Better health for people living
with dementia
Changed behaviours
Dementia affects how a person thinks, feels and communicates.
Being unable to communicate what you are thinking and how you are feeling can be frustrating and distressing.
A person may express in their behaviour what they cannot get across in other ways. These are often described as behavioural and psychological symptoms of dementia, or BPSDs. They are symptoms of disturbed perception, thought content, mood and behaviour. Alternatively, they are described as the expression of unmet needs. Both terms reflect that the behaviour is not wilful, but might be an attempt to meet a need which the person living with dementia is not able to identify or communicate.
BPSDs can include aggression, agitation, irritability, apathy, sleep problems, wandering, social and sexual disinhibition, verbal outbursts, delusions, hallucinations, anxiety and depression. They can be exacerbated by pain, unfamiliar environments, overstimulation and unhelpful responses.
These changes in behaviour can be confusing for both the person living with dementia and for the people around them.
Practice points
Neuropsychologists:
- assess what cognitive difficulties may underpin behavioural changes
- offer strategies to assist the person living with dementia and their carers how to best manage them.
Occupational therapists :
- observe a person in their usual environment to determine what may contribute to changed behaviour
- can provide an understanding of a person’s functional cognition and how this impacts on ability to communicate needs
- provide a carer with coping strategies and help establish changes in routines that may improve the situation
- in consultation with a person and their carer, prescribes activities within cognitive ability to engage the person in familiar and enjoyable tasks
- adapt the environment to facilitate optimal functioning and minimise distress.
Other allied health professionals who specialise in dementia:
- may be able to offer support and suggest strategies.
Felipe's story
Felipe migrated to Australia with his wife and two children in his mid-fifties. He was a very active man who had played soccer professionally. After settling in Australia, Felipe worked two full-time jobs – one by day, and one at night – to support his family. After retiring, Felipe remained very active, taking up kayaking in his late seventies, paddling for hours most days. When health problems prevented Felipe keeping up with his exercise and fitness, he became depressed. He then developed dementia.
The combination of depression and dementia hit Felipe very hard; he became forgetful, got angry easily, started getting up many times through the night and became very agitated when his beloved wife went to hospital.
Felipe received multidisciplinary intervention from a dementia service when things at home became too difficult for him and his family. Under the care of a team of medical and allied health professionals, Felipe improved.
He saw the clinical neuropsychologist for assessment of his cognition and mood, as well as for regular counselling to talk through his feelings about the changes that were taking place. An interpreter who Felipe had known for some time relayed his ‘poetic and philosophical nature’ that was not observable by others, as he had lost the ability to express freely in English. Physiotherapy developed a tailored program to build his strength and fitness. An occupational therapist supported his engagement with valued and meaningful activities. A social worker assisted the family in their decision to accept an aged care facility placement for Felipe, and provided the practical support to make this happen. Felipe started exercising again and also started watching replays of European football, which he enjoyed. His family was given support and education about communicating with Felipe in different ways. With all these strategies and some medication changes, Felipe’s depression improved, and he became somewhat fitter and happier again.
The National Dementia Helpline is an Australian Government funded initiative.