Dementia: Recognising and responding to personality changes

Brain and personality changes with dementia

Some of the personality changes we see in those living with dementia arise because of the way in which the disease affects different parts of the brain. For example, if the part of the brain responsible for motivation is damaged by disease, that might lead to changes relating to loss of motivation. These changes might manifest as a loss of interest, a lack of enthusiasm, or an appearance of being passive or indifferent to matters that they would otherwise have been interested in or cared about.

Alternatively, if the part of the brain that controls our impulses becomes damaged, that might lead to someone being more rude or insensitive, and less able to plan or stay focused on specific tasks.

Types of dementia and personality changes

All sorts of personality changes can emerge during the course of dementia, but Alzheimer’s disease is often associated with apathy and depression; mood fluctuations may be more prominent in vascular dementia; and disinhibition is more common in frontotemporal dementia.

Early signs of personality changes in dementia

Changes in personality can occur at any stage of the dementia process. In some individuals, the early signs of personality changes appear even before dementia is diagnosed.

The most common personality changes affecting people with dementia relate to differences in mood, motivation, and emotional control.

Low mood and anxiety can be common. Depression is thought to affect more than half of those diagnosed with dementia. Those affected can be inclined to express feelings of failure or despair about the future, they might be tearful or cry. Less commonly, there might be a shift towards being inappropriately positive, giggling and laughing at random, playing childish games, or making grandiose claims about one’s abilities or wealth.

However, some individuals exhibit rapid mood changes, known as emotional lability.  Those affected can experience rapid and extreme mood  shifts, moving from tears to laughter within a few moments. This emotional lability is often seen in those living with vascular dementia.

Also, the ability to respond appropriately can become blunted so that individuals who are affected become more intolerant, bad tempered, irritable, agitated, or even aggressive.

In some individuals, there might also be a tendency to appear more self-centred, to lack empathy or insight, and to lose social graces such as tact, or flexibility. Sometimes people can say or do things which might be socially inappropriate or embarrassing to those around them.

Losing the person you knew and loved while helping someone with new, unpredictable, or less attractive personality traits can generate difficult emotions for you and make caring more challenging.

Recognise that any failure to help you, thank you, interact with you, or appreciate you can be a reflection of the disease process and a damaged brain rather than a deliberate intent to be unhelpful or disagreeable.

If you do not understand that these responses are unintentional, you will be wasting your time berating, arguing, or reasoning. None of these efforts will work, but they might cause both of you more distress and make a difficult situation even worse. Seek to understand more about BPSD in dementia so that you can manage it more effectively.

If you are experiencing lots of negative emotions, then do seek help. Speak to your doctor, to talking therapy, to friends and family  and be kind to yourself. Recognise that you are doing your best in a difficult situation and take active steps to care for your own emotional and physical health.

Do what you can to outweigh the negative emotions with more positive thoughts and experiences. Take time to do enjoyable things wherever or whenever you can, and avoid dwelling on negative thoughts.

Ask specifically about programmes such as START, which are specifically designed to help people caring partners and relatives living with dementia.