Emotional Outbursts: An Early Sign Of Dementia?

Dementia affects people in different ways, but it often causes changes in behaviour and mood. People with dementia may experience rapid mood swings, becoming unusually tearful or happy. They may also be prone to aggressive behaviour, agitation, and irritability. These emotional changes can be very distressing for the person with dementia, as well as their loved ones and caregivers. It's important to remember that these changes are caused by the illness and are not directed personally.

Emotional lability, irritability, and rapid mood swings

BPSD can manifest in multiple ways, including behavioural, affective, psychotic, and somatic symptoms. Emotional lability, irritability, and rapid mood swings are common behavioural symptoms. These symptoms can be challenging for caregivers to deal with, as they are partly caused by damage to the person's brain. This brain damage can also cause a decline in the person's ability to think clearly and a loss of factual memories, leading to the person reacting more emotionally to situations than might be expected.

The assessment and management of BPSD are essential components of dementia treatment. Non-pharmacological interventions are usually the first line of treatment and can include environmental modifications, social interactions, and behavioural interventions. Pharmacological interventions, such as cognitive enhancers, atypical antipsychotics, and antidepressants, may be used in acute situations or when non-pharmacological methods have failed.

Aggressive behaviour and physical outbursts

Causes of Aggressive Behaviour in Dementia

People with dementia may behave aggressively due to:

• Memory loss, language problems or disorientation: For example, they may forget where the toilet is, or become confused if the room is too dark.
• Pain or discomfort: They may be thirsty, need the toilet, or be experiencing an infection, constipation, or toothache.
• Side effects of medication: Such as drowsiness or confusion, which can cause frustration or make communication more difficult.
• Delusions or hallucinations: These can be frightening and cause an aggressive response.
• Frustration at their situation: For example, not being able to do things they used to, or feeling patronised by others.
• Depression or other mental health conditions
• Feeling threatened or unsettled: They may feel they are in the wrong place, or that there are strangers in their home.
• Misunderstanding the intentions of their carer: For example, seeing personal care as an invasion of their personal space.
• Loneliness or isolation
• Boredom or lack of stimulation
• Different approaches from multiple carers: This can be confusing, and they may not like a particular carer or their approach.
• Hiding their condition from others: They may become angry if their dementia is mentioned.
• Lack of awareness of their condition: They may become irritated if their difficulties are pointed out.
• Feeling undervalued: They may feel they are not able to contribute.

Strategies for Managing Aggressive Behaviour

• Give the person space: They may feel their personal space has been invaded.
• Don't argue: This will likely only make the person angrier.
• Distract them: Try playing their favourite music, or putting on a TV show or sports game.
• Limit interactions to one carer at a time: Multiple carers can raise anxiety and trigger aggression.
• Identify and address the person's needs: For example, ensure they are eating the right foods, and keep the dining space calm.
• Look for patterns in their behaviour: For example, they may tend to get angry in the evening.
• Consider medication: This should not be the first choice, but there are times when it may be necessary.

Catastrophic reactions and over-sensitivity

People with dementia may experience what is known as a catastrophic reaction, which involves overreacting to a minor setback or criticism. This could manifest as screaming, shouting, making unreasonable accusations, becoming agitated or stubborn, or uncontrollable crying or laughing at inappropriate times. This behaviour can be very distressing for carers, who may feel frightened by the intensity of the reaction.

Catastrophic reactions are caused by the illness and are beyond the person's control. They are often triggered by stress, frustration caused by misinterpreted messages, or another underlying illness. Keeping a diary can help carers identify the triggers of such behaviour and avoid them in the future.

It is important to remember that the person with dementia may be just as frightened by their reaction as those around them. They need reassurance and understanding from their carers, who should try to remember that the behaviour is not directed at them personally.

Loss of emotional control and motivation

These changes in emotional responses can be difficult for caregivers to deal with. It's important to remember that these changes are partly caused by damage to the person's brain and a decline in their ability to think clearly. Strong emotions may also be caused by unmet needs, and caregivers should try to identify and meet these needs where possible.

One particular aspect of emotional changes in people with dementia is a decline in emotional control or motivation. This can manifest as emotional lability (rapid mood swings), irritability, apathy, and coarsening of social behaviour. These changes in social behaviour can include decreased social engagement, emotional indifference, diminished reactivity, and a lack of persistence in social interactions.

In addition to changes in emotional control, people with dementia may also experience changes in their sexual behaviours and intimacy. They may exhibit increased or diminished sexual desire, along with changes in their expression of sexuality. Partners of individuals with dementia may struggle with feelings of rejection, distaste, or guilt regarding their sexual relationship. It's important to remember that these changes are part of the illness and are not directed personally.

Managing changes in sexual behaviours and intimacy can be challenging. Carers may need to keep out of the way during periods of increased sexual demands or find ways to redirect the person's attention to other activities. They may also need to focus on providing different forms of touch, such as massage, holding hands, or embracing, to meet the person's need for physical contact.

Changes in sexual behaviour and intimacy

Dementia can cause changes in a person's sexual behaviour and desire for intimacy. This can be distressing for the person with dementia and their partner, but there are ways to cope with these changes.

People with dementia may experience physical and emotional changes that affect how they feel about sex and intimate relationships. For example, frontotemporal dementia (FTD) can affect a person's inhibitions, sexual behaviour, and attitude towards sex. FTD may also impair a person's ability to feel empathy, which can impact both partners' sense of intimacy.

How to cope with changes to your sex life caused by dementia

It is normal for people in long-term relationships to experience differences in their levels of interest in sex. If this happens, try to find realistic, practical solutions, and consider talking to someone you trust about it.

There are also ways to relieve pent-up sexual tension, such as masturbation, exercise, and other energetic activities.

Talking about dementia, sex, and intimacy

Physical intimacy can continue to be a source of comfort, support, and pleasure for people with dementia and their partners. However, it can be a difficult subject to discuss. It may be helpful to talk to a trusted friend or family member, or to raise the issue in a carers' support group.

Managing challenging sexual behaviour

A person with dementia may behave in a 'sexual' way that they and those around them find challenging. They may be inappropriate or aggressive, mistake a person for someone else, or behave sexually in public.

If your partner behaves inappropriately towards care staff, it is important to share your concerns with the care workers themselves or other health or social care professionals. They may be able to prevent this from happening or suggest ways to minimise the impact.

If the person with dementia acts in a sexual way around, or towards, children or other vulnerable people, it is important to take steps to protect them. For example, you may need to stop unsupervised time between the person with dementia and their grandchildren.

In rare cases, a person with dementia may go through a phase of being sexually aggressive, such as making repeated demands for sex. If this happens, it may be helpful to remove yourself or others from the situation until they calm down. You can also ask care workers if they have noticed any inappropriate behaviour.

If you feel that there is an immediate risk of violence to yourself or others, you should call the police. It is important that you still feel safe.

Dementia can affect a person's inhibitions, causing them to express private thoughts, feelings, and behaviours – including those related to sex – publicly. They may make sexual advances to others, undress or touch themselves in public, or use language that you have never heard them use before.

Frequently asked questions