Dementia is not only about memory. Over time, most people living with dementia also show changes in mood and behavior. They may pace, shout, refuse a bath, ask the same question again and again, or see things that are not there. For families, these changes are often harder than the memory loss itself.2
This page explains why these behaviors happen and gives you a simple way to figure out what is behind them. It also links to a guide for each common behavior.
Key points
- Behavior changes are part of the illness. Nearly everyone with dementia has at least one at some point.1,2
- A behavior is often a message. The person may be in pain, scared, bored, lonely, too hot, or need the toilet, but cannot say so.3,6
- Use a step-by-step method, such as DICE or ABC, to find the cause before you try fixes.4,5
- Try non-drug approaches first. Medicines are a second step and carry real risks.2,6,9
- A sudden change in behavior or alertness can mean an illness like an infection. Call the doctor the same day. Call 911 if anyone is in danger.6,8
How common are these changes?
Doctors call these changes "behavioral and psychological symptoms of dementia," or BPSD. They include agitation, aggression, depression, apathy (loss of interest and drive), anxiety, hallucinations, sleep problems and wandering.2
They are very common. In a large study in Cache County, Utah, about 97 in 100 people with dementia had at least one of these symptoms over five years. Depression (77%), apathy (71%) and anxiety (62%) were the most frequent.1
These symptoms add stress for families. Agitation in particular is a leading reason people move into assisted living or a nursing home.9 The good news is that many symptoms ease once you find what is driving them.
Why do behaviors happen?
Dementia damages the parts of the brain that handle memory, language, judgment and self-control. That is the root cause.6 But it rarely explains why a behavior happens at a certain time and place. Something usually sets it off.
Experts group the triggers into four kinds:2,6,7
- Unmet needs. The person may be hungry, thirsty, tired, in pain, constipated, or need the bathroom. They may also be bored, lonely or scared.
- Medical problems. Infections (bladder, ear, chest), new or mixed medicines, poor sleep, and hearing or vision loss that has not been corrected.
- The setting. Too much noise, glare, a loud TV, crowds, a new place, a new caregiver, or a change in routine.
- The way a task is asked or done. Being rushed, corrected, given too many steps at once, or asked to do something that has become too hard.
Unmet needs are easy to miss
A person with dementia may not be able to say "my knee hurts" or "I'm lonely." Instead, they may yell, grab, refuse care or try to leave. One study looked at nursing home residents with advanced dementia who had behavior problems. Boredom, loneliness and a lack of meaningful activity were the most common unmet needs. The researchers estimated that boredom and loneliness each affected about 7 in 10 residents. Staff often missed pain and discomfort.3
This is why it helps to think of a behavior as communication. Ask "What is this person trying to tell me?" instead of "How do I make this stop?" The person is not being difficult on purpose.6
A sudden change is a medical warning sign. If behavior, confusion or alertness gets much worse over hours or a few days, the person may have delirium (sudden, severe confusion caused by an illness or a medicine). Common causes include urinary tract infections, pneumonia and medicine side effects.8 Call the doctor the same day. If the person is very drowsy, cannot be woken, has trouble breathing, or shows signs of a stroke, call 911.
A step-by-step way to find the cause: DICE
DICE is a method created by a panel of dementia experts in 2014. It helps families and health care teams work together on a behavior instead of reaching first for a pill.4 The letters stand for Describe, Investigate, Create and Evaluate.
- Describe. Write down what happened. Who was there? What were you doing? Where and when did it happen? What did the person say or do? Bring these notes to the doctor.4
- Investigate. The doctor or nurse looks for causes. They check for pain, infection, constipation, sleep problems and medicine side effects. They also consider the setting and the way care is given.4
- Create. You and the care team make a plan together. It may change the routine, the room, or how a task is done. It should also include support and teaching for you, the caregiver.4
- Evaluate. After you try the plan, check back. Did it help? Is it doable? If not, adjust it and try again.4
A simpler home tool: ABC
Many caregiver classes teach the ABC method. It turns you into a "behavior detective."5
| Letter | Means | Questions to ask |
|---|---|---|
| A | Antecedent (what came before) | What time was it? Who was there? Was I asking them to do something? Was it noisy? Had anything changed? |
| B | Behavior | What exactly did the person do or say? How long did it last? |
| C | Consequence (what happened after) | How did I and others react? Did that calm things down or make them worse? |
Look for patterns over a week or two. Also notice when the behavior does not happen. That tells you what works.5 People with dementia often cannot learn from consequences the way they used to. So it usually works better to change the "A" (the setting and the approach) and your own reactions than to correct the person.5
You can use our behavior diary to keep track. It works for both DICE and ABC.
What helps in the moment
When a behavior is happening, the goal is calm and safety, not winning the argument.7
- Check basic needs first: pain, hunger, thirst, toilet, temperature, tiredness.7
- Slow down. Speak softly and simply. Give one step at a time.7
- Do not argue, correct or scold. Respond to the feeling behind the words. "You seem worried. I'm here."7
- Step back if the person is upset. Give them space. Do not corner or hold them.7
- Offer two simple choices or gently change the subject to something pleasant.7
- Lower noise and glare. Turn off the TV, close the blinds, move to a quieter room.7
For more on calm talk, see Talking with someone who has dementia. A steady daily routine and meaningful activities prevent many problems before they start.
Where do medicines fit?
Non-drug approaches should come first for most behaviors. The strongest research supports programs that teach and support family caregivers.2 Moderate evidence
Medicine may be added when non-drug steps have been tried and have not worked, or when symptoms are severe or someone is at risk of harm.6 A few medicines are FDA-approved for specific symptoms, such as agitation in Alzheimer's disease.6,9
Antipsychotic medicines need special care. All of them carry the FDA's strongest warning, a boxed warning, because older adults with dementia who take them have a higher risk of death.9 The Alzheimer's Association also notes a higher risk of stroke, and says these medicines should never be used just to sedate or restrain a person.6
Never start, stop or change a medicine on your own. Talk with your doctor or pharmacist first. Some common medicines can make confusion worse. See Medicines that can worsen memory, Medicines for agitation and behavior and Sleep medicines in dementia.
Guides to common symptoms and behaviors
Each page below explains why the behavior happens and what you can do.
| Symptom or behavior | What the guide covers |
|---|---|
| Memory loss and confusion | What is changing, cues and memory aids, routines |
| Repeated questions and stories | Why it happens, calm answers, written cues |
| Agitation and aggression | Triggers, calming steps, safety, when to get urgent help |
| Sundowning | Late-day confusion, light, routine, naps |
| Wandering and getting lost | Prevention, ID programs, what to do if someone is missing |
| Hallucinations, delusions and paranoia | Responding without arguing, accusations of stealing, Lewy body dementia |
| Sleep problems | Night waking, day-night mix-up, light, caregiver sleep |
| Bladder and bowel problems | Causes, toileting schedules, products, skin care, dignity |
| Eating, drinking and swallowing | Weight loss, finger foods, swallowing signs, dehydration |
| Refusing baths, help or medicine | Why people refuse, timing, choices, bathing and dressing tips |
| Apathy and depression | How to tell them apart, treatment, meaningful activity |
| Not knowing they are ill (anosognosia) | Why it is brain-based, not denial, and how to work around it |
| Unusual or embarrassing behavior | Disinhibition in public, calm responses, frontotemporal dementia |
Behaviors also differ by type and stage. For example, vivid hallucinations are common early in Lewy body dementia, and personality change is often the first sign of frontotemporal dementia. Many behavior changes peak in the middle stage.
Take care of yourself, too
Living with these behaviors day after day is exhausting. It is normal to feel frustrated, sad or worn out. Getting help is part of good care, not a sign of failure. The Alzheimer's Association runs a free 24/7 Helpline at 800-272-3900, with care advice in more than 200 languages.6
See Caregiver stress and burnout, Caregiver training and support programs, Respite care and our calm plan.
In this section
Memory loss
Why dementia causes memory loss and confusion, how to give gentle cues, which memory aids and routines help, and when new confusion needs a doctor.
Read →Repeated questions
Why a person with dementia asks the same question or tells the same story again and again, calm ways to answer, and written cues that help.
Read →Agitation and aggression
Why a person with dementia may become agitated or aggressive, common triggers like pain and infection, calming steps, safety, and when to call 911.
Read →Sundowning
Why some people with dementia get more confused or upset late in the day, and how light, routine, naps, caffeine and a calm home can help.
Read →Hallucinations
Why people with dementia may see things or believe things that are not true, how to respond without arguing, Lewy body cautions and theft accusations.
Read →Wandering
Why people with dementia wander, how to lower the risk at home, ID programs like MedicAlert and Project Lifesaver, and what to do if someone goes missing.
Read →Sleep problems
Why people with dementia wake at night or mix up day and night, and how routines, daylight, a safe bedroom and caregiver rest can help.
Read →Bladder and bowel
Why people with dementia lose bladder or bowel control, treatable causes to check, toileting routines, products, skin care, and keeping dignity.
Read →Eating and swallowing
Why people with dementia eat and drink less, how to help with weight loss and finger foods, signs of swallowing trouble, and when to get help.
Read →Refusing care
Why a person with dementia may refuse a bath, help with dressing or their medicine, and gentle ways to help using choices, timing and a calm approach.
Read →Apathy and depression
How to tell apathy from depression in dementia, what treatment can and cannot do, and how meaningful daily activity can help both.
Read →Disinhibition
Why a person with dementia may say or do embarrassing things, how to respond calmly at home and in public, links to FTD, and when to call the doctor.
Read →Lack of awareness
Why some people with dementia truly believe nothing is wrong, how it differs from denial, and calm ways to keep them safe without arguing.
Read →When to get help
- Call 911 if anyone is in danger, if the person is violent and you cannot stay safe, if they are missing (do not wait), or if they suddenly cannot be woken, have trouble breathing or show stroke signs.
- Call the doctor the same day for any sudden change in behavior, confusion or alertness. It may be an infection or a medicine problem.8
- Make a doctor visit if a behavior is new, getting worse, or wearing you down. Bring your notes or behavior diary.4
- Call or text 988 (the Suicide and Crisis Lifeline) if the person talks about wanting to die, or if you as the caregiver feel hopeless or think about harming yourself or someone else.
Will these behaviors last forever?
Not always. Behaviors often shift as the disease changes, and new ones may appear. Finding and fixing a trigger, such as pain, hunger or a noisy room, can bring relief.7
Sources
- Steinberg M, Shao H, Zandi P, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry, 2008. Utah State University
- Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 2015. PubMed
- Cohen-Mansfield J, Dakheel-Ali M, Marx MS, et al. Which unmet needs contribute to behavior problems in persons with advanced dementia? Psychiatry Res, 2015. PMC
- University of Michigan Depression Center. Experts propose new approach to manage the most troubling symptoms of dementia, lessen use of drugs (on the DICE approach, J Am Geriatr Soc 2014). University of Michigan, 2014. Depression Center
- Penn Memory Center. Caring for the Caregiver, Week 4: Managing Behavioral Symptoms (class slides). University of Pennsylvania, 2021. Penn Memory Center
- Alzheimer's Association. Treatments for Behavior. Alzheimer's Association, accessed 2026. alz.org
- Alzheimer's Association. Dementia-Related Behaviors (tip sheet). Alzheimer's Association, 2021. alz.org
- MedlinePlus. Delirium. U.S. National Library of Medicine, accessed 2026. MedlinePlus
- U.S. Food and Drug Administration. FDA approves first drug to treat agitation symptoms associated with dementia due to Alzheimer's disease. FDA, 2023. FDA
Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.