Challenging Behaviours: Mood Disorders

Challenging Behaviours: Mood Disorders

Challenging Behaviours: Mood Disorders

Mood disorders in individuals with dementia can indeed be perplexing. Most people do not understand that we have very little or no control over our moods, making it impossible for the person with dementia to understand or control their moods.

Let’s delve into why this complexity arises:

Brain Changes:

Dementia affects various regions of the brain, including the frontal lobe (which controls thinking, memory, behaviour, and movement), the occipital lobe (responsible for sight), the parietal lobe (language and touch), and the temporal lobe (hearing, learning, and emotions). As dementia progresses, these areas may deteriorate, leading to mood regulation and behaviour disruptions.

Memory Loss:

In the early stages of dementia, short-term memory is often affected. The person struggles to recall recent events or conversations. Long-term memory loss occurs later. Imagine a bookcase filled with memories—books representing skills and experiences. As dementia progresses, these “books” fall off the shelves, starting with recent memories. The person may mistakenly recall older memories as recent ones.

Emotional Processing:

The amygdala, a brain region, processes emotions and records reactions. In dementia, this function can become impaired. Individuals may no longer control or understand their emotions. They might express frustration, anger, or sadness without apparent cause. Their ability to communicate discomfort or pain may also diminish.

Neuropsychiatric Symptoms:

Agitation, anxiety, irritability, anger, depression, and apathy occur frequently in people with dementia. These behavioural changes collectively contribute to mood swings. Recognising that these shifts are often beyond the person’s control is essential.

Loss of Interest:

People with dementia may lose interest in activities they once enjoyed. Their emotional engagement wanes, leading to withdrawal and depression. They may struggle to manage their emotions, further complicating mood-related challenges.

Understanding mood disorders in dementia requires empathy, recognising brain changes, and acknowledging that these behaviours are not deliberate. Compassionate care and adapting our own behaviour can make a significant difference in supporting individuals with dementia. Here are helpful tips for caregivers who are dealing with mood disorders:


Mood disorders

The following mood disorders are seen by persons living with dementia:

  1. Crying
  2. Shouting out
  3. Agitation and anxiety

Always remember that people living with dementia do have speech problems and lose their words, and for that reason, they cannot tell you how they feel. They use their non-verbal body language to tell you something, and this includes many times mood disorders. They want to tell you something.

  • The person with dementia might cry for no apparent reason at all. However, the person might have a good reason but cannot communicate it to you.
  • It is, therefore, important to know the person’s history so that you may be able to identify possible causes.
  • The person might be anxious about something. Try and figure out what it could be, e.g. a child is coming to visit, and she or he is scared that they might forget something important.
Shouting or Screaming

Some people with dementia may shout or moan loudly. It may be a way to tell you they have a need or discomfort.

  • If this is not a usual behaviour or they don’t seem to need something or feel discomfort, it could be changes in the brain disease.
  • The person could also be agitated or frustrated.
  • Management of people screaming or shouting is to consider which of the three triggers causes it. Triggers are the physical, emotional or environmental factors.
Agitation and Anxiety
  • This is an extremely common problem in people with dementia and is often the reason why they are placed in a Home. It is also a common contributing factor towards caregiver burnout and distress.
  • Agitation may be divided into three main subgroups:
    • Combative behaviour (verbal or physical against self and others and destruction of property).
    • Repetitious behaviour (repetition, pacing, shadowing)
    • Socially unacceptable behaviours (sexual inhibitions, screaming, shouting, refusal to cooperate with activities of daily living)
  • Agitation usually results from feeling uneasy or restless within the person. Some will say they have this feeling inside that they are trying to run away from themselves.
  • The agitated person may pace, rock their body, wring their hands or even hit/shout/scream/curse or swear to others.

AGAIN: The management of people with agitation and/or anxiety involves considering the physical, emotional and environmental factors and the duration and consequences.

Let’s have a look at depression and mania in persons living with dementia:

Depression in general
  • Depression can affect anyone.
  • Each person experiences it differently.
  • Triggers for depression: death of a loved one, retiring, moving to a new house, divorce, or an illness.
  • Depression can also be a result of chemical changes in the brain. A person suffering from this depression usually has no control over their depression.
  • A depressed person has:
    • A constant feeling of sadness.
    • Have no energy or will to achieve.
    • Feel they just can’t cope anymore.
    • Lose interest in what is going on around them; withdraw.
    • Blame themselves for anything.
    • Feel people would be better off without them.
  • They may also have physical symptoms: Headaches, stomach pains, loss or weight gain, and difficulty sleeping.

Living with a person who has depression is very difficult. It doesn’t matter how hard you try or how much energy you put into helping them; they often respond for short periods or not at all.

Imagine what it must be to live with a person who has depression and dementia.

Depression and Dementia
  • Depression and dementia exhibit the same symptoms, often resulting in the elderly who have depression being diagnosed as having dementia and vice versa.
  • A dementia diagnosis may trigger depression. It is important to observe changes in mood and report this as the person may be depressed.
  • Antidepressant medication may help the person who has a chemical imbalance but does not always help depression caused by an outside trigger.
  • In the late stages, counselling is not an option.
  • Depression may become mania.
  • The person suddenly becomes extremely active (overactive).
  • Often, the person becomes uncontrollable, and when attempts are made to control them, they become physically and, or verbally combative.
  • The person often interferes with others and becomes a nuisance.
  • The person does not eat or sleep, as they believe they “do not have time”.
  • Exhaustion is another problem, as the person may not get enough rest – a way to calm them down is with medication prescribed by a doctor.
  • Keep the environment as calm as possible, and try to keep them away from places like e.g. malls or big gatherings.
  • This period of mania might revert to a period of depression or back to dementia.

It will take time to discover why the person behaves the way he/she does.

The carer might never find a solution. The fact that the carer recognises a problem and attempts to solve it is the most important factor in a person-centred care (PCC) approach.

Teamwork and communication are essential in person-centred care. Person-centred care means working with people and learning what is important to them.

For more information and individual help, please contact a Regional Manager or Social Worker in a region close to you. Search our website under regions:

By Welma Geldenhuys and Nerésa Bowen