourage physical exercise
  • Provide balanced meals to avoid constipation
  • Try a glass of juice, wine or sherry, if medications permit, before the meal to whet appetite
  • Offer ice cream or milk shakes
  • Try to prepare familiar foods in familiar ways, especially foods that are favourites
  • Encourage eating all or most of one food before moving on to the next: some people can become confused when the tastes and textures change
  • Try to make mealtimes simple, relaxed and calm. Be sure to allow enough time for a meal. Assisting a very impaired person can take up to an hour
  • Consult a doctor if there is a significant weight loss (such as 2.5kg in 6 weeks)
  • Check with the doctor about vitamin supplements.

Overeating or Insatiable Appetite

What to try

  • Leaving snack foods on the table may be enough to satisfy some people
  • Try 5-6 small meals each day
  • Have low calorie snacks available, such as apples and carrots
  • Consider whether other activities such as walks, or increased social contacts may help
  • Lock some foods in cupboards, if necessary.

Sweet Cravings

What to try

  • Check medications for side effects. Some antidepressant medications can cause a craving for sweets
  • Try milk shakes, egg nogs or low calorie ice cream.

Mouth, Chewing, and Swallowing Problems

Some causes of problems with eating may relate to the mouth. A dry mouth, or mouth discomfort from gum disease or ill-fitting dentures are common problems.

What to try

  • Have a dental check up of gums, teeth and dentures
  • Moisten food with gravies and sauces if a dry mouth is causing problems
  • For chewing problems, try light pressure on the lips or under the chin, tell the person when to chew, demonstrate chewing, moisten foods or offer small bites one at a time
  • For swallowing problems, remind the person to swallow with each bite, stroke the throat gently, check the mouth to see if food has been swallowed, do not give foods which are hard to swallow, offer smaller bites and moisten food
  • Consult the doctor if choking problems develop.

At the Table

Pouring a glass of juice into a bowl of soup, buttering the serviette or eating dessert with a knife indicate that a person with dementia is having difficulty at the dinner table.

What to try

  • Serve one course at a time and remove other distracting items from the table such as extra cutlery glasses or table decorations
  • Ensure that the crockery is plain and is a different colour to the plain table cloth
  • If the use of cutlery is too difficult serve finger food
  • Eat with the person with dementia so that they can copy you
  • Make sure that they are not rushed
  • Keep noise and activities in the environment to a minimum
  • Ensure there is adequate lighting
  • Serve familiar food.

Other Considerations

  • Keep eating simple. Not all food has to be eaten with cutlery if this is becoming difficult. Finger food can be a nutritious and easy alternative
  • Keep in mind a person’s past history with food. They may have always had a small appetite, been a voracious eater or had a sweet tooth Watch food temperatures. While warm food is more appetising, some people with dementia have lost the ability to judge when food is hot or cold. Beware of using Styrofoam cups which not only hold the heat for a long time, but also tip over easily
  • Spoiled food in the refrigerator, hiding food or not eating regularly may all be signs that someone living alone is in need of more support
  • Many people with dementia do not get enough fluids because they may forget to drink or may no longer recognise the sensation of thirst. Be sure to offer regular drinks of water, juice or other fluids to avoid dehydration
  • Many eating problems are temporary and will change as the person’s abilities deteriorate.

Adapted from Understanding difficult behaviours, by Anne Robinsons, Beth Spencer and Laurie White.

Alzheimer’s Australia


Understanding How Alzheimer’s Changes People

(Alzheimer’s Disease Education and Referral Center) Alzheimer’s disease is an illness of the brain. It causes large numbers of nerve cells in the brain to die. This affects a person’s ability to remember things and think clearly. People with AD become forgetful and easily confused. They may have a hard time concentrating and behave in odd ways. These problems get worse as the illness gets worse, making your job as caregiver harder.

It’s important to remember that the disease, not the person with AD, causes these changes. Also, each person with AD may not have all the problems we talk about in the publication.

The following sections describe the three main challenges that you may face as you care for someone with AD:

  1. changes in communication skills
  2. changes in personality and behavior
  3. changes in intimacy and sexuality

Each section includes information on how to cope with these challenges. If you would rather get a copy of this publication for your own use (than read it here), click:  Print this publication (Download PDF 5.96 MB) »

1. Challenge: changes in communication skills

“Talking with Dad is hard. Often, I don’t understand what he is trying to say or what he wants. We both get pretty frustrated sometimes.”


Communication is hard for people with AD because they have trouble remembering things. They may struggle to find words or forget what they want to say. You may feel impatient and wish they could just say what they want, but they can’t. It may help you to know more about common communication problems caused by AD. Once you know more, you’ll have a better sense of how to cope.

Here are some communication problems caused by AD:

  • Trouble finding the right word when speaking
  • Problems understanding what words mean
  • Problems paying attention during long conversations
  • Loss of train-of-thought when talking
  • Trouble remembering the steps in common activities, such as cooking a meal, paying bills, getting dressed, or doing laundry
  • Problems blocking out background noises from the radio, TV, telephone calls, or conversations in the room
  • Frustration if communication isn’t working
  • Being very sensitive to touch and to the tone and loudness of voices

Also, AD causes some people to get confused about language. For example, the person might forget or no longer understand English if it was learned as a second language. Instead, he or she might understand and use only the first language learned, such as Spanish.

How to cope with changes in communication skills

The first step is to understand that the disease causes changes in these skills. The second step is to try some tips that may make communication easier. For example, keep the following suggestions in mind as you go about day-to-day care.

To connect with a person who has AD:

  • Make eye contact to get his or her attention, and call the person by name.
  • Be aware of your tone and how loud your voice is, how you look at the person, and your “body language.” Body language is the message you send just by the way you hold your body. For example, if you stand with your arms folded very tightly, you may send a message that you are tense or angry.
  • Encourage a two-way conversation for as long as possible. This helps the person with AD feel better about himself or herself.
  • Use other methods besides speaking to help the person, such as gentle touching to guide him or her.
  • Try distracting someone with AD if communication creates problems. For example, offer a fun activity such as a snack or a walk around the neighborhood.
“Every few months I sense that another piece of me is missing. My life… my self… are falling apart. I can only think half-thoughts now. Someday I may wake up and not think at all.”
— From “The Loss of Self”


To  encourage the person with AD to communicate with you:

  • Show a warm, loving, matter-of-fact manner.
  • Hold the person’s hand while you talk.
  • Be open to the person’s concerns, even if they are hard to understand.
  • Let him or her make some decisions and stay involved.
  • Be patient with angry outbursts. Remember, it’s the illness “talking.”
  • If you become frustrated, take a “timeout” for yourself.

To speak effectively with a person who has AD:

  • Offer simple, step-by-step instructions.
  • Repeat instructions and allow more time for a response. Try not to interrupt.
  • Don’t talk about the person as if he or she isn’t there.
  • Don’t talk to the person using “baby talk” or a “baby voice.”

Here are some examples of what you can say:

  • “Let’s try this way,” instead of pointing out mistakes
  • “Please do this,” instead of “Don’t do this”
  • “Thanks for helping,” even if the results aren’t perfect

You also can:

  • Ask questions that require a yes or no answer. For example, you could say, “Are you tired?” instead of “How do you feel?”
  • Limit the number of choices. For example, you could say, “Would you like a hamburger or chicken for dinner?” instead of “What would you like for dinner?”
  • Use different words if he or she doesn’t understand what you say the first time. For example, if you ask the person whether he or she is hungry and you don’t get a response, you could say, “Dinner is ready now. Let’s eat.”
  • Try not to say, “Don’t you remember?” or “I told you.”

Helping a Person Who Is Aware of Memory Loss

AD is being diagnosed at earlier stages. This means that many people are aware of how the disease is affecting their memory. Here are tips on how to help someone who knows that he or she has memory problems:

  • Take time to listen. The person may want to talk about the changes he or she is noticing.
  • Be as sensitive as you can. Don’t just correct the person every time he or she forgets something or says something odd. Try to understand that it’s a struggle for the person to communicate.
  • Be patient when someone with AD has trouble finding the right words or putting feelings into words.
  • Help the person find words to express thoughts and feelings. For example, Mrs. D cried after forgetting her garden club meeting. She finally said, “I wish they stopped.” Her daughter said, “You wish your friends had stopped by for you.” Mrs. D nodded and repeated some of the words. Then Mrs. D said, “I want to go.” Her daughter said, “You want to go to the garden club meeting.” Again, Mrs. D nodded and repeated the words.
  • Be careful not to put words in the person’s mouth or “fill in the blanks” too quickly.
  • As people lose the ability to talk clearly, they may rely on other ways to communicate their thoughts and feelings.

For example, their facial expressions may show sadness, anger, or frustration. Grasping at their undergarments may tell you they need to use the bathroom.

Pages: 1 2 3 4 5

Alzheimer’s Disease: Potential Causes of Behavioral Symptoms

(Alzheimer’s Foundation of America) While the underlying cause of the behavioral symptoms of Alzheimer’s disease and related dementias is the illness itself—changes in the brain due to the death of brain cells, there are multiple other factors that may trigger the various behaviors and emotions that can unfold during the progression of the disease. Understanding the cause and effect can help family and professional caregivers better manage situations that may arise.

Reaction to Loss

We all rely on input from our environment to guide us in activities and relationships. An individual with dementia has lost both the benefit of such input and the ability to inform us of their internal world. This absence causes fear, insecurity and frustration, which may present in the form of aggression and agitated behavior.

Some Suggestions:

  • Provide reassurance.
  • Speak in a calm voice.
  • Promote a sense of security and comfort.

Inability to Meet Basic Needs

As a result of cognitive impairment and psychiatric symptoms, a person’s basic needs might not be met. The resulting hunger, dehydration, elimination problems and fatigue can produce behavioral changes. Individuals with dementia may stay hungry because of, for example, their inability to feed themselves, depression or loss of muscle coordination. They may show their discomfort through agitated and aggressive behavior.

Likewise, they may forget how to pour water into a cup or never ask for a drink due to their inability to communicate. Dehydration can lead to urinary tract infection, constipation and fever—putting individuals at a high risk for delirium and consequently more behavioral problems.

Similarly, individuals may forget where or what the bathroom is, and eventually may not recognize the internal cues for urination or a bowel movement. Elimination problems may prompt agitation, aggression,wandering, pacing, and incontinence. Compounding this, they may develop urinary tract infections or constipation which, left untreated, could result in delirium.

Lastly, people with dementia may get tired easily because of wandering, pacing and disruption of the sleep-wake cycle. Fatigue often leads to irritability and aggression.

Some Suggestions:

  • Offer verbal and physical assistance during meals.
  • Serve foods that the individual likes.
  • Provide adequate snacks and supplements.
  • Prevent distraction during meals by rearranging the environment
  • Serve pre-cut or finger food if using utensils becomes difficult.
  • Consult with a healthcare professional about swallowing problems.
  • Schedule fluid intake to ensure six to eight glasses of liquid per day.
  • Avoid coffee, tea beverages with caffeine that act as diuretics.
  • Establish a routine for using the toilet, such as assisting them to the bathroom every two hours.
  • A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.
  • Put up signs (with illustrations) to indicate the bathroom door.
  • Use easy-to-remove clothing, such as those with elastic waistbands.
  • Try soothing music or a massage to induce sleep.
  • Reduce environmental stimuli.
  • Encourage short periods of napping to prevent exhaustion.

Co-Existing Medical Problems

Pain and discomfort from a medical problem (i.e., dental pain, urinary tract infection) or medication side effects can go unnoticed because of the individual’s inability to report it due to poor memory and/or loss of verbal skills. In addition, caregivers may have difficulty gauging the individual’s pain because the person does not respond to questions. As a result, these individuals may not receive necessary medication or treatment. Those who are in pain and discomfort tend to exhibit verbal and physical aggression, restlessness, wandering and pacing.

Some Suggestions:

  • Become familiar with the person’s medical history.
  • Assess their non-verbal behavior to help identify the cause of distress.
  • Watch for signs of urinary tract infection and other medical conditions.
  • Monitor medications for side effects.

Co-Existing Psychiatric Disorders

Individuals with a previous diagnosis of psychiatric disorders, such as schizophrenia, depression or mania, and those with mental retardation are likely to exhibit more behavioral problems when they develop dementia than other individuals without psychiatric illnesses. Those with hallucinations or delusions and who are depressed or manic tend to exhibit more aggressive and agitated behavior.

Some Suggestions:

  • Consult with your physician about available medications, such as anti-depressants, anti-psychotics and other mood stabilizers, to control severe symptoms, if appropriate. Also discuss non-drug interventions, like behavioral modifications and environmental changes.
  • Provide reassurance.
  • Distract and redirect with other activities.

Environmental Factors

Excessive noise, poor or glaring lighting and cold temperature in the home or a long-term care facility, and overcrowding in a group setting can increase agitation, screaming and aggressive behavior. Any change in the environment or routines, such as bathing and eating, can cause frustration and agitation. As well, boredom that results from lack of activities, and conflicts among residents in a group setting can manifest in behavioral changes.

Some Suggestions:

  • Reduce excess stimuli, such as the TV or radio.
  • Elevate the room temperature.
  • Ensure adequate lighting.
  • Carefully and gradually introduce changes in routine or the environment.
  • Provide activities that are simple and creative.
  • In a group setting, staff should anticipate the characteristics of each resident and adjust the environment accordingly.

Sensory Impairment

Individuals with hearing or visual impairments tend to be more paranoid, hallucinate more, and feel more frightened and frustrated. For example, those with poor eyesight may not eat their food or they may be at risk for falls.

Some Suggestions:

  • Assess vision and hearing.
  • Ensure that individuals who wear glasses or hearing aids have them in place.
  • Evaluate problems such as cataracts, glaucoma or other eye diseases, and correct them with surgery, if feasible, or by creative environmental changes.

Factors Related to the Caregiver

A caregiver’s attitude and knowledge of dementia affect the care of individuals with the disease.  Individuals usually respond to a caregiver’s mood and cues accordingly.

Some Suggestions:

  • Become educated about the disease.
  • Stick to routines.
  • Learn effective communication techniques and how to cope with specific behavioral challenges.
  • Use a calm tone of voice combined with gentle touch to convey reassurance.
  • Validate the person’s feelings.
  • Speak slowly and simply.
  • Distract and redirect to positive activities.
  • Be patient and kind.
  • Remember that behavior problems result from the disease. Do not take things that the person says and does personally; it is the disease speaking.
  • Recall fond memories from the past, including ways in which your loved one cared for and supported you in the past.  This will increase your ability to be patient and understanding in difficult situations.
  • Reach out to friends and family for support, educate them about Alzheimer’s disease, and consider sharing with them the specific symptoms that your loved one is experiencing.  This way, they will be better able to both support you and interact positively with your loved one.
  • Acknowledge your own feelings, possibly sadness, anger or frustration, and consider joining a caregiver support group or attending individual counseling.
  • Remember to practice good self-care—physically and mentally.  Try to eat nutritious meals, get a good night’s sleep, exercise regularly, and make time for your own interests and friendships.  The better you take care of yourself, the better you can care for your loved one.

©2015 Alzheimer’s Foundation of America. All rights reserved.


Understanding Dementia Behaviors

(Family Caregiver Alliance) Caring for a loved one with dementia poses many challenges for families and caregivers. People with dementia from conditions such as Alzheimer’s and related diseases have a progressive brain disorder that makes it more and more difficult for them to remember things, think clearly, communicate with others, or take care of themselves. In addition, dementia can cause mood swings and even change a person’s personality and behavior.

This factsheet provides some practical strategies for dealing with the troubling behavior problems and communication difficulties often encountered when caring for a person with dementia.

To get your own copy of this factsheet, go here: Understanding Dementia Behaviors


Ten Tips for Communicating with a Person with Dementia

We aren’t born knowing how to communicate with a person with dementia—but we can learn. Improving your communication skills will help make caregiving less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.

  1. Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.
  2. Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.
  3. State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or question. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.
  4. Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended questions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clarify your question and can guide her response.
  5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.
  6. Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.
  7. When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”
  8. Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.
  9. Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.
  10. Maintain your sense of humor. Use humor whenever possible, though not at the person’s expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

Handling Troubling Behavior

Some of the greatest challenges of caring for a loved one with dementia are the personality and behavior changes that often occur. You can best meet these challenges by using creativity, flexibility, patience and compassion. It also helps to not take things personally and maintain your sense of humor.

To start, consider these ground rules:

We cannot change the person. The person you are caring for has a brain disorder that shapes who he has become. When you try to control or change his behavior, you’ll most likely be unsuccessful or be met with resistance. It’s important to:

  • Try to accommodate the behavior, not control the behavior. For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable.
  • Remember that we can change our behavior or the physical environment. Changing our own behavior will often result in a change in our loved one’s behavior.

Check with the doctor first. Behavioral problems may have an underlying medical reason: perhaps the person is in pain or experiencing an adverse side effect from medications. In some cases, like incontinence or hallucinations, there may be some medication or treatment that can assist in managing the problem.

Behavior has a purpose. People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why. It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behavior—and, when possible, try to accommodate them.

Behavior is triggered. It is important to understand that all behavior is triggered—it doesn’t occur out of the blue. It might be something a person did or said that triggered a behavior or it could be a change in the physical environment. The root to changing be-havior is disrupting the patterns that we create. Try a different approach, or try a different consequence.

What works today, may not tomorrow. The multiple factors that influence troubling behaviors and the natural progression of the disease process means that solutions that are effective today may need to be modified tomorrow—or may no longer work at all. The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.

Get support from others. You are not alone—there are many others caring for someone with dementia. Locate your nearest Area Agency on Aging, the local chapter of the Alzheimer’s Association, a Caregiver Resource Center or one of the groups listed below in Resources to find support groups, organizations and services that can help you. Expect that, like the loved one you are caring for, you will have good days and bad days. Develop strategies for coping with the bad days (see the FCA Fact Sheet, Dementia, Caregiving and Controlling Frustration).

The following is an overview of the most common dementia-associated behaviors with suggestions that may be useful in handling them. You’ll find additional resources listed at the end of this Fact Sheet.


People with dementia walk, seemingly aimlessly, for a variety of reasons, such as boredom, medication side effects or to look for “something” or someone. They also may be trying to fulfill a physical need—thirst, hunger, a need to use the toilet or exercise. Discovering the triggers for wandering are not always easy, but they can provide insights to dealing with the behavior.

  • Make time for regular exercise to minimize restlessness.
  • Consider installing new locks that require a key. Position locks high or low on the door; many people with dementia will not think to look beyond eye level. Keep in mind fire and safety concerns for all family members; the lock(s) must be accessible to others and not take more than a few seconds to open.
  • Try a barrier like a curtain or colored streamer to mask the door. A “stop” sign or “do not enter” sign also may help.
  • Place a black mat or paint a black space on your front porch; this may appear to be an impassable hole to the person with dementia.
  • Add “child-safe” plastic covers to doorknobs.
  • Consider installing a home security system or monitoring system designed to keep watch over someone with dementia. Also available are new digital devices that can be worn like a watch or clipped on a belt that use global positioning systems (GPS) or other technology to track a person’s whereabouts or locate him if he wanders off..
  • Put away essential items such as the confused person’s coat, purse or glasses. Some individuals will not go out without certain articles.
  • Have your relative wear an ID bracelet and sew ID labels in their clothes. Always have a current photo available should you need to report your loved one missing. Consider leaving a copy on file at the police department or registering the person with the Alzheimer’s Association Safe Return program (see Resources).
  • Tell neighbors about your relative’s wandering behavior and make sure they have your phone number.


The loss of bladder or bowel control often occurs as dementia progresses. Sometimes accidents result from environmental factors; for example, someone can’t remember where the bathroom is located or can’t get to it in time. If an accident occurs, your understanding and reassurance will help the person maintain dignity and minimize embarrassment.

  • Establish a routine for using the toilet. Try reminding the person or assisting her to the bathroom every two hours.
  •  Schedule fluid intake to ensure the confused person does not become dehydrated. However, avoid drinks with a diuretic effect like coffee, tea, cola, or beer. Limit fluid intake in the evening before bedtime.
  • Use signs (with illustrations) to indicate which door leads to the bathroom.
  • A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.
  • Incontinence pads and products can be purchased at the pharmacy or supermarket. A urologist may be able to prescribe a special product or treatment.
  • Use easy-to-remove clothing with elastic waistbands or Velcro closures, and provide clothes that are easily washable.


Agitation refers to a range of behaviors associated with dementia, including irritability, sleeplessness, and verbal or physical aggression. Often these types of behavior problems progress with the stages of dementia, from mild to more severe. Agitation may be triggered by a variety of things, including environmental factors, fear and fatigue. Most often, agitation is triggered when the person experiences “control” being taken from him.

  • Reduce caffeine intake, sugar and junk food.
  • Reduce noise, clutter or the number of persons in the room.
  • Maintain structure by keeping the same routines. Keep household objects and furniture in the same places. Familiar objects and photographs offer a sense of security and can suggest pleasant memories.
  • Try gentle touch, soothing music, reading or walks to quell agitation. Speak in a reassuring voice. Do not try to restrain the person during a period of agitation.
  • Keep dangerous objects out of reach.
  • Allow the person to do as much for himself as possible—support his independence and ability to care for himself.
  • Acknowledge the confused person’s anger over the loss of control in his life. Tell him you understand his frustration.
  • Distract the person with a snack or an activity. Allow him to forget the troubling incident. Confronting a confused person may increase anxiety.

Repetitive Speech or Actions (Perseveration)

People with dementia will often repeat a word, statement, question or activity over and over. While this type of behavior is usually harmless for the person with dementia, it can be annoying and stressful to caregivers. Sometimes the behavior is triggered by anxiety, boredom, fear or environmental factors.

  • Provide plenty of reassurance and comfort, both in words and in touch.
  • Try distracting with a snack or activity.
  • Avoid reminding them that they just asked the same question. Try ignoring the behavior or question and distract the person into an activity.
  • Don’t discuss plans with a confused person until immediately prior to an event.
  • You may want to try placing a sign on the kitchen table, such as, “Dinner is at 6:30” or “Lois comes home at 5:00” to remove anxiety and uncertainty about anticipated events.
  • Learn to recognize certain behaviors. An agitated state or pulling at clothing, for example, could indicate a need to use the bathroom.


Seeing a loved one suddenly become suspicious, jealous or accusatory is unsettling. Remember, what the person is experiencing is very real to them. It is best not to argue or disagree. This, too, is part of the dementia—try not to take it personally.

  • If the confused person suspects money is “missing,” allow her to keep small amounts of money in a pocket or handbag for easy inspection.
  • Help them look for the object and then distract them into another activity. Try to learn where the confused person’s favorite hiding places are for storing objects, which are frequently assumed to be “lost.” Avoid arguing.
  • Take time to explain to other family members and home-helpers that suspicious accusations are a part of the dementing illness.
  • Try nonverbal reassurances like a gentle touch or hug. Respond to the feeling behind the accusation and then reassure the person. You might try saying, “I see this frightens you; stay with me, I won’t let anything happen to you.”


Restlessness, agitation, disorientation and other troubling behavior in people with dementia often get worse at the end of the day and sometimes continue throughout the night. Experts believe this behavior, commonly called sundowning, is caused by a combination of factors, such as exhaustion from the day’s events and changes in the person’s biological clock that confuse day and night.

  • Increase daytime activities, particularly physical exercise. Discourage inactivity and napping during the day.
  • Watch out for dietary culprits, such as sugar, caffeine and some types of junk food. Eliminate or restrict these types of foods and beverages to early in the day. Plan smaller meals throughout the day, including a light meal, such as half a sandwich, before bedtime.
  • Plan for the afternoon and evening hours to be quiet and calm; however, structured, quiet activity is important. Perhaps take a stroll outdoors, play a simple card game or listen to soothing music together.
  • Turning on lights well before sunset and closing the curtains at dusk will minimize shadows and may help diminish confusion. At minimum, keep a nightlight in the person’s room, hallway and bathroom.
  • Make sure the house is safe: block off stairs with gates, lock the kitchen door and/or put away dangerous items.
  • As a last resort, consider talking to the doctor about medication to help the agitated person relax and sleep. Be aware that sleeping pills and tranquilizers may solve one problem and create another, such as sleeping at night but being more confused the next day.
  • It’s essential that you, the caregiver, get enough sleep. If your loved one’s nighttime activity keeps you awake, consider asking a friend or relative, or hiring someone, to take a turn so that you can get a good night’s sleep. Catnaps during the day also might help.


Ensuring that your loved one is eating enough nutritious foods and drinking enough fluids is a challenge. People with dementia literally begin to forget that they need to eat and drink. Complicating the issue may be dental problems or medications that decrease appetite or make food taste “funny.” The consequences of poor nutrition are many, including weight loss, irritability, sleeplessness, bladder or bowel problems and disorientation.

  • Make meal and snack times part of the daily routine and schedule them around the same time every day. Instead of three big meals, try five or six smaller ones.
  • Make mealtimes a special time. Try flowers or soft music. Turn off loud radio programs and the TV.
  • Eating independently should take precedence over eating neatly or with “proper” table manners. Finger foods support independence. Pre-cut and season the food. Try using a straw or a child’s “sippy cup” if holding a glass has become difficult. Provide assistance only when necessary and allow plenty of time for meals.
  • Sit down and eat with your loved one. Often they will mimic your actions and it makes the meal more pleasant to share it with someone.
  • Prepare foods with your loved one in mind. If they have dentures or trouble chewing or swallowing, use soft foods or cut food into bite-size pieces.
  • If chewing and swallowing are an issue, try gently moving the person’s chin in a chewing motion or lightly stroking their throat to encourage them to swallow.
  • If loss of weight is a problem, offer nutritious high-calorie snacks between meals. Breakfast foods high in carbohydrates are often preferred. On the other hand, if the problem is weight gain, keep high-calorie foods out of sight. Instead, keep handy fresh fruits, veggie trays and other healthy low-calorie snacks.


People with dementia often have difficulty remembering “good” hygiene, such as brushing teeth, toileting, bathing and regularly changing their clothes. From childhood we are taught these are highly private and personal activities; to be undressed and cleaned by another can feel frightening, humiliating and embarrassing. As a result, bathing often causes distress for both caregivers and their loved ones.

  • Think historically of your loved one’s hygiene routine – did she prefer baths or showers? Mornings or nights? Did she have her hair washed at the salon or do it herself? Was there a favorite scent, lotion or talcum powder she always used? Adopting—as much as possible—her past bathing routine may provide some comfort. Remember that it may not be necessary to bathe every day—sometimes twice a week is sufficient.
  • If your loved one has always been modest, enhance that feeling by making sure doors and curtains are closed. Whether in the shower or the bath, keep a towel over her front, lifting to wash as needed. Have towels and a robe or her clothes ready when she gets out.
  • Be mindful of the environment, such as the temperature of the room and water (older adults are more sensitive to heat and cold) and the adequacy of lighting. It’s a good idea to use safety features such as non-slip floor bath mats, grab-bars, and bath or shower seats. A hand-held shower might also be a good feature to install. Remember—people are often afraid of falling. Help them feel secure in the shower or tub.
  • Never leave a person with dementia unattended in the bath or shower. Have all the bath things you need laid out beforehand. If giving a bath, draw the bath water first. Reassure the person that the water is warm—perhaps pour a cup of water over her hands before she steps in.
  • If hair washing is a struggle, make it a separate activity. Or, use a dry shampoo.
  • If bathing in the tub or shower is consistently traumatic, a towel bath provides a soothing alter-native. A bed bath has traditionally been done with only the most frail and bed-ridden patients, soaping up a bit at a time in their beds, rinsing off with a basin of water and drying with towels. A growing number of nurses in and out of facilities, however, are beginning to recognize its value and a variation—the “towel bath”—for others as well, including people with dementia who find bathing in the tub or shower uncomfortable or unpleasant. The towel bath uses a large bath towel and washcloths dampened in a plastic bag of warm water and no-rinse soap. Large bath-blankets are used to keep the patient covered, dry and warm while the dampened towel and washcloths are massaged over the body. For more information, see the book Bathing Without a Battle (details in the Recommended Reading section below), or visit

Additional Problem Areas

  • Dressing is difficult for most dementia patients. Choose loose-fitting, comfortable clothes with easy zippers or snaps and minimal buttons. Reduce the person’s choices by removing seldom-worn clothes from the closet. To facilitate dressing and support independence, lay out one article of clothing at a time, in the order it is to be worn. Remove soiled clothes from the room. Don’t argue if the person insists on wearing the same thing again.
  • Hallucinations (seeing or hearing things that others don’t) and delusions (false beliefs, such as someone is trying to hurt or kill another) may occur as the dementia progresses. State simply and calmly your perception of the situation, but avoid arguing or trying to convince the person their perceptions are wrong. Keep rooms well-lit to decrease shadows, and offer reassurance and a simple explanation if the curtains move from circulating air or a loud noise such as a plane or siren is heard. Distractions may help. Depending on the severity of symptoms, you might consider medication.
  • Sexually inappropriate behavior, such as masturbating or undressing in public, lewd remarks, unreasonable sexual demands, even sexually aggressive or violent behavior, may occur during the course of the illness. Remember, this behavior is caused by the disease. Talk to the doctor about possible treatment plans. Develop an action plan to follow before the behavior occurs, i.e., what you will say and do if the behavior happens at home, around other adults or children. If you can, identify what triggers the behavior.
  • Verbal outbursts such as cursing, arguing and threatening often are expressions of anger or stress. React by staying calm and reassuring. Validate your loved one’s feelings and then try to distract or redirect his attention to something else.
  • “Shadowing” is when a person with dementia imitates and follows the caregiver, or constantly talks, asks questions and interrupts. Like sundowning, this behavior often occurs late in the day and can be irritating for caregivers. Comfort the person with verbal and physical reassurance. Distraction or redirection might also help. Giving your loved one a job such as folding laundry might help to make her feel needed and useful.
  • People with dementia may become uncooperative and resistant to daily activities such as bathing, dressing and eating. Often this is a response to feeling out of control, rushed, afraid or confused by what you are asking of them. Break each task into steps and, in a reassuring voice, explain each step before you do it. Allow plenty of time. Find ways to have them assist to their ability in the process, or follow with an activity that they can perform.

Credits and Recommended Reading


Family Caregiver Alliance
National Center on Caregiving

785 Market Street, Suite 750
San Francisco, CA 94103
(415) 434-3388
(800) 445-8106

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy.

Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers.

For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s and other debilitating health conditions that strike adults.

FCA Publications

FCA Fact Sheets. All Family Caregiver Alliance Fact Sheets are available free online. Printed versions are avilable for purchase for each title—send your requests to FCA Publications, 785 Market Street, Suite 750, San Francisco, CA 94103.

Other Web Sites

Alzheimer’s Disease Education and Referral (ADEAR) Center
(800) 438-4380

This service of the National Institute on Aging offers information and publications on diagnosis, treatment, patient care, caregiver needs, long-term care, education and research related to Alzheimer’s disease.

Eldercare Locator
(800) 677-1116

This service of the Administration on Aging offers information about and referrals to respite care and other home and community services offered by state and Area Agencies on Aging.

Alzheimer’s Association Safe Return Program
(800) 272-3900

A nationwide program that identifies people with dementia who wander away and returns them to their homes. For a registration fee, families can register their loved one in a national confidential computer database. They also receive an identification bracelet or necklace and other identification and educational materials.


This fact sheet was prepared by Family Caregiver Alliance in cooperation with California’s statewide system of Caregiver Resource Centers. Reviewed by Beth Logan, M.S.W., Education and Training Consultant and Specialist in Dementia Care.  Funded by the California Department of Mental Health. © 2004, 2008 Family Caregiver Alliance. All rights reserved.

Copyright © 2015 Family Caregiver Alliance. All rights reserved.