​Behavioural changes in persons living with dementia can occur as a result of changes in their brain.

The Department of Psychological Medicine from Changi General Hospital (CGH), a member of the SingHealth group, explains the common symptoms displayed by persons with dementia and offers caregivers tips on how to better manage these behaviour changes when caring for their loved ones with dementia.

Inappropriate (disinhibited) behaviours in persons with dementia

Inappropriate (or disinhibited) behaviours are actions, which may appear offensive, inconsiderate and disrespectful. 

They occur when people act and express themselves in a socially inappropriate manner, such as being over-friendly to strangers, making inappropriate sexual advances at caregivers or strangers, undressing in public, or making inappropriate or rude comments about others in pubic. 

People displaying such disinhibited behaviours may be perceived as causing deliberate embarrassment or harassment to others. 

Disinhibited behaviours in persons with dementia can contribute to caregiver burden of their families and caregivers. These changes in behaviour may be particularly challenging for others, as well as for the person with dementia, who might find it difficult to cope and react accordingly.

9 Tips to manage inappropriate (disinhibited) behaviours in persons with dementia

1. Don't be embarrassed when the person with dementia displays disinhibited behaviour

As a caregiver, try not to overreact when your loved one with dementia displays inappropriate (disinhibited) behaviour even though it may be embarrassing. Remember that these behaviours are not intentional and they stem from the condition that they are suffering from – dementia.

2. Find out from the person if there is a cause for his/her disinhibited behaviour

Check with the person with dementia if there is another reason (besides dementia) behind their behaviour. For example, their clothes may be making them feel too hot or their diaper could be wet.

3. Find out from your doctor if there is a cause

Check with the doctor that is seeing your loved one with dementia whether the behaviour is caused by physical illness, discomfort or a side effect of the medication that he/she is on.

4. Let others know that the person has dementia

Explain to others that the loved one you're caring for has dementia and to pardon his/her behaviour if any situation arises.

5. Do give the person with dementia some privacy

Provide privacy and time so that your loved one with dementia can meet their needs discreetly.

6. Adjust their wardrobe according to their needs

Consider buying pants without zippers for your loved one with dementia so that it is easier for him to dress, especially when the condition gets more severe.

7. Avoid overreacting in public when the person with dementia displays disinhibted behaviour

If your loved one with dementia engages in inappropriate sexual behaviour, lead him to a quiet corner out of public view then gently remind him that such behaviour is improper.

8. For persons with dementia, try to keep their time occupied

Try to distract your loved one by keeping him/her occupied with activities.

9. Keep the person with dementia focused on the here and now

It is important to frequently orientate your loved one to the time, people and place, as well as keeping him/her informed of any upcoming activities.

Reasons for persons with dementia displaying inappropriate (disinhibited) behaviours

1. Disease progression of dementia, especially when they forget their social skills or lose their ability to judge. Certain types of dementia which affect the front parts of the brain may cause these disinhibited behaviours.

2. Medical conditions (e.g., infection or pain) that may cause sudden confusion.

3. Disorientation to places (e.g., mistaking a public venue for their own room).

4. Misidentification (e.g., mistaking a caregiver for someone else).

5. Disorientation to time (e.g., being confused about the time of the day and believing that it is time for their bath or bed at the wrong time).

6. Discomfort (e.g., their clothes may be too tight but they are unable to express themselves).

About BPSD (Behavioural and psychological symptoms of dementia)

Behavioural and psychological symptoms of dementia (BPSD) are neuropsychiatric symptoms and behaviours displayed by persons with dementia.

These symptoms constitute a huge aspect of dementia irrespective of its subtype, and they demonstrate a strong correlation with the degree of functional and cognitive impairment.

Learn how to manage anger and aggression, click here.

Learn how to manage apathy, click here.

Learn how to manage hallucinations, click here.

Learn how to manage paranoia and delusion, click here.

Learn how to manage repetitive behaviours, click here.

Learn how to manage sundown syndrome, click here.

Learn how to manage wandering behaviour, click here.

Ref: H24