Personality changes in a person with dementia, including unusual behaviors that may be seen as “mean” by others, often have more to do with neurodegenerative processes than with the person’s true feelings.
Dementia is a category of medical conditions involving symptoms such as memory loss, decreased cognitive performance, and diminished reasoning ability. Alzheimer’s disease is the number one cause of dementia.
While dementia is often associated with growing older, it isn’t considered a part of natural aging.
Symptoms of dementia result from brain cell damage. As communication between neurons decreases, a person may begin to behave differently than they used to, including in ways that may be perceived as mean.
Dementia can involve changes in thoughts and behaviors, including some behaviors that may seem to indicate meanness. Someone with dementia may suddenly seem like they don’t care about your feelings. They may snap at you, doubt your intentions, resist your efforts to help them, or say hurtful things.
These behaviors are often manifestations of dementia rather than indications of a person’s true feelings or choices. This type of behavior is associated with dementia symptoms such as:
- agitation
- aggression
- disinhibition
- depressed mood
- anxiety
- sleep disturbance
- psychosis
As many as
In a 2021 review, researchers indicated that agitation (which included symptoms of aggressiveness, restlessness, and emotional distress) had an overall prevalence of 30% across all types of dementia, with the highest prevalence (up to 50%) occurring in Alzheimer’s disease.
Dementia symptoms can show up differently depending on which areas of the brain are affected by cellular change.
Dementia and altered thinking skills
Seemingly mean and aggressive behaviors, including those directed toward family members, are often due to changes in thinking that are associated with neurodegeneration — a decrease in cellular health and function in the central nervous system.
A 2021 study suggests that late-life cynical hostility — a type of meanness that involves a mistrust of others — is linked to white matter changes in the brain that may be early indicators of Alzheimer’s disease.
“The more the cortex is sludged with plaques and tangles like in Alzheimer’s disease, the more it fails to inhibit,” explained Dr. Sudhir Gadh, a board certified psychiatrist from New York City. “Underlying impulses are no longer controlled, patience is lost, memories are lost, abilities diminish, and anger can reign.”
The complexity of altered thinking in dementia can mean that minor frustrations turn into aggressive outbursts and that other intense emotions, such as fear and confusion, show up as combativeness.
Someone with dementia may experience more anxiety, agitation, and confusion if they don’t understand their circumstances because of memory loss.
Caring for someone with dementia who is experiencing personality changes and being mean to their family can be challenging. You may feel that you’ve lost the loving bond you once had with that person.
While progressive dementia, such as the type associated with Alzheimer’s disease, has no cure, it’s possible to manage the symptoms and decrease the occurrence of mean behavior.
Identify everyday life adjustments
What may be comforting or natural for you may be a source of frustration for someone who is living with dementia.
Dr. Donna Seminara, director of the division of geriatrics at Staten Island University Hospital, New York, says mean-spirited behaviors are often the only way that some people with dementia can express frustration. For example, a person with dementia may say something hurtful or become physically combative when you’re helping them take a bath.
“What is often relaxing to most — having warm water trickle from the head and face down the body — is often agitating to […] individuals who can’t control the flow of water,” she said. “Using a handheld shower nozzle where the patient can exert some control may make this experience much less stressful for all.”
Establish a stable, consistent environment
Seminara pointed out that bringing someone with dementia into new environments can have complicated outcomes, such as fear, confusion, and memory loss.
By keeping routines and environments as consistent as possible, you can promote a sense of familiarity and comfort that can reduce aggressiveness and mean behaviors.
Medical perspective“Consistency in routine can help decrease certain aggressive or ‘mean’ behavior, as well as not reacting emotionally in the moment if offensive things are said or done.”
— Megan Soliman, MD
Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Take the slow approach
Abrupt movements may be disconcerting to someone living with dementia.
“Try to maintain a positive, smiling face toward the patient, and always touch the patient with a slow approach. Fast, sudden movements are startling to most dementia patients and can start a cascade of resistant speech and behavior,” explained Seminara.
Consider appropriate medications
Medications may help manage some of the behavioral symptoms of dementia.
“There are several treatments for the depression and anxiety associated with dementia, assuming a treatable medical condition has been ruled out, including psychotherapy, antidepressants, antianxiety agents, and the nutritional support of the B vitamins folate and B12,” said Dr. Sheldon Zablow, a board certified psychiatrist from San Diego.
Gadh pointed out that prevention is paramount and should be considered a form of dementia treatment. This is particularly the case because there’s no specific treatment for dementia that has remarkable results and a low side effect risk.
An emerging treatment option for dementia, low dose lithium, may fill that treatment gap one day. Gadh explained that lithium, a natural salt, has been associated with improved mental health and decreased dementia risk.
Lithium is currently used to treat bipolar disorder.
“It is already being studied by the National Institutes of Health for the prevention of Alzheimer’s because lithium is a known neurotrophic (enhancer of brain growth via GSK-3 inhibition),” he added.
A focus on the hallmarks of dignity, respect, and choice can help you support a loved one who is living with dementia.
Regardless of their level of cognitive function, people with dementia want to be treated humanely. By keeping this in mind, you may be able to better manage or limit their behavioral symptoms.
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- recognizing how much support they need in areas of daily functioning, such as dressing, eating, and using the bathroom
- tailoring their care to their abilities, likes, and dislikes
- giving them opportunities to make simple choices, such as when dressing or eating
- upholding their dignity and respect during vulnerable or private moments, such as when they are using the bathroom
- being aware of their comfort at all times, particularly in relation to incontinence, dental health, and personal hygiene
- creating a quiet, comfortable, and home-like atmosphere
- considering cultural practices, such as those associated with mealtime
It can be challenging to determine how best to support your loved one and maintain their dignity. You may find professional guidance helpful for learning strategies to keep private moments, such as bathing and using the toilet, safe and respectful.
Medical perspective“It can be very difficult to manage your own emotions when your loved one has behavior that can come across as offensive or ‘mean.’ It is important to understand that increased aggression can be due to dementia affecting certain areas of the brain, which disinhibits different emotions. They may be completely unaware of their behavior, and they also may not be able to control it.”
— Megan Soliman, MD
Quotes represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
You may feel that a loved one with dementia has started being mean to you and others. But these new behaviors do not likely indicate that the person has negative feelings toward you. Instead, this behavior is likely a manifestation of other symptoms of dementia.
As people with dementia experience greater memory loss and disorientation, they are likely to feel fearful and frustrated and may express these feelings through aggressive behavior. Dementia can also affect a person’s ability to regulate emotional responses.
While there’s no cure for progressive forms of dementia, professional treatments may help. As a caregiver, you can support someone with dementia by focusing on consistency, freedom of choice, and humane treatment.