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Behavioral Problems Related to Dementia
The aging of the U.S. population has been accompanied by a dramatic rise in the prevalence of dementia. Several studies indicate that 3-11% of persons over age 65 and 25% to 47% of those over 85 have dementia. In addition to cognitive decline, patients with dementia suffer from non-cognitive problems such as decline in functional status and disturbed or agitated behaviors. It is these behavioral problems, rather than the cognitive decline as such, that seem to cause most stress in caregivers.

Agitation, disturbed behavior, and behavioral problem related to dementia are different terms that have been used to describe a single phenomenon, defined as an inappropriate, verbal, vocal, or motor activity that is not explained by the person's needs.

Disturbed behaviors can be divided into four major categories:

  • Physically aggressive: Hitting, scratching, spitting, kicking

  • Physically nonaggressive: Wandering, pacing, inappropriate undressing

  • Verbally aggressive: Cursing, screaming, yelling, temper outbursts

  • Verbally nonaggressive: Whining, negativism, constantly asking for attention

Agitated behaviors are associated with earlier nursing home referral, poorer outcomes, greater costs, and increased caregiver burden. They negatively affect the quality of life of sufferers and their caregivers. While moderate cognitive impairment has a higher level of physically non-aggressive behaviors, mild cognitive impairment correlates with verbally agitated behavior.

The "ABC" Approach for behavioral problems
Drug therapies are almost always used as the disease progresses, but nonpharmacologic (non-drug) interventions for behavioral problems can help to reduce stress in both dementia sufferers and their caregivers. When assessing behavioral problems, use the "ABC" approach.

  • A = antecedent: what prompts the undesirable behavior?  
  • B = behavior: what does the behavior consist of?  
  • C = consequences: what are the consequences of the undesirable behavior?

Disclaimer: Always seek the advice of a physician or other health care provider when considering an intervention. Many of these interventions can only be done by trained professionals.