Non-drug approaches to changes in mood and behaviour

It is common for people with dementia to develop changes in mood and behaviour, particularly as their condition progresses.

In most cases, with the right care and support, these changes will pass. However, sometimes they may persist or get worse over time. This can be very upsetting, both for the person with dementia and for those caring for or supporting them.

There are ways of managing and coping with these changes. Non-drug approaches (described on this page) that should always be tried first.

What changes in mood and behaviour may a person with dementia experience?

A person with dementia will experience changes in the way they think and feel as their condition progresses. Certain tasks and activities will become more difficult.

Damage to the brain may make it harder for them to understand what is real and what isn’t. This can cause them to react to situations differently from how they used to. It can also become more difficult for the person to see things from someone else’s point of view. They may no longer be able to understand how their actions make someone feel.

Changes experienced by the person may include the following:

Changes in mood

• Depression – feeling sad, worthless, guilty or hopeless most of the time.
• Anxiety – feeling afraid, tense, worried or threatened.
• Apathy – having less energy, motivation or interest in things they used to do.

Changes in perception

• Misperceptions – when a person sees one thing as something else. For example, mistaking blue floor tiles for water.
• Misidentifications – when a person has problems identifying specific objects and people. For example, mistaking their son for their husband.
• Delusions – when a person believes things that are not true, such as a family member being a stranger.
• Hallucinations – when a person senses things (such as seeing people or hearing voices) that aren’t really there.

Delusions and hallucinations are forms of ‘psychosis’, which is where a person loses contact with reality.

Changes in behaviour

• Aggression – intimidating outbursts or trying to harm or threaten another person, either verbally (shouting, swearing or screaming) or physically (such as resisting care, slamming doors or breaking things). 
• Sleep problems and night-time disturbance – for example, insomnia (not being able to go to sleep or waking frequently during the night). 
• Losing inhibitions – behaving in ways that others may find embarrassing, such as making inappropriate comments or undressing in public.
• Agitation – becoming excited and restless without any obvious purpose – for example, pacing, fidgeting or making repetitive gestures.
• Social withdrawal – interacting and communicating less with other people and doing fewer activities.

These changes can be very upsetting for the person with dementia and for those close to them. It can feel difficult to understand why they are happening. It’s important to try to see things from the person’s point of view, and not to blame them for their behaviour.

Changes in mood or behaviour are often signs of stress or distress. They may be an attempt by the person to communicate that something is making them feel bad. For example, they may have pain or discomfort, or feel overwhelmed and afraid. Or they may need more stimulation and interaction with other people.

Most problems improve within a few weeks of identifying the problem and making simple changes without the need for medication. Spending more time with the person or changing their daily routine are examples of small changes that can make a big difference.

Changes in mood and behaviour are often signs of stress or distress. It’s important to try to see things from the person’s point of view, and not to blame them for their behaviour.

What non-drug approaches are available to people affected by dementia?

Supporting a person to get better means looking closely at their situation and working out what might be causing the problem. This means thinking about the person as an individual.

The person's personality, life history, likes, dislikes and relationships with other people will all affect the person’s physical and mental health. As will their surroundings, their medical conditions and the types of care they are receiving.

Person-centred care

Helping the person to live well involves providing practical and emotional support, based on what you know about them. The following suggestions may be helpful:

• If the person has a hearing aid or glasses, it’s important to make sure they are clean, correctly prescribed and used. If they are not being worn or are not working properly, the person may become confused or disoriented. This can lead to them becoming anxious or distressed.
• Helping the person to have a daily routine can provide them with a sense of comfort and familiarity. Sudden changes to this routine can be confusing or distressing for the person.
• The person’s environment should not be too noisy, too hot or cold, uncomfortably bright or cluttered. These can all cause the person to become over-stimulated, which can lead to agitation.
• If the person does not have enough interaction with other people, this can sometimes contribute to changes in behaviour. Having regular one-to- one time can help significantly. When communicating, it is important to listen carefully to the person, look for non-verbal cues (such as facial expressions and body language) and try to understand the reality they are experiencing. 
• Staying active and involved can help to reduce feelings of stress, frustration and boredom. The person may enjoy activities that are matched to their interests and abilities. These could include arts and crafts, music, exercise, reminiscence or anything else that is meaningful for the person including things they have previously enjoyed. For more information see our activities handbook.

It can be helpful to keep a diary of the person’s behaviour and the circumstances around it. This can often help to identify and resolve reasons for their distress before they get worse. 

Visit the GP

The next step is to find out whether any underlying physical or medical problems may have triggered the person’s changes or made them worse.

If the changes in the person’s mood or behaviour are not easily resolved, they should have an assessment by their GP as soon as possible to check whether the person has:

• pain or discomfort
• an infection
• problems with hearing or vision
• dehydration
• constipation
• alcohol or drug withdrawal
• problems with their metabolism
• problems with sleeping.

If any of these are found, the GP will try to manage them appropriately. They will also be able to review the person’s medications. Sometimes the interaction of different medications affects the person’s mood or behaviour.

Occasionally the GP will refer the person to a specialist, such as a geriatrician, psychiatrist, occupational therapist, physiotherapist or dietitian. Together these health professionals can develop a care plan specifically for the person. However, if the problem is very severe or urgent the person may need to go to hospital.

If you are caring for someone and they go into hospital or a care home, staff may ask you to complete a patient information form on their behalf such as Alzheimer’s Society’s This is me. This form records a person’s history, preferences and routines. It can help staff know the person better and help work out what might be causing the person’s distress. Try to involve the person as much as possible when filling this out. 

If the GP thinks that the person could have depression or anxiety, they may recommend trying a combination of drug and non-drug approaches.