While dementia leads to memory loss and makes it difficult to carry out everyday tasks, the disease also changes one’s personality. Experts share insights into managing these changes.
One of the earliest signs of dementia are personality changes, occurring before other symptoms like memory loss become apparent. Brain cells in regions of the brain called the hippocampus and the frontal cortex are responsible for memory, complex behaviors and personality. As dementia progresses, these cells die off, leading to uncharacteristic personality traits or behaviors, like anxiety, aggression, apathy, paranoia or depression.
“It is very common to see a patient with early Alzheimer’s disease, sometimes even before they’ve manifested a memory disorder, to be anxious, hyper-reactive and very concerned about things that are going on around them,” Dr. Bruce Miller, a behavioral neurologist at the University of California, San Francisco told Being Patient.
While some of these changes occur in the brain, others are caused by environmental interactions. As a caregiver, you can’t reverse all of these personality changes. While sometimes prescriptions are issued to treat these symptoms, it’s important to note that, while sometimes doctors may prescribe drugs to treat these symptoms, there are not currently any FDA-approved treatments specifically for people living with dementia. However, there are some possibilities in the drug development pipeline. In the meantime, experts say there are certain actions that may help accommodate these symptoms and improve quality of life for the person living with dementia and for their loved ones.
What do we know about personality and dementia?
Overall, personalities tend to mellow out with age: People become more emotionally stable, agreeable and conscientious. However, extreme personality changes, may be a sign that something is going wrong. As the early stages of dementia set in, family members and friends often notice increased anxiety, worry, fear, loneliness or anger.
“My rule of thumb is: When there’s a sudden behavior change, take a broad look at your loved one,” Miller said. “Make sure they don’t have an infection. Make sure that nothing’s changed in the brain.”
Research has found that major changes in personality have some kind of relationship with the onset of dementias like Alzheimer’s disease, and while the exact nature of that relationship is still unclear, such changes could be a sign for a doctor to suggest more definitive tests.
Managing changes in personality and behavior
According to Miller, environmental factors could also exacerbate these behaviors and reactions, but by keeping a consistent routine, family members can help manage some of the personality changes that come with dementia.
“Remember that a lot of our patients can’t remember, so what’s very, very upsetting to them at one point is less so at another point,” Miller said. “Figure out what the triggers are.” The U.S. National Institute on Aging provides additional suggestions to manage these personality changes.
Ask or say only one thing at a time.
Provide reassurance that you’re there to help and focus on the person's feelings rather than their words.
Don’t argue or try to reason with the person.
Don’t show frustration or anger.
Use music or singing as a distraction.
Another group of researchers developed a handy method called “D.I.C.E.” to help care partners identify behavioral triggers and potential solutions:
D: Describe what is happening with your loved one.
I: Investigate possible causes of these behaviors.
C: Create a plan.
E: Evaluate the plan. If it doesn’t work, consider trying a different response next time.
If you notice extreme personality changes in your loved ones, it may be an early sign of dementia or another health problem. Booking a doctor’s visit can help you get to the bottom of these personality changes and could even help lead to an early dementia diagnosis, creating the opportunity for better care.
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