Managing dementia: Communication and behavioural changes

Published on 26 Jan 2024

Are communication problems and dementia-related changes in your loved one’s behaviour giving you a hard time?

Turns out you're not alone. Studies have shown that caregivers often find these aspects of dementia care difficult to navigate.[1][2] Fortunately, there are strategies we can use to manage these challenges.

Jump to the following:


How does dementia affect communication

Dementia affects the regions of the brain responsible for language, memory, and cognitive function.

As a result, a person with dementia may face changes in communication such as:

  • Difficulty finding the right words

  • Reduced ability to follow a conversation

  • Incoherent or repetitive speech

  • Decline in reading and writing skills


Tips for effective communication with a person with dementia

Individuals with dementia often experience frustration and confusion as they struggle to express themselves and understand others. However, it’s possible to alleviate some of their stress and encourage positive interactions by adapting your approach and responding with patience.

Here are some ways you can make communication easier for them:

Talk Slowly

Speak at a slower pace, and pause between sentences to give a person with dementia sufficient time to process the information and respond.

Keep the Conversation Simple

Use simple words and keep your sentences short. Focus on one topic at a time, to make it easier for them to follow the conversation.

Try asking questions with limited answer choices such as “Would you like juice or water?” to minimise confusion. For individuals with more advanced dementia, it can be helpful to ask close-ended questions that can be answered with a simple "yes” or "no".

Minimise Distractions

Create a distraction-free environment to help individuals living with dementia focus on the conversation. Move to a quieter area, or turn off the television and radio to ensure that you have their attention. If they have hearing or vision issues, make sure their hearing or visual aids are equipped.

Offer Reassurance

When someone with dementia encounters difficulties with speech or a task, avoid criticising them. Instead, use comforting words such as "You're doing great" or "It’s okay, take your time" to encourage and reassure them.

Include them in conversations and acknowledge what they say, even if their words do not make sense. Non-verbal gestures like holding their hand or offering a hug can convey support, and help your loved one feel safe and motivated to continue trying.

Look Out for Non-Verbal Cues

Individuals living with dementia often rely on non-verbal cues such as gestures and touch to communicate. By paying attention to their body language and facial expressions, you can gain valuable insights into their needs and level of comfort.

Use hand gestures to demonstrate what you want them to do, as that can help them understand your intentions more effectively. Approach them with a smile and relaxed posture, make eye contact at their level, and use touch to foster a closer connection.

Why Do Behavioural Changes Occur?

Due to changes in the brain, up to 90% of people with dementia will exhibit behavioural changes at some point in the course of their illness.[3] Some of these behaviours can be concerning and completely uncharacteristic at times. However, it's important to recognise that these changes are a result of the disease and not intentional.

Caregivers can help in reducing the occurrence of these behaviours, by actively identifying and addressing the unmet needs that trigger them.

Common Behaviours Associated with Dementia

Wandering, sundowning and aggression are three behaviours often observed in people with dementia. In this section, we’ll explore the possible reasons for these behaviours and provide practical strategies to manage their impact.

Wandering Behaviour

Wandering occurs in around 60% of individuals with dementia, and it poses a significant safety concern.[4] Those who wander are at an increased risk of falling and getting lost.

Possible Reasons for Wandering

Boredom or restlessness: Wandering can be a way to use up excess energy, which may indicate your loved one needs more physical, social or mental activity.

Searching for the past: Individuals with dementia may get confused and wander off in search of someone or something from their past. They may also believe that they are performing a previous role like going to work, or marketing.

Memory loss and confusion: Someone with dementia may set off with a specific task in mind, but forget where they were going or what they intended to do.

A desire for familiarity and routine: A noisy or unfamiliar environment can trigger wandering as a way to get away from the noise, or go in search of familiar surroundings.

Physical discomfort: Wandering may be an attempt to relieve discomfort from excessive cold or heat, thirst and hunger, constipation, tight clothing or ailments like urinary tract infections (UTI).

How to Manage Wandering Behaviour

Safety is the top priority when dealing with this behaviour, especially if the person with dementia is a fall risk. Apart from providing close supervision, here are some preventive measures caregivers can take:

  • Engage individuals in meaningful activities and establish a structured routine that addresses their social, physical, mental, and psychological needs. This can involve activities they find familiar and enjoyable, such as reminiscing with their loved ones, arts and crafts, or music and pet therapy.

  • Install electronic home alarms or locks that are out of their line of sight.

  • Remove objects that may trigger wandering, such as car keys, shoes or handbags.

  • Put up visual barriers on an exit door. like covering the door knob or using cloth barriers to hide the door.

  • Use assistive devices such as a GPS tracker, or an identity bracelet that can provide vital information like their name, address and details of a contact person in the event that they get lost.


Sundown Syndrome

Sundowning refers to a pattern of increased confusion, agitation, and restlessness that individuals with dementia typically experience in the late afternoon or evening.

It often increases caregiving demands and responsibilities through the night, and can cause physical and emotional exhaustion for caregivers.

Possible Reasons for Sundowning Behaviour

Fatigue: As the day progresses, exhaustion builds up and can lead to increased confusion and mood changes.

Environmental factors: Changes in lighting, noise levels and evening shadows can be unsettling for individuals with dementia.

A lack of daytime routine: The absence of structure during the day, such as inconsistent mealtimes, irregular naps or medication schedules, can contribute to disorientation and sleep issues later in the day.

How to Manage Sundowning Behaviour

  • Design a daily routine that includes regular mealtimes, activities, and bedtime to provide them with a sense of structure to lessen their confusion.
  • Promote relaxation by scheduling calming activities before bedtime, such as listening to soothing music, reading a book, or a hand massage. Try to avoid caffeine and alcohol near bedtime, as they can interfere with sleep and exacerbate sundowning.
  • Plan outdoor activities during the day to expose your loved one to natural light, as this can help regulate their sleep-wake cycle. Towards the evening, consider switching on warmer lights with a yellow or orange hue to create a calming and comforting atmosphere.

Aggression and Agitation

A person with dementia may get agitated without provocation, and show signs of anxiety, worry and anger. This can escalate into aggressive behaviour such as swearing, shouting, or physical acts of violence towards others.

These behaviours can be particularly distressing for caregivers. However, it may be useful to identify the potential triggers to find ways to manage it more effectively.

Possible Reasons for Aggression and Agitation

Frustration: Dementia can intensify a person’s feelings of emotional distress and cause depression. Some may feel humiliated or pressured when they fail to perform certain tasks. This is further exacerbated by their inability to express themselves.

Fear and confusion: People with dementia may get frightened because they no longer recognise certain people or places.

A need for attention. They may be trying to express physical discomfort, or experiencing feelings of loneliness, isolation, and boredom.

How to Manage Agitation and Aggression

  • Prevent the outburst before it happens by redirecting their attention to activities they enjoy, such as going for a walk together. This should be done preemptively, upon noticing signs of agitation that could lead up to aggression.

  • Stay calm and ensure the environment is safe by putting away dangerous items such as knives or sharp objects.

  • Avoid restraining them physically unless they are causing harm to themselves or others, as it can increase aggression. Give them some space to cool down, and seek help if needed.

  • Review your loved one’s medical condition with their doctor regularly to ensure it is not an adverse reaction to medication, or another illness causing the agitation.


Self-Care and Support for Caregivers

Managing dementia behaviours can quickly tire out a caregiver, so it’s crucial to take regular breaks from your carer duties to look after yourself.

Join a support group to get access to practical advice and emotional support from individuals who can understand your journey.

Seek support

Families who need more help to provide a better quality of life for their loved one can turn to NTUC Health’s dementia care services and programmes. If your loved one requires care round the clock, our nursing homes have specialised programmes, like Namaste Care, which includes music therapy and massages that can provide those with Dementia with a loving touch and promote a better sense of well-being. While you are away in the day, our dementia day care can support you by taking care of your loved one and engaging them.

Remember, you’re not alone on your caregiving journey! Get in touch with us for more information on how we may support your needs today.

1. The Effects of Communication Problems on Caregiver Burden (link)

2. The Impact of Behavioural Symptoms in Dementia Patients on Family Caregiver Burden (link)

3. 90% of people with dementia will exhibit behavioural changes (link)

4. 60% of people with dementia exhibit wandering behaviour at some point. (link)

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