Three Common Dementia Symptoms

About Juliet Holt Klinger

Senior Director of Dementia Care

Juliet is a passionate advocate for people living with dementia and their families. She is deeply committed to improving the cultural acceptance of those with cognitive differences. As our gerontologist and Senior Director of Dementia Care, Juliet develops person-centered care and programming for Brookdale’s dementia care communities. But if you ask her, Juliet says she continues to learn every day from the true experts, those living with dementia and their care partners. Juliet believes we need to move beyond the concept of caregiving, which implies a one-sided relationship, and embrace the idea of care partnering. Care partnering is about relationships built on cooperation—a two-way street promoting person-centered care and mutual feelings of purpose, where the person living with dementia also plays a strong role in shaping their care and daily routine. We are here to partner, learn and grow with our residents and families to make aging a better experience. After volunteering in nursing homes in high school, Juliet knew she wanted to work with older adults. While working on her bachelor’s degree in social work at the University of Iowa, she completed an Aging Studies Certificate program, before there were formal gerontology programs available. At Iowa, Juliet also had the chance to study with pioneers in the field of dementia care, an opportunity that shaped her passion for caring for those living with dementia. Trained as a gerontologist, with a master’s degree from the University of Northern Colorado, Juliet joined Brookdale in 2004. She is a seasoned senior living executive with more than 30 years of experience designing and executing innovative Alzheimer's and dementia care programs and living environments in both assisted living and skilled settings.

brookdale associate and resident looking at tablet

As dementia progresses, many things a loved one does and says can be frustrating and hard to fathom. I hear stories from resident families all the time – their sweet mom now gets angry and swears or their dad wanders out into the street in the middle of the night.

However, these behavioral expressions are actually symptoms of dementia. The actions make sense to the person with the disease. Understanding them can help you successfully respond and support the person.

Here are three examples:

Wandering

According to the Alzheimer’s Association, more than 60 percent of people with dementia will leave home and become lost at some point. Up to half will suffer serious injury or die if they aren’t found in 24 hours.

Wandering can stem from many different things. The person living with dementia may be restless or have a sense that there is a need to go somewhere (either realistically or unrealistically). If your loved one has pent-up energy due to lack of exercise or isn’t sleeping well at night because of daytime napping, there may be more physical restlessness at night.

Likewise, boredom may prompt the desire to leave in search of something more interesting, or the person may be acting on an old, recalled pattern of movement such as going home after work at 5 p.m. Ensuring exercise, limiting naps and providing meaningful things to do that meet current ability levels and interests can all combat this issue.

Issues with personal hygiene

Losing the ability to identify the meaning of objects, a symptom called agnosia,usually develops during dementia’s middle stage and can affect personal hygiene. If the brain can no longer tell the difference between the meaning of the couch, which is a place to sit and relax, and the meaning of the toilet, which is a place to sit and urinate, accidents can happen. Because this loss of meaning can apply to all things, the brain may no longer remember the important “not touch” lessons associated with excretions that we learn at a very early age and this can cause situations where maintaining cleanliness is more difficult.

Identifying whether your loved one uses a trigger phrase, such as “I want to go down the hall,” that really conveys the need to use the toilet can help. So can ensuring he or she visits the bathroom frequently, and making it easy to find by leaving the door open and light on when not in use. Recognize that adult briefs may be necessary and reassure your loved one that there is no need to be embarrassed by them. In fact, these products are now more discreet and comfortable.

Making off-color or profane comments

Dementia affects the frontal lobe of the brain, which is the area that controls inhibition, and the areas of the brain that control language. Both of these issues can lead a loved one to use inappropriate language when they are simply trying to express an unmet need. Maybe your loved one is trying to tell you they are in pain, need socialization or is asking for help with a task. If you take a closer look and identify what they are trying to tell you, you may be able to address their needs proactively and resolve this challenge.

Deciphering the reasons behind the behavioral expression can help greatly in preventing them in the future. However, don’t fault yourself if you still can’t read all the behaviors. Please take a realistic look at whether it remains practical for you to continue to meet your loved one’s needs at home. This is especially true if wandering is becoming a danger. If you are in this situation, I urge you to explore Brookdale’s Alzheimer’s and dementia care communities or other options in your area.