Challenging Behaviors of Alzheimer's Disease

  • Anxiety/Agitation/Assaultiveness
    These behaviors manifest themselves in various ways, including pacing, fidgeting, yelling, throwing objects, refusing help, or hitting. They can also be secondary to tension, to feelings of loss or depression, to changes within the brain itself, to other physical illness, to pain, or to the side effects of medications. Assaultive behavior may even occur in persons who have not demonstrated it in the past.

  • Aphasia
    Impairment or absence of speech or written communication due to the progression of the disease.

  • Apraxia
    The inability to carry out purposeful movements. The patient may know what to do, but is unable to do it. (Tie shoelaces, wave good-bye or button a shirt.)

  • Catastrophic reactions
    Emotionally intense responses to seemingly trivial occurrences. They can appear as sudden mood changes, crying, verbal abuse, and physical violence. Catastrophic behaviors may be a response to overstimulation in the environment. They usually happen when an event overwhelms an individual's ability to think or react.

  • Delirium
    A group of symptoms referring to a temporary impairment of mental function. It is characterized by a clouding of consciousness with a reduced capacity to shift, focus and sustain attention. It is manifested by difficulty in sustaining attention to both external and internal stimuli, sensory misperception, and a disordered stream of thought.

    Disturbances of sleep-wakefulness and psychomotor activity are present. The individual suffering from delirium has a decreased ability to attend to environmental stimuli and often shows highly disruptive and variable behaviors. Delirium is usually worse at night. Onset is relatively rapid and the course typically fluctuates.

    The total duration is acute, usually brief, ranging from hours to days, but can be fatal if delirium is not identified and treated. Delirium can occur alone or concurrently with dementia or other medical conditions. The majority of individuals presenting delirium suffer from a specific physical illness. If the individual decompensates rapidly over a period of several hours to days, there is very likely a superimposed medical problem that must be rapidly identified and treated. Recognizing the difference between dementia and delirium is essential.
    • Delusions
      Beliefs that are contrary to fact. They remain fixed or persistent despite all evidence to the contrary.
    • Depression
      One of the most common behavior symptoms of AD (Alzheimer's Disease). Various reports suggest that it is present in 15 to 55 percent of persons with AD. Clinical depression is different from ordinary sadness and grief. It may have a biochemical basis in the brain, and its symptoms include difficulty concentrating, apathy, social withdrawal, loss of interest in usual activities, slowness of movements, fatigue, weight loss, and insomnia.

    • Hallucinations
      Sensory experiences that cannot be verified by anyone other than the person experiencing them. Any sense may be involved, particularly seeing and hearing.

    • Illusions
      Misinterpreted perceptions that usually do not last long, such as when an individual mistakes moving shadows for people or animals.

    • Paranoia/Suspiciousness
      Unrealistic, blaming beliefs. Paranoia results from damage to the part of the brain that makes judgments and separates facts from fiction. A dementia person with paranoia will not connect the unrealistic, blaming belief to a realistic belief, no matter how many explanations or clarifications are given by caregivers.

    • Restlessness/Wandering
      A common behavior and can be difficult to manage because of its unpredictability. Wandering may result from restlessness and pacing, or getting lost, or may occur with a change in environment.

    • Sleep disturbances
      Occurs throughout the course of the disease. A person may actually complain of sleeplessness, or may just be found wandering at night. Sleep disturbances accompany many of the other behavioral symptoms listed above. Some researchers believe that changes taking place within the brain disrupt the normal sleep-wake cycle.

    • Sundowning
      An increased frequency or severity of confusion or other behavioral symptoms (often anxiety) late in the day or after dark. It may be a result of fatigue or reduced sensory stimulation (less light or activity). Sundowning is often easier to manage than some of the other symptoms because it occurs at a predictable time of day.

    • Verbal noises
      Any vocal behavior which is disturbing to others, for which a meaning or significance is unclear. This may include screaming, repetition of recognizable words, nonsensical verbal noises, talking incoherently, moaning and whistling.
    Source: Aronson, M. 1988. Understanding Alzheimer's Disease. New York: Macmillion Publishing Co.

    Robinson, A., Spencer, B. and White, L. 1989. Understanding Difficult Behaviors. Ypsilanti, Michigan: Eastern Michigan University.

    Compiled by the Lincoln/Greater Nebraska Chapter of the Alzheimer's Association, 1999.

    For further information about Alzheimer's Disease or related disorders, contact the Alzheimer's Association at: