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Emotional Challenges

Dealing with mood changes in a person with dementia

When we think about dementia symptoms, we tend to think about memory loss and being generally forgetful. However, the symptoms of dementia are more varied and complex than simply forgetting things, and the condition can also affect people in different ways.

It’s important to understand dementia is a disease of the brain which means a person can struggle to make judgements and decisions, formulate words and process information. Some of the more challenging symptoms of dementia can include mood swings, anger and in some cases, challenging behaviour. 

The person may also become more emotional. One minute they may seem happy and the next they may be tearful, seemingly for no reason. However, to the person with dementia, there will be a reason for the sudden shift in mood. 

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Damage to the brain

Dementia can cause damage to different parts of the brain, which can mean that symptoms are varied and wide-ranging. It can also affect a part of the brain called the amygdala, which processes emotions and records reactions.

In the case of vascular dementia, damaged blood vessels can mean cells don’t get enough blood and become starved of oxygen and nutrients, and die.

When you take all of this into consideration, it’s easy to understand why the person with dementia may become frustrated, restless and moody on occasion. 

The Bookcase Model

The Bookcase Model is an analogy used to describe dementia as it develops over time. Picture a bookcase full of books. Each book represents a skill or memory a person has gained. On the top shelf are the most recent memories such as what the person had for lunch that day. On the next shelf are less recent memories such as events in the past few months or year. On the next shelf down, the memories relate to the person’s earlier life, with memories from previous decades. 

When someone has dementia, the bookcase starts to move. Books begin to fall out. Books that fall out first tend to be the ones at the top relating to short-term memory. As the condition progresses, books from subsequent shelves may fall out and the person may end up with what they think are most recent memories. However, these are actually from an earlier decade or life stage. The person may think they are much younger than they are in reality.

When you communicate with a person in the later stages of dementia, try to do it in a way that makes them feel safe, loved and secure. Be aware of your tone of voice. Speak calmly and with compassion. Tell them you’re there to support them and hold their hand if they find this comforting.

If the person seems angry and you don’t know why, there will be a reason for the anger. Here’s some things you can try to help them calm down:

  • Try to identify why they might be angry. Are they struggling to say something or perform a task? Offer guidance if they are but don’t completely take over.

  • Sit calmly with them and hold their hand if they find it comforting, but only if they are open to physical contact. 

  • If it’s safe to do so, give them space. Walk away and do something else.

  • Try not to take it personally, even if the person says nasty things to you. It’s usually the disease talking, not the person.

Reasons why the person may be angry or upset

  • Being in pain – they may be unable to tell you they are in pain or if they can tell you, they may not be able to describe what’s wrong. Signs of discomfort can include a change in walking pattern, being hunched over, grimacing or being pale or sweaty. Ask if the person is in pain. If they say yes and can’t describe where the pain is or how it feels, their GP might be able to prescribe a general analgesia for mild to moderate pain.

  • Being hungry or thirsty – the person may not be able to tell you they need something to eat or drink. Dehydration can cause confusion, so ensure they have plenty to drink and other small, easily digestible snacks.

  • An infection – urinary tract infections can be common in elderly people with dementia and can cause increased confusion. It’s important for the person to see their GP as soon as possible.

  • Boredom – the person may have been very sociable before their dementia and may now be more withdrawn. Or they may miss hobbies they have enjoyed in the past. See if you can look into local groups or arrange for them to have a visit from a friend.

  • Fatigue – if they had a bad night’s sleep, a short nap may benefit them, though ideally not too late in the day so that it doesn’t prevent them from sleeping at night.

Dementia and sundowning

Sundowning refers to a sudden change in mood and behaviour that usually affects a person with dementia in the afternoon or early evening. It has been suggested that it could be due to chemical changes in the brain. The person can become more stressed or agitated at this time. Try to distract the person at this time of day, perhaps by going out for a walk together or putting on some music.

Resources:

Alzheimer’s Society has a detailed downloadable guide to the brain and how it is affected by dementia:

https://www.alzheimers.org.uk/sites/default/files/2019-05/456lp-dementia-and-the-brain-190521.pdf