Trouble sleeping, restlessness, and hallucinations can all be a part of dementia with behavioral disturbances, but environmental management may help ease these symptoms and bring about a sense of calm.

Living with dementia isn’t just about experiencing memory loss. Dementia is a term that describes impairing changes to cognition in a number of medical conditions.

While memory loss is a prominent symptom, dementia can bring about behavioral symptoms, as well.

Behavioral disturbances can occur in a variety of physical and mental health conditions. They’re usually disruptive behaviors that haven’t been a part of your personality before.

In dementia, behavioral disturbances aren’t something you can control. They’re a result of the cognitive changes you’re experiencing.

Michelle Giordano, a community counselor and outreach specialist from John’s Creek, Georgia, explains that as dementia behavioral disturbances persist, they can rapidly diminish the quality of life for both the person and their caretakers.

This may also hasten the decision to make a move to a care facility, she adds.

According to a 2020 review, as many as 90% of people living with dementia experience behavioral disturbances along with cognitive decline.

The symptoms of dementia with behavioral disturbance can be different from person to person. While the symptom categories vary depending on literature, behaviors can generally be placed into four groups:

  • sleep disturbance
  • psychosis
  • agitation
  • mood changes

Within these four categories is a wide range of behavioral possibilities. You may experience agitation, for example, but that can mean anything from restlessness and fidgeting to physical or verbal aggression.

Sleep problems

Sleep disturbances in dementia can include insomnia, frequent wakefulness, daytime sleepiness, and even reversed sleep patterns.

You may experience end-of-day disorientation known as “sundowning,” which starts at dusk and may continue through the night.

Overstimulation from the day, a diminished need for sleep, and changes to your circadian rhythm may all contribute to these types of sleep disruptions.


Psychosis is a term in psychology used to describe symptoms related to altered reality perception.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) lists the symptoms of psychosis as:

  • hallucinations
  • delusions
  • disorganized thinking
  • disorganized motor function
  • negative symptoms (avolition, alogia, anhedonia, asociality, diminished emotional expression)

In certain forms of dementia, such as Alzheimer’s disease, hallucinations and delusions are the most clinically relevant psychosis symptoms.

Hallucinations involve false sensory experiences. You may hear, see, smell, taste, or touch things that aren’t really there.

Delusions are inaccurate beliefs held even in the face of indisputable evidence proving otherwise.


Agitation is a word often used synonymously with annoyance, but it holds a different meaning in the medical world. Aggression is just one possible manifestation of behavioral disturbances under the category of agitation.

In dementia and other conditions, agitation is a state of unrest created by inner tension. Agitation can display in many different ways, including:

  • pacing
  • aimless wandering
  • verbal aggression
  • spitting
  • constant requests for help or attention
  • kicking, hitting, biting, grabbing, or pushing
  • screaming
  • throwing things
  • negativism
  • complaining
  • intentional falling
  • trying to escape the current space
  • inappropriate eating or drinking
  • self-harm
  • hiding things
  • hoarding
  • destroying property
  • verbal or physical sexual advances
  • repetitive mannerisms
  • making unusual sounds

Agitation is considered the third most common neuropsychiatric symptom of dementia, after mood symptoms of apathy and depression.

Mood changes

Depression and anxiety are common mood symptoms of dementia with behavioral disturbance. According to a 2021 study, they may be most commonly associated with specific genetic variants seen in frontotemporal dementia.

Dementia can bring with it a number of mood changes. These are sometimes referred to as personality changes and can include:

  • apathy
  • social withdrawal
  • lack of motivation or initiative
  • insensitivity
  • depression
  • anxiety

The exact cause of behavioral disturbances in dementia isn’t clear but appears to be related to wide-spread neuron dysfunction in the brain.

“Neuronal loss has been identified as a key pathophysiological feature of dementia,” Giordano explains. “These include neurons from specific nuclei, such as cholinergic cells of the dorsal raphe [nucleus], in addition to nerve cells of association cortices.”

As nerves in specific areas of the brain lose function, different behavioral symptoms can appear.

The dorsal raphe nucleus, for example, is a brainstem nucleus involved in learning, memory, and mood. Research suggests changes to this area of the brain may contribute to depression in some conditions of dementia.

As neurons are lost, changes can occur in levels of neurotransmitters and communication throughout the brain.

“All these culminate to cause behavioral disturbances in dementia and, if not managed, can make the signs severe,” says Giordano, who adds that behavioral symptoms often coincide with the progression of dementia.

Behavioral disturbances in dementia are a symptom of the condition, not a reflection of how your loved one really feels about you.

Many times, these behaviors are responses to pain, stress, fear, confusion, or loss of autonomy.

Medications are available to help manage behavioral disturbances, but they’re not the first-line approach. Managing triggers and the environment are preferred options for dementia with behavioral disturbances.

Overall, during behavioral episodes, caregivers are encouraged to:

  • use calm, positive statements
  • back off and ask permission
  • slow down
  • reassure
  • adjust lighting
  • add visual or verbal cues
  • offer guided but limited choices
  • focus on pleasant experiences
  • engage in simple exercises
  • decrease stimulation

Raising your voice, attempting force, disagreeing, or demanding aren’t recommended approaches.

Other strategies to help decrease the chances of behavioral disturbance include:

  • reducing noise and light glare
  • limiting background distractions (like television)
  • checking for physical discomfort
  • limiting caffeine
  • involving your loved one in relaxation activities
  • finding outlets for energy like walking or exercising
  • simplifying tasks
  • adding rest periods between activities
  • improving lighting to reduce confusion
  • providing labels
  • providing security objects, like favorite blankets or personal items

Dementia with behavioral disturbances is common. As dementia causes neuron loss in the brain, many different areas of function can be affected.

Behavioral symptoms aren’t deliberate. They’re often uncontrollable responses to underlying stress and discomfort.

Environmental management of stressors, and calm, respectful interactions may help manage disruptive behavioral symptoms. Behavioral disturbances may also be helped through prescription drugs. Consider speaking with a doctor to determine the best treatment plan for you or a loved one.