Other Symptoms of Dementia

Recognizing the Signs Beyond Memory Loss

When most people think of dementia, they picture forgetfulness — misplaced items, repeated questions, or difficulty remembering familiar names.While memory loss is a key feature, dementia affects much more than the ability to remember. It changes how the brain processes information, interprets sensations, organizes thoughts, and controls emotions.

This means the person’s behavior, sleep, personality, and reactions may all change. To family members, these changes can be confusing or painful to witness — but they are not signs of laziness, stubbornness, or deliberate behavior.They are expressions of a changing brain trying to make sense of a confusing world.

By learning about these other symptoms, caregivers can respond with understanding instead of frustration, and create a calmer, safer environment for everyone.

1. Sundowning

Why late-day confusion happens

Sundowning is one of the most recognizable patterns in dementia care. It refers to increased confusion, restlessness, or agitation that appears in the late afternoon or evening.A person who was calm all day may become anxious, pace, or insist they need to “go home.”

Why It Happens

• Fatigue: As the day progresses, both mind and body become tired. The brain loses energy to filter noise and manage stress.

• Lighting changes: As daylight fades, shadows and reflections can confuse perception. Someone might misinterpret a coat on a chair as a person or think reflections are movement.

• Body clock disruption: Dementia damages the brain’s internal timekeeper, the suprachiasmatic nucleus, leading to disordered sleep–wake rhythms.

• Unmet needs: Hunger, thirst, pain, or needing the toilet often worsen as the evening routine begins.

What Caregivers May See

• Repeatedly asking to go home, even if already home

• Pacing or following caregivers from room to room

• Yelling, crying, or clinging

• Insisting on seeing someone or completing a task from the past (like “picking up the kids”)

How to Respond

Care Tips• Keep evenings calm and predictable — no sudden schedule changes.• Use warm, soft lighting and close curtains before sunset to prevent confusing reflections.• Offer a light snack or warm drink if hunger or thirst may be factors.• Speak slowly, maintain eye contact, and reassure gently: “You’re safe. We’ll rest soon.”• Play soft, familiar music or engage in a repetitive, calming task (folding towels, brushing a pet).

2. Delirium

When confusion worsens suddenly

Delirium is a medical emergency, not a normal part of dementia. It’s a sudden change in alertness and awareness that can occur in hours or days.To a family, it might look like dementia has worsened overnight — but delirium is usually caused by something treatable.

Common Causes

• Infections: especially urinary tract or chest infections.

• Dehydration: older adults often drink less without realizing it.

• Pain: untreated pain or constipation can trigger delirium.

• Medication effects: even small medication changes or side effects (like sedatives, painkillers, or sleep aids) can cause confusion.

• Hospital stays or new environments: sensory overload and disrupted sleep increase risk.

What Caregivers May See

• Sudden personality or behavior change

• Fluctuating alertness — very sleepy one moment, agitated the next

• Rambling or incoherent speech

• Hallucinations or paranoia

• Refusal to eat, drink, or cooperate

How to Respond

Care Tips• Call a doctor immediately if confusion appears suddenly or worsens rapidly.• Keep the person hydrated — offer small, frequent sips of water or juice.• Reduce noise, dim bright lights, and provide familiar objects.• Stay nearby and speak softly; your presence offers comfort.• After medical care, keep routines consistent to help recovery.

3. Hallucinations and Delusions

Seeing or believing things that aren’t real

In some dementias, especially Lewy Body, Parkinson’s-related, or advanced Alzheimer’s, the person may experience hallucinations (seeing or hearing things that aren’t there) or delusions (false beliefs that feel true).They may see children playing in the room, believe their spouse is an impostor, or think someone is stealing their possessions.

Why It Happens

Damage to visual and reasoning parts of the brain causes misinterpretation of sensory information. The brain fills gaps in memory with imagined details to make sense of confusion — a process called confabulation.Certain medications or infections can also trigger hallucinations.

What Caregivers May See

• Talking to unseen people

• Claiming to see bugs, animals, or intruders

• Accusing others of stealing

• Refusing to sleep in a room because they “see strangers”

How to Respond

Care Tips• Never argue or insist that the hallucination isn’t real. This increases fear.• Validate emotions: “That must feel scary” or “I see that worries you.”• Change the environment — adjust lighting, remove mirrors, turn off TV if reflections or sounds confuse them.• Offer distraction: “Let’s have some tea together,” or suggest looking at a photo album.• If hallucinations are frequent or distressing, talk to a doctor — medications or sensory adjustments may help.

4. Sleep Disturbances

When day and night get mixed up

People with dementia often develop fragmented sleep patterns. They might nap all day and stay awake at night, wander, or wake frequently in confusion.Poor sleep increases daytime confusion, irritability, and fall risk.

Why It Happens

• The brain’s internal clock loses rhythm, confusing night and day.

• Reduced physical activity and less daylight exposure lower melatonin production.

• Pain, anxiety, or medication effects disturb rest.

What Caregivers May See

• Waking frequently through the night

• Daytime drowsiness or dozing during activities

• Nighttime wandering or calling out

• Refusal to sleep in bed, preferring to sit upright

How to Respond

Care Tips• Keep regular sleep–wake times.• Ensure daily sunlight and mild exercise.• Use dim nightlights instead of total darkness to prevent fear.• Avoid caffeine and alcohol after mid-afternoon.• Provide comfort objects — a blanket, familiar pillow, or soft music.• If medication side effects are suspected, consult a healthcare provider.

5. Wandering

When someone keeps walking or searching

Wandering doesn’t always mean aimless walking — it’s often purposeful searching for something the person feels they’ve lost.They may be looking for a sense of home, routine, or belonging.

Why It Happens

• Disorientation: memory loss makes familiar places feel unfamiliar.

• Restlessness: excess energy, boredom, or lack of exercise.

• Emotional need: desire to find someone or complete a remembered task.

• Unmet physical needs: hunger, thirst, needing the washroom.

What Caregivers May See

• Walking continuously indoors or outdoors

• Packing bags to “go home”

• Becoming upset when stopped

• Trying to open doors or follow others outside

How to Respond

Care Tips• Keep a predictable daily structure — consistent meal and activity times.• Offer safe walking spaces indoors or supervised outdoor strolls.• Place stop signs or camouflage patterns on exit doors (subtly, not as punishment).• Use ID bracelets or medical alert devices.• Engage the person with purpose — folding towels, sweeping, or sorting items.• Never scold; instead, reassure: “We’ll go soon, but let’s rest for a bit first.”

6. Anxiety and Agitation

When the world feels overwhelming

As dementia progresses, stress tolerance decreases. Even mild noise, fast speech, or change in routine can overwhelm the brain’s ability to process.Anxiety and agitation are not deliberate resistance — they’re signs of distress.

Common Causes

• Overstimulation (TV, loud music, too many people)

• Physical discomfort (pain, constipation, hunger)

• Feeling rushed or confused by instructions

• Separation from familiar people

What Caregivers May See

• Pacing, fidgeting, restlessness

• Shouting, crying, or striking out

• Repeating questions constantly

• Refusal to bathe, eat, or dress

How to Respond

Care Tips• Speak calmly and slowly; avoid multiple instructions at once.• Limit background noise and use gentle lighting.• Offer simple choices rather than demands (“Would you like a bath now or after lunch?”).• Use touch only if it’s comforting — some may find it startling.• Identify patterns — does agitation happen at the same time daily? Adjust the environment.• Breathing together, soft humming, or rhythmic activities (like folding laundry) can be very soothing.

7. Depression and Apathy

When interest fades away

Depression and apathy are extremely common but often mistaken for “just aging.”Depression brings sadness, hopelessness, or tearfulness; apathy causes emotional flatness and loss of motivation.In both cases, the person’s world shrinks — not because they don’t care, but because their brain’s emotional and reward centers no longer function as before.

What Caregivers May See

• Less conversation, more withdrawal

• Refusal to join activities

• Lack of facial expression or laughter

• Sleeping excessively

• Saying “I can’t” or “It doesn’t matter”

How to Respond

Care Tips• Encourage gentle, purposeful activities — folding laundry, tending plants, painting, listening to music.• Don’t push; offer companionship instead of correction.• Engage senses — smell, sound, and touch can awaken connection.• Maintain social contact: visits, phone calls, or pets.• Ask healthcare providers about treatment for depression; sometimes medication or counseling helps significantly.

8. Paranoia

When fear replaces trust

Paranoia in dementia often arises from misunderstanding and memory loss.If someone forgets where they placed an item, they may believe it was stolen.If they misinterpret a facial expression, they may think someone is angry or lying.These beliefs are real to them and often cause deep fear or anger.

What Caregivers May See

• Accusing others of stealing

• Believing caregivers or family members are impostors

• Refusing medication or food out of suspicion

• Hiding or hoarding items for protection

How to Respond

Care Tips• Stay calm and non-defensive. Don’t argue or try to prove them wrong.• Validate the feeling (“That must be frightening”) even if the belief is false.• Keep personal items visible and labeled.• Create a secure environment — predictable, quiet, familiar.• Redirect attention with comfort: “Let’s sit down together for a bit.”• If paranoia escalates or leads to aggression, seek medical advice.

Final Thoughts

Every one of these symptoms tells a story about the changing brain — not about stubbornness, laziness, or intention.When caregivers understand that behavior is communication, they begin to see patterns and meaning behind the actions.

Dementia care is not about control; it’s about connection.Meeting needs — for comfort, safety, reassurance, and dignity — transforms distress into peace.

At EmpowerLiving Community Services Society, we believe that every individual deserves care rooted in understanding and respect.Through education and compassion, we can empower families and caregivers to transform fear into confidence and confusion into calm.

Join Our Community

If you or your loved one is looking for a supportive, inclusive day program in the Tri-Cities area, we would love to meet you.

Email: contact@elcss.org

Phone: 604-945-2117

Website: https://www.empowerlivingsociety.org/

Together, we can create a community where every individual — regardless of ability — is empowered to live, learn, and belong.