When people with dementia are mean to family, it often has more to do with neurodegenerative processes and less with how they feel about their loved ones.

Dementia includes medical conditions that cause symptoms of memory decline, impaired cognitive performance, and diminished reasoning ability. Alzheimer’s disease is the number one cause of dementia.

While often associated with growing older, dementia isn’t considered a part of natural aging.

Symptoms are the result of brain cell damage, and as communication between neurons breaks down, a number of different behaviors may appear — including those associated with meanness.

Dementia can cause behaviors that may present as meanness. Someone with dementia may suddenly seem like they don’t care about your feelings. They may snap at you, doubt your intentions, resist your efforts to aid them, or say hurtful things.

These behaviors are often the manifestation of common behavioral components of dementia such as:

  • agitation
  • aggression
  • disinhibition
  • depression
  • anxiety
  • psychosis
  • sleep disturbance

In Alzheimer’s disease alone, as many as 90% of people face behavioral challenges that can include agitation and irritability.

Not everyone living with dementia will display mean behaviors, however.

In a 2021 review, researchers indicated agitation, which included symptoms of aggressiveness, restlessness, and emotional distress, had an overall prevalence of 30% across all types of dementia, with the highest prevalence seen (up to 50%) in Alzheimer’s disease.

How dementia symptoms emerge in your life depends on which areas of the brain are impacted by cellular change.

Dementia and altered thinking skills

Living with dementia and being mean to family members often comes down to the altered thinking associated with neurodegeneration — the decline of cellular health and function in the central nervous system.

Dr. Sudhir Gadh, a board certified psychiatrist from New York City, explains dementia can lead to a number of neuropsychiatric symptoms, including irritability, agitation, and violence.

“As for why, in a word: disinhibition,” he says. “The more the cortex is sludged with plaques and tangles like in Alzheimer’s disease, the more it fails to inhibit. Underlying impulses are no longer controlled, patience is lost, memories are lost, abilities diminish, and anger can reign.”

The complexity of altered thinking in dementia can mean minor frustrations turn into aggressive outbursts and other negative emotions, such as fear and confusion, result in combativeness.

Feelings of anxiety, agitation, and confusion can increase with dementia when someone doesn’t understand their circumstances because of memory loss.

Meanness as an early symptom of dementia

Late-life cynical hostility, a type of meanness based on a mistrust of others, was linked in a 2021 study to white matter changes in the brain that may be early indicators of Alzheimer’s disease.

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Caring for someone with dementia who’s being mean to the family can be challenging. You may feel you’ve lost the loving bond you once had with that person.

While progressive dementia, such as that associated with Alzheimer’s disease, has no cure, it’s possible to manage symptoms and maintain a caring relationship.

Identifying everyday life adjustments

What may be comforting or natural for you may be a source of frustration for someone living with dementia.

Dr. Donna Seminara, director of the division of geriatrics at Staten Island University Hospital, New York, says mean-spirited behaviors are often the only way some people with dementia can express frustration, as often seen in the situation of showering.

“What is often relaxing to most, having warm water trickle from head and face down the body, is often agitating to demented individuals who can’t control the flow of water,” she says. “Using a hand-held shower nozzle where the patient can exert some control may make this experience much less stressful for all.”

Establishing a stable, consistent environment

Seminara points out that bringing someone living with dementia into new environments can have poor outcomes, as fear, confusion, and memory loss can increase anxiety and agitation.

By keeping routines and environments the same, you can encourage a sense of familiarity and comfort that can keep meanness at bay.

Taking the slow approach

Abrupt movements may be disconcerting to someone living with dementia.

“Try to maintain a positive, smiling face towards the patient, and always touch the patient with a slow approach. Fast, sudden movements are startling to most dementia patients and can start a cascade of resistant speech and behavior,” says Seminara.

Medication strategies

Medications may help manage some of the behavioral symptoms seen with dementia.

“There are several treatments for the depression and anxiety associated with dementia, assuming a treatable medical condition has been ruled out, including psychotherapy, antidepressants, antianxiety agents, and the nutritional support of the B vitamins folate and B12,” says Dr. Sheldon Zablow, a board certified psychiatrist from San Diego.

He adds that folate and B12 are essential for making the neurotransmitters that lower the likelihood of depression and dementia.

Gadh points out that prevention is paramount and should be considered a form of dementia treatment, especially, he says, because there’s no approved treatment for dementia that has had remarkable results and a low risk of serious side effects.

An emerging treatment option for dementia, low dose lithium, may fill that treatment gap one day. Gadh explains that lithium, a natural salt, has been associated with improved mental health and decreased dementia risk.

Lithium is currently used to treat bipolar disorder, but experts are now investigating whether it may help with dementia.

“It is already being studied by the National Institutes of Health (NIH) for the prevention of Alzheimer’s because lithium is a known neurotrophic (enhancer of brain growth via GSK-3 inhibition),” he says.

Following the hallmarks of dignity, respect, and choice can help you support a loved one living with dementia.

Regardless of impaired cognitive function, people living with dementia keep the desire to be treated humanely, and keeping this in mind can help limit behavioral symptoms.

A review published in 2018 found the best-in-practice approaches to the management of dementia behaviors included:

  • the recognition of required support levels in areas of daily functioning such as dressing, eating, and using the bathroom
  • individually-catered care that acknowledges the likes and dislikes of the person
  • a focus on simple choice opportunities such as when dressing or eating
  • upholding dignity and respect during vulnerable or private moments such as bathroom usage
  • awareness of comfort at all times, particularly related to incontinence, dental health, and personal hygiene
  • creation of a quiet, comfortable, and homelike atmosphere
  • consideration of cultural practices such as those associated with mealtime

Determining how to support your loved one and keep their dignity can be challenging. It may be helpful to look for professional guidance to learn strategies for keeping private moments, such as bathing or using the toilet, safe and respectful.

When someone is living with dementia and being mean to family trying to care for them, it’s rarely because that person holds negative feelings toward a loved one.

Dementia can include aggressive symptoms as memory loss increases feelings of fear and frustration, and the body loses its ability to regulate emotional responses.

While there’s no cure for progressive forms of dementia, medication treatments may help in addition to caregiver focus on consistency, freedom of choice, and humane treatment.