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Progressive Behavior Changes With Dementia
Stages of Dementia






Recent memory loss

Distant memory loss

No apparent memory
Social behaviors forgotten

Judgment and

Appears absent minded
Poor concentration

Decisions difficult
No complex tasks

Little or no thought observable


Moody and withdrawn
Denies forgetting
Still emotionally "tuned in"

Irritability, pacing
Night wandering
Misplacing and accusing others of stealing

VERY irritable

Language and

Reduced vocabulary
Difficulty writing

Understanding well when attending, but has poor attention
Slow or hesitant expression of thought

Extremely limited
Words said have little to no meaning



Limited when tasks are complex
Cannot find toilet, etc.

Little or none

Motor Control


Poor coordination/balance No independence

* Activities of Daily Living (e.g., bathing, grooming, eating, dressing)

Suggestions for Working With People With Dementia

bulletApproach in a slow, calm manner.
bulletMaintain a pleasant, quiet environment.
bulletGive positive responses to appropriate behavior.
bulletRespect personal space - use touch discriminately.
bulletUse humor with interactions.
bulletCall residents by name and identify yourself by name.
bulletAvoid confrontations and arguments.
bulletRemove from group if behavior warrants it.
bulletUse validation therapy when reality orientation is no longer appropriate.
bulletShare non-verbal techniques that work with co-workers.


Assumptions About Alzheimer's Disease

Don't ask me...

bullet...if my mood swings are directed at you. They are part of my disease and I can't control them.
bulletif I recognize you or that I should.  To me, you may look like my husband, wife, son, daughter, grandchild or old friend.  Just be whoever I need you to be for the moment.
bulletif I need to be constantly reoriented with reality.  In my mind I have created a place and time where I feel safe.  Let me stay there as long as I need to.
bulletif I can see or hear, or perceive thing as you do.  My peripheral vision is gone, my depth perception is construed and I can no longer hear high pitched sounds.   Please approach me from the front and speak slowly, calmly and deeply.
bulletif things smell or taste the same to me.  I have lost almost all sense of smell, therefore, my sense of taste has diminished too.
bulletif because my speech is garbled or absent that I can no longer hear or communicate.   My eyes and body language are speaking to you loud and clear.
bulletif I can sit quietly in a chair or lie in my bed all day.  I have worked and been busy all my life, so I'm used to being "on the move."  Keep my environment safe enough for me to wander and if I appear tired, remind me to rest occasionally.
bulletif I need to be awakened and dressed to eat breakfast at a certain time.  I will wake up on my own when I am no longer sleepy.  I ate breakfast in my nightclothes at home and was quite comfortable.  If I miss my hot breakfast tray, I would be quite content with a bowl of cereal, a piece of toast, a little fruit, and a cup of coffee or tea.  I'm really not too hard to please.
bulletif I need a bath or shower every day or even every week.  I come from a generation where not every home had running water, and if we did, we bathed Saturday evenings to be ready for church the next morning.  Please help me maintain my dignity by assisting me when I'm soiled, but don't strip me and force me into an unwanted bath or shower.
bulletif you can bladder train me or teach me to perform new tasks consistently.  My memory cannot retain this kind of information.  It will only frustrate me and you.
bulletif because I may be overly vocal or active that I need to be medicated with sedatives or antipsychotic medications.  If I am showing signs of depression, please help me.   But otherwise, please don't medicate my spirit.
bulletif, because I keep taking my clothes off that I must have been a "flasher" in my past or that I an too confused to know what I am doing.  Because of my disease, my skin can be hypersensitive and even the weight of my clothing can feel painful at times.   Please offer me a mild pain reliever (like Tylenol) to help me cope with this.
bulletif I am a "dirty old man" or "pervert" if I try to make a pass at you.  In my mind I may see myself as being your age and may, at times, find myself attracted to you.  Please don't be offended.  Politely tell me that you are married or otherwise "taken" then have someone else give me care until my behavior passes.
bulletif I will be ready to go to bed as soon as dinner is over.  Allow me the freedom to stay up if I wish so I can feel like this is really my home.
bulletif I am no longer capable of sharing love and affection.  When you hold my hand, or wrap your arm around my shoulder, or kiss my cheek and tell me you love me, it makes me feel like I matter to you.
bulletif because I have Alzheimer's Disease that I have nothing left to offer.  Help me celebrate my good points without being condescending and treating me like a child.   Give me tasks I can handle so that I will feel important.  Treat me as you would your own mother or father.  Who knows...they may be me someday!

New Horizons, July/August, 1997