5 Challenging Dementia Behaviors Explained!

5 Challenging Dementia Behaviors Explained! post page

Teepa Snow

By Teepa SnowJune 25th, 2020

5 Challenging Dementia Behaviors Explained!

Have you ever struggled with these situations, commonly seen in those living with dementia?
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Vision changes in dementia can be dramatic, and can account for numerous unusual actions, including:

1. Picking at or grabbing at things that are not there
Your first thought may be that the individual is hallucinating. While this could certainly be true, it is equally likely to be caused by vision loss. At a more advanced state of dementia, when depth perception is lost, the individual could actually be trying to turn off the ceiling light or fan, not realizing that it is more than six feet away. Or, they could be trying to pick up objects from the floor, not understanding that they are actually far from reaching them.
2. Startling very easily
Have you noticed that people living with dementia often seem to be startled easily when you approach them? Sometimes they may even react by striking out, verbal anger, or losing their balance. Since people living with dementia lose peripheral vision early, and lose even more visual field as the disease progresses, it is very difficult for them to tell when someone is approaching from the side or behind. This often results in a reaction of surprise or fear or anger. Approaching from the front, in the middle of their visual field, is the best practice.
3. Trouble with eating or drinking
Although difficulties with eating or drinking can be caused by a variety of issues in dementia, vision loss definitely contributes to these difficulties. When their visual field and depth perception is reduced, people living with dementia may not easily be able to see their utensils, plate, or beverage. Also, since visual discrimination is diminished, it may be difficult for them to clearly see the food if it is not a contrasting color with their plate. This can result in not eating or drinking, eating without utensils, or spills.
4. Losing objects in plain sight
People with dementia often spend a lot of time looking for objects that, to you, appear to be right in front of them. The main reason for this is due to vision changes in dementia. Without properly functioning peripheral vision and depth perception, it can be challenging to see the pair of glasses that are sitting on the table right in front of them or the remote control that is on their lap.
5. Wearing clothes that are visibly soiled
There are several reasons that people living with dementia may do this, but changes in vision definitely contributes. If they have lost significant peripheral vision and have a very narrow visual field, it is extremely challenging for individuals to see whether or not they have spilled down the front of their shirt. So, it is quite possible that they are unaware that the clothing is stained, simply because they are unable to see it.



Visual abilities change drastically throughout the GEMS States progression of dementia. For instance, in a Diamond state of early dementia, an individual loses peripheral vision. By the Ruby state of late dementia, an individual experiences monocular (single eye) vision without depth perception.
Understanding and responding appropriately to vision changes can significantly improve your daily interactions and reduce stress, both for yourself and the person for whom you are caring.

Learn more about vision changes and the GEMS States from these Positive Approach to Care Resources:

GEMS
Resource Card
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Learn More >>
Dementia Care
Provisions DVD
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Learn More >>
Progression of
Dementia DVD
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Learn More >>
Interested in learning about even more
challenging behaviors?

View our follow-up blog post by clicking here.

24 Comments on “5 Challenging Dementia Behaviors Explained!”

  1. Avatar

    Thank you very much for this article about vision and perception. This explains how my husband Kent acts sometimes.

  2. Avatar

    Would like to know more but am not able to purchase your resources at this time until I am able to find another job.

    Is there any way to borrow them for one month?

    1. Alejandro DeJesus

      Hey Rebecca,
      My name is Alejandro and I work for PAC as a mentor. Thanks for taking a look at our resources. We would love for you to continue to explore content and keep learning. We offer a few things that are always fee and some items that are very low cost.

      Our Online Dementia Journal is released monthly and can go right to your email address. You can signup on this page and read through any of the previous journal articles. https://teepasnow.com/services/online-learning/online-dementia-journal/

      We are also on Facebook twice a day to offer more education for free. Teepa is on at 8am eastern every morning and our mentors are on at 5pm eastern every weekday.https://www.facebook.com/teepasnow.dementiaexpert/

      We launched a new service a few months back called “Teepa’s Clips”. You can try it out for free for 14 days. If you want to continue the service after that there are two subscription levels. One is 2.99 a month and the other is 9.99 a month. https://teepasnow.com/product/teepas-clips/?switch-subscription=207831&item=49728&_wcsnonce=0819b81545&auto-switch=true

  3. Avatar

    Thank you. This has helped to explain some of my husband’s difficulties.
    More information would also be welcomed.

    1. Alejandro DeJesus

      Hey Dolores,
      My name is Alejandro and I work as a mentor for PAC. I am very glad to hear that this gave you some understanding about what is happening with your husband. We have a variety of ways that you can learn more.

      Our Online Dementia Journal is published monthly and all of the issues are available on the website. If you go to this page you can read any past articles and signup for the journal so that it is emailed to you each month. https://teepasnow.com/services/online-learning/online-dementia-journal/

      The Carepartner Support Series is a way that lots of carepartners can get information about what is happening with their loved ones. It is a small group session that is run in a series and facilitated by our mentors. You can check out this page for more information. https://teepasnow.com/services/consulting/care-partner-support-series/

      If you are on Facebook, then you can checkout Teepa’s page for new information and videos. https://www.facebook.com/teepasnow.dementiaexpert/ She goes “live” every morning at 8am eastern and our team is live again at 5pm eastern every weekday.

  4. Avatar

    Thank you for sharing this. My mother is in late stage dementia and this helps to explain much of my observations over the years. Thank you

  5. Avatar

    I did not understand the loss of peripheral vision and depth perception that my brother had when I was caring for him. We spent so much money doing eye tests and buying glasses. The optician did not understand that it was Alzheimer’s. He also complained of having a box in front of his years. I could not understand what he meant by that.
    Thank you for sharing and teaching .

  6. Avatar

    my husband was diagnosed with FTD late last summer. he is 78, is no longer driving, etc. I have having trouble handling his demands to “go home’, go up the mountain to see the people’, and a seeming need to drive somewhere to a house, location, etc that he can never say where it is. ideas?

    1. Alejandro DeJesus

      Hey Lisa,
      My name is Alejandro and I work as a mentor for PAC. We certainly appreciate you reading the article. It is tough to know what to say when someone is asking to go home. Here are a couple of options that you can explore.

      If you would like to connect with a consultant on our team we offer free half hour consults. You can set one up by using this link. https://teepasnow.com/services/consulting/phone-consultations/

      If you would prefer to gather more information about strategies by watching a video we have a recorded webinar where Teepa covers the topic of “I wanna go home”. Here is a link if you are interested, https://teepasnow.com/product/i-want-to-go-home-recorded-webinar/

      Also, Teepa has a free “Ask Teepa Anything” session once a month. You can be a part of them and possibly ask your question there. Here is a link for more information, https://teepasnow.com/events-calendar/category/live-public-webinars/ata/

  7. Avatar

    My mom is 84 with Dementia. We are trying to keep her at her home. The main problem we have is getting her to agree to let me bathe her in the shower. She has always taken showers, not tub baths. We remodeled her shower with a larger shower. She sits in her shower chair while I bathe her. She holds the shower hose and I let her wash her private parts. But her showers are at least 2 weeks apart. The smell is almost unbearable. What can I do to encourage her to bathe more often?

    1. Alejandro DeJesus

      Hi Elizabeth,
      My name is Alejandro and I work for PAC as a mentor. Thanks for reading the article and reaching out with the question. We would love to try and help with the situation. Our consulting team offers free half hour consultations. If you would like to setup a time with our team please use the link here to reach out. https://teepasnow.com/services/consulting/phone-consultations/

      Teepa has also done some webinars that deal with issues realted to bathing. Here is an option for a recorded webinar that goes through some common issues and may give some ideas to try out. https://teepasnow.com/product/bathing-issues-family-friends/

  8. Avatar

    I would like to buy the DVD bundle .Just checking that it will be compatible to play on a portable DVD player . I am in England I assume all will work the same on any appliance and in any country. Thank you.

    1. Alejandro DeJesus

      Hi Christine,

      Thanks for connecting to us from across the pond! Great question about the DVD and using it in the UK. I have passed your email and question over to one of our team members that works with products. She will be contacting you to get your question worked out.

  9. Avatar

    Thank you so much for your very helpful insights into what is happening for the patient with dementia. I teach health care assistants in a large hospital in New Zealand and often use your videos and advice to help them understand the patient’s perspective as opposed to a “challenging patient”.

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