Understanding and Interpreting Alzheimer’s Behaviors

Medically Reviewed by Sabrina Felson, MD on August 12, 2022
7 min read

When a loved one has Alzheimer’s disease, the disorder leads to changes in their ability to remember, think, and reason. As it progresses, they may begin to have trouble with language and everyday tasks. Communication as you’ve known it may stop altogether as the disease gets more severe.

But knowing how to understand, interpret, and respond to common Alzheimer’s behaviors as they come up can make the process a bit easier. Changes in the brain aren’t the only reason your loved one may act differently. You can learn a lot about their feelings, health, pain, and needs by paying close attention to their behavior. It’s a form of communication. Learn some common Alzheimer’s behaviors and ideas about what they might mean.

As Alzheimer’s gets worse, your loved one may seem agitated, angry, anxious, or aggressive. They may pace, worry, or have trouble sleeping. They may lash out at you with words or even hit. It may seem like this happens for no obvious reason. But, they may be trying to communicate something. Ask yourself these questions:

  • Is your loved one in pain or uncomfortable?
  • Could they have an infection, constipation, or other ailment?
  • Are they not sleeping well?
  • Are they hungry or thirsty?
  • Are they having side effects from the medicine they’re taking?
  • Are there overwhelming loud noises, clutter, or large crowds?
  • Are they feeling lost?
  • Are you interacting at a time of day that isn’t their best?
  • Are you speaking to them in a way that’s too simple or too much?
  • Do you yourself sound as if you’re irritated or stressed?

It’s best to look for signs of agitation, anxiety, or aggression early before they get worse. If you can’t figure out what’s wrong and it continues even in calm environments, ask a doctor for help. They may be able to run tests and check them for an underlying health issue.

Your loved one may rummage through cabinets and drawers. They also may hide things in odd places around the house. There could be a logical reason for this. But it might be a sign of something else.

  • Are they looking for something they think they’ve lost?
  • Are they able to tell you what they’re looking for?
  • Are they bored?
  • Are they hungry?
  • Do they need something else?

You may not be able to stop this behavior. So you’ll want to think about how to keep them safe. Remove or secure any items that are:

  • Dangerous
  • Toxic
  • Spoiled
  • Dirty
  • Valuable
  • Important

They may forget where they are, even while out for a short walk. They may wander and get lost. It’s possible your loved one will start doing this repeatedly.

Some signs your loved one is at risk of wandering include:

  • Forgetting familiar locations
  • Talking about things they need to do, such as going to work
  • Wanting to go home even when they’re home
  • Pacing or restless behavior
  • Having trouble navigating the home
  • Asking where friends and family are

To help lower the risk of wandering, ask yourself:

  • Are they getting enough activity during the day?
  • Are there certain times of day they tend to wander?
  • Are they having basic needs met?
  • Do they need to use the bathroom?
  • Do they need reassurance?
  • Do they need more help getting around?
  • Are they finding busy places like a restaurant or mall too disorienting?

In addition to trying to understand the behavior, you’ll want to take steps to keep your loved one safe. This may include bolts and alerts on doors. Make sure they have an ID bracelet and let neighbors and the local police know about your concerns.

Your loved one may sense or feel something that isn’t there. They may seem frightened. Or they may have hallucinations about ordinary events, people, and places from their past. Chances are hallucinations are the result of changes in their brain related to Alzheimer’s. But keep in mind that hallucinations also can be caused by:

  • Kidney or bladder infections
  • Dehydration
  • Pain
  • Alcohol or drug abuse
  • Vision or hearing problems
  • Medications

Also ask yourself:

  • Is there a sound they’re misinterpreting?
  • Is it something on TV?
  • Are there lights or shadows they’re seeing?
  • Are they looking in a mirror?
  • Was it a dream or memory?

Don’t argue with your loved one about what they’ve seen or heard. But if you think there are any reversible factors, you might be able to respond in helpful ways.

Your loved one is doing or saying something again and again. They might do something and then undo it repeatedly. Ask yourself:

  • Are they bored?
  • Are they looking for comfort?
  • Do they need some security?
  • Is it giving them a sense of familiarity?
  • Are they concerned or frustrated?

It may help you to think less about what they’re saying or doing and more about how they feel. Try to engage with them in the activity. Answer them as best you can. If it isn't causing a problem, do your best to accept the repetition and work with it.

Your loved one may have trouble sleeping. They may get more agitated, confused, or restless at dusk and through the night. It’s not clear why sundowning happens. But there may be factors to consider:

  • Are they getting mentally exhausted during the day?
  • Are they physically exhausted?
  • Are they spending time in places that aren’t familiar and causing more confusion?
  • Is their internal clock mixed up?
  • Are they seeing lighting or shadows that they don’t understand?
  • Are they stressed or frustrated?
  • Are they unable to tell dreams from reality?
  • Do they need less sleep?

By trying to identify causes of confusion as the day wears on, you may find ways to help. Keep notes about what happened during the day at times when sundowning happens to see if you can find triggers to avoid.

Sometimes it’s hard to tell if a person with Alzheimer’s is depressed. But 4 in 10 people with Alzheimer’s will have significant depression. Ask yourself:

  • Are they apathetic?
  • Have they lost interest in activities they once enjoyed?
  • Have they withdrawn from friends?
  • Are they isolated?
  • Are they having trouble concentrating?

Depression might look different in someone with Alzheimer’s. If you have concerns, see a doctor for help. Getting treatment for depression may help them have a better quality of life. Support groups, a regular routine, and reassurance from loved ones may help, too.

Your loved one may have reached a point where they need help with bathing, brushing teeth, dressing, and many other everyday activities. Keep in mind that they also may feel embarrassed by this. They may feel anger. If your loved one is beginning to show signs they can’t take care of these basic needs, you’ll need to find ways to help them or get them help.

If your loved one needs help with bathing, ask yourself:

  • Are they afraid to bathe or simply unable to do it?
  • Are they embarrassed for you to help with bathing?
  • If so, how can you make it less embarrassing or more relaxed?
  • When did they typically bathe so you can choose that time to help?
  • Is the water the right temperature?
  • Do they have all the items they need for bathing?

If they need help dressing, consider these questions:

  • Do they need help choosing clothes? If so, can you lay them out?
  • Do they need step-by-step instructions?
  • Would it help if they had fewer choices?
  • Could they wear different sets of the same clothes every day?
  • Do they need clothes that are more comfortable?
  • Would Velcro or zippers be easier than shoelaces, buttons, and buckles?
  • Would a different pair of shoes be easier to put on?

If they need help with grooming, ask yourself:

  • Do they need help brushing their hair?
  • Do they need help brushing their teeth?
  • Do they have dentures they need help with?
  • What about glasses or contacts?
  • Do they need help with makeup if they typically wore it?
  • What about shaving and fingernails?

Your loved one may struggle to keep themselves clean and well cared for. But if you are able to help in thoughtful ways with how they look, it may also help them to feel better.

It’s important to remember that your loved one may not be able to communicate their needs to you. But their behaviors and facial expressions may help you know when something is wrong. By staying calm and trying to read the situation, you can help to identify areas where you can help.

As you try to think through their behavior and what it means, take a three-step approach:

  • Validate. Let your loved one know you understand and respect how they feel. Validating their feelings can help them feel less anxious. It may also reduce their resistance to your help as you try to think through the behavior and what they may need.
  • Reassure. Let your loved one know that you’re there for them. Talk to them in a calm voice. Listen to what they have to say. Show them that you understand if they feel angry, afraid, or any other negative emotion.
  • Redirect. Once your loved one is validated and reassured, try to direct them to a more positive feeling or activity if you can.

Other general tips to cope with difficult feelings and behaviors include:

  • Give your loved one as much control as you can.
  • Keep their routine as constant as you can.
  • Make sure the day includes activity but also quiet time.
  • Keep familiar and well-loved objects around.
  • Use gentle touches, soft music, reading, or walks.
  • Avoid noise and clutter.
  • Limit your loved one’s caffeine.

If you’re worried your loved one has a new health problem, talk to their doctor. There’s a team of people who can help with difficult behavior and offer strategies for maximizing independence. They include:

  • Primary care doctors
  • Neurologists
  • Psychiatrists
  • Occupational and physical therapists
  • Social workers

You can also look to online organizations for caregiver support and advice.