Dementia Mental Health Changes

Overview

Dementia is a group of brain conditions that affect memory, thinking, and daily life. Many people with dementia also have changes in mood, emotions, or behavior. These are sometimes called psychological and behavioral symptoms of dementia. They can include feeling low, anxious, or irritable, seeing or believing things that are not there, or losing interest in things. These changes are part of the condition for many people, not a sign that someone is bad or failing. They can change over time and often improve with the right support.

Yes. Many people with dementia have at least one change in mood, thinking, perception, or behavior during their illness. It can happen at any stage, but it is more likely as dementia progresses.

It affects people living with dementia and those who care for them. It can happen in all types of dementia and at any age, though dementia is more common in older adults. Younger people can also have dementia and related mental health changes.

Symptoms

Common symptoms

• Feeling sad, hopeless, or tearful for much of the day
• Worry or fear that is hard to control, sometimes with panic
• Losing interest in things once enjoyed and withdrawing from others
• Irritability, anger, or rapid mood swings
• Restlessness, pacing, or trouble sitting still
• Believing things that are not true, called delusions, such as that someone is stealing from them
• Seeing or hearing things that are not there, called hallucinations
• Suspicion or fear of familiar people
• Sleep problems, including waking at night or being awake at night and sleepy in the day
• Changes in personality, such as becoming more withdrawn or less caring
• Difficulty managing emotions or controlling impulses

Symptoms in children

• Dementia is very rare in children. If a child has a serious change in memory, thinking, mood, or behavior, a doctor should assess it. In children, such changes are much more likely to have other causes.

Symptoms in older adults

• Older adults with dementia may show mood changes as physical symptoms, such as pain, tiredness, poor appetite, or agitation. They may not be able to explain feeling low or anxious. Watch for new clinginess, refusing care, shouting out, or withdrawing.

Causes

Main causes

• Dementia itself: changes in the brain from diseases such as Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia
• Delirium: a sudden confused state caused by infection, pain, dehydration, constipation, poor sleep, or a new illness
• Untreated pain, constipation, urinary infection, chest infection, or other physical illness
• Side effects or interactions from medicines, including prescribed, over-the-counter, and herbal products
• Sensory problems, such as poor hearing or eyesight, that make it harder to understand what is happening
• Changes in routine, moving home, or unfamiliar surroundings
• Grief, loneliness, money worries, or relationship stress
• Alcohol or drug use, or withdrawal
• Sleep problems

Risk factors

• Having dementia, especially as it progresses
• Older age
• Previous depression or anxiety
• Poor hearing or vision
• Pain, long-term illness, or recent infection
• Many medicines or a recent medicine change
• Loneliness, low social support, or carer stress
• Moving to a new place or a big change in routine
• Alcohol or drug use

When to see a doctor

See a doctor urgently if:

• New thoughts of suicide or self-harm. Seek emergency help now.
• Severe agitation or aggression with risk of harm
• Sudden confusion or a big change in behavior, especially with fever, pain, or not passing urine
• Hallucinations or delusions that cause fear or danger
• Not eating or drinking, or refusing essential care
• A fall or head injury

Book a routine appointment if:

• Any new or worsening mood, anxiety, or behavior change
• Sleep problems that affect daily life
• Withdrawal from activities or people
• Suspicion, false beliefs, or seeing things that are not there
• Carer stress or difficulty coping
• Questions about medicines or side effects

Diagnosis

A doctor will ask about the person's symptoms, when they started, and what makes them better or worse. They will review health problems, medicines, sleep, diet, and home life. They will check for physical causes such as infection, pain, constipation, dehydration, or side effects. They may speak to family or carers. If needed, they will refer to a memory clinic or mental health team for dementia. The aim is to understand the cause and find ways to help.

Tests that may be done

• Questions and physical checks
• Blood and urine tests to look for infection, dehydration, or other illness
• Review of all medicines, including over-the-counter and herbal products
• Memory and thinking tests
• Assessment of mood and behavior
• Checks of hearing and vision
• Sometimes a brain scan
• Sometimes referral to a specialist

What to expect at your appointment

You may have more than one appointment. The doctor may ask someone who knows the person well to come. Keep a diary of symptoms, triggers, sleep, food and drink, and medicines. This helps the doctor see patterns. Ask for an interpreter if needed.

Treatment

There is no single cure for dementia, but much can be done to support mood, behavior, and quality of life. Treatment starts with finding and treating physical causes, such as pain, infection, constipation, or medicine side effects. Then the focus is on routine, communication, activity, and support for the person and carers. Specialist teams can offer talking therapy, social support, and, in some cases, medicines for specific symptoms. Always discuss benefits and risks with a healthcare professional.

Self-care at home

• Keep a simple daily routine for meals, sleep, and activities
• Use calm, short sentences and allow extra time to answer
• Check for pain, hunger, thirst, constipation, or needing the toilet before assuming behavior is just dementia
• Keep hearing aids and glasses clean and in use
• Reduce noise and crowds when the person seems overwhelmed
• Do gentle activities they enjoy, such as music, folding laundry, or walking
• Keep a diary of triggers and what helps
• Make sure carers get breaks and support
• Keep the home safe, with good lighting and less clutter

Medical treatments

Doctors may treat physical problems that worsen mood or behavior, such as infections, pain, constipation, or sleep problems. They may review medicines that could be causing side effects. Talking therapies, social groups, and support for carers can help. For some severe symptoms, specialists may prescribe medicines for a short time. These are not used for everyone, and they need careful review because they can have risks. No medicine should be started or stopped without advice from a healthcare professional.

When is surgery considered?

Surgery is not a treatment for dementia-related mental health changes. Sometimes people with dementia need surgery for other health problems. If so, the care team will plan around the person's needs, medicines, and confusion risk.

Living with this condition

Life can be calmer with routine, clear communication, and support. Focus on what the person can still do. Break tasks into small steps. Avoid arguing about false beliefs; instead, comfort and redirect. Make sure the home is safe. Plan for good days and hard days. Carers should ask for help early and take breaks.

Lifestyle tips

• Keep regular sleep and wake times
• Stay socially connected, even in small ways
• Do gentle physical activity if safe
• Eat regular meals and drink enough fluids
• Limit alcohol and avoid recreational drugs
• Use hearing aids and glasses
• Keep the home familiar and well lit
• Plan pleasant activities that match the person's abilities

Diet and exercise

A balanced diet and enough fluids can help prevent constipation, dehydration, and infections that worsen confusion. Gentle movement, such as walking or seated exercise, can lift mood and improve sleep if the person is safe to do it. Ask a healthcare professional before starting a new exercise plan.

Mental health and emotional wellbeing

Mood and behavior changes can be distressing for the person and for those who care for them. It is normal to feel sad, worried, guilty, or exhausted. These feelings matter. Talk to a doctor or nurse about support. Carers can also have depression or anxiety and deserve help. If anyone has thoughts of suicide or self-harm, get emergency help immediately and contact a crisis line in your area.

Prevention

Dementia cannot always be prevented, and mental health changes in dementia cannot be fully prevented. But you can lower risk and reduce distress. Treat pain and infection early. Keep hearing aids and glasses in use. Stay active, socially connected, and mentally engaged. Manage blood pressure, diabetes, and smoking with your doctor. Keep a routine and get support for carers.

Vaccines

There is no vaccine for dementia. Keep up with routine vaccines recommended for your age and health. Preventing infections can lower the risk of delirium.

Screening programmes

There is no simple screening test for dementia-related mental health changes. If you notice changes in mood, thinking, or behavior, ask a doctor for an assessment. NHS guidance recommends that people with concerns about memory or thinking should be offered an assessment.

Complications

If left untreated

• More distress for the person and carers
• Worsening confusion or delirium if a physical cause is missed
• Falls, injuries, or unsafe behavior
• Poor eating and drinking, leading to dehydration or weight loss
• Sleep problems and exhaustion for carers
• Relationship strain and carer burnout
• Depression or anxiety that is not treated

Long-term outlook

Many people with dementia live well for years with the right support. Mood and behavior symptoms often change and can improve when physical causes are treated and routines are adjusted. Getting help early can reduce distress and keep people safer. Every person's path is different, and support is available.

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