Who has a behavior that is challenging?

In Europe there are living are approx. 8,702,033 persons with dementia. A lot of these people does have challenging behavior and other behavioral disorders. Much persons with dementia will experience BPSD as part of their illness, and nearly two-thirds of people with dementia in nursing homes experience these symptoms at some point. BPSD causes suffering for the individual and increases the burden on the caregiver, which can result in serious danger to the individual and others.

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The challenging behavior can be expressed verbally in the form of, for example, shouting and threats or physically, where the person act violently, uneasily or exhibit boundless behavior such as inappropriate sexual or otherwise abusive and socially unacceptable acts. Challenging behavior, as a rule cannot be isolated to a particular type of dementia, but is most commonly seen in people with frontotemporal dementia or in advanced stages of dementia.

Persons with frontotemporal dementia (FTD) may be at increased risk of developing challenging behavior because damage to the brains frontal and temporal lobes makes it difficult to interpret and respond to impressions and stimuli, both visually, socially and from the physical environment. It is also in the part of the brain where the social learned skills lie, which can also cause unexpected reactions. There are few people living with this diagnosis and therefore special knowledge is needed about this group. About 2% of people with dementia have this type of dementia. Frontotemporal dementia does not cover a specific dementia disease, such as Alzheimer’s disease, but is a common term for several diseases, particularly affecting the frontal lobes or the temporal lobes, where the most prominent symptoms are behavior disorders, personality and / or language unlike Alzheimer’s dementia where memory impairment and other cognitive problems are the most prominent.

However, there also is challenging behavior in persons who have more frequent forms of dementia, including Alzheimer’s disease and vascular dementia.

The reactions can occur in combinations between dementia and psychiatric diagnoses, conditions of confusion, delusions, psychoses, anxiety or depression. You cannot say that the behavioral patterns are common to this or that type of dementia, yet there are some distinctive behavioral patterns, which characterize people with late-stage dementia. For example:

• Aggressive behavior in the form of outbursts of anger, gross verbal language and physical violence in the form of punches, kicks and pushes.

• Sudden outbursts of very agitated and aggressive behavior without necessarily warning. It is typical of people with frontotemporal dementia, but it can also occur in other dementia diseases.

• A restless walk around without knowing why and where to go. The persons with dementia cannot find peace and rest anywhere. Sometimes the uneasy behavior intensifies during the evening. Which is called “sun downing”.

• Tendency to want to control others and decide what others have to say and do and how to do it.

• Repetitions of words, sentences and questions endlessly without having any sense of the situation.

• Drumming on the table or hitting things on the table in repeated rhythms.

• Talking loudly and shouting out into the room without being in dialogue with other people.

• Breaking down and crying aloud – without any logical reason for it.

• Throwing items such as service, vases, candlesticks and in some cases furniture

• Refusing to receive help with, for example, personal hygiene such as bathing, brushing teeth, changing incontinence products, taking on clothes, etc. The denial can also have a violent expression.

• Often contact seeking and constantly calling on others to come and help or talk to them but without the person with dementia being able to enter into the relationship.

• Completely apathetic and confined behavior where the person with dementia will not participate in activities or get-togethers and where it may be difficult to get in touch with him or her.

• Abusive and cross-border sexual behavior towards others.