Top 10 Triggers for Sudden Behavioral Changes in Dementia

Have you ever been caring for someone living with dementia when, out of nowhere, their entire mood shifts? One moment everything seems fine, and the next they refuse to finish a shower, become anxious, angry, or even combative — leaving you wondering, What just happened?

In this episode, Lisa Skinner explores the top 10 triggers that can cause sudden behavioral changes in dementia. She explains why these changes occur, and more importantly, how caregivers and families can respond in ways that de-escalate the situation and create positive outcomes.

Listeners will learn:

• The most common triggers, including overstimulation, fatigue, hunger, pain, communication gaps, changes in routine, and more.
• Tips for de-escalation and response strategies that bring calm to difficult moments.
• Practical approaches for creating safe environments, using patient communication, establishing predictable routines, and applying soothing techniques.
• Safety considerations to protect both the person with dementia and the caregiver.

If you’ve ever felt frustrated or helpless during a sudden behavioral change, this episode will provide encouragement, tools, and strategies to help you navigate with confidence and compassion.

Mentioned Resources:

• Truth, Lies & Alzheimer’s Podcast Archive
• Lisa’s book: Truth, Lies & Alzheimer’s — Its Secret Faces (available on Audible: https://www.audible.com/pd/Truth-Lies-Alzheimers-Audiobook/B0BHDZ61RY)

About the Host:

Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.

Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.

So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.

Thanks for listening!

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Episode Transcript

Lisa Skinner (00:00):
Hi everyone. Welcome to another new episode
of the truth lies andAlzheimer's show. I'm Lisa
Skinner, your host. I have aquestion for you. How many of
you have encountered asituation, whether it would be
spending time with a loved oneliving with dementia or caring

(00:21):
for someone who's living withdementia, and then, out of
nowhere, the entire climatechanges, and you have no idea
what just happened. Does thissound familiar? And maybe for no

(00:41):
apparent reason. For example,the person you're caring for
just flat out digs their heelsinto the floor and refuses to
take a shower. Or you could beright in the middle of that
shower, shampoo is still ontheir head, and they all of a

(01:02):
sudden, out of the blue, decidethey're done, but obviously the
shower isn't. Or couple otherscenarios that happen pretty
regularly and are very common,is that all of a sudden they
become angry or anxious orcombative for no apparent

(01:24):
reason. Well, these suddenchanges in moods do happen
regularly with dementia, as alot of you probably already
experienced, but there is almostalways a reason, I would say
99.9% of the time. And we callthese incidences triggers,

(01:51):
something trigger the suddenchange in mood, and
unfortunately, the hard parts onus as family members and
caregivers, because we aretasked with having to figure out
what that something is, and it'snot always obvious. And the

(02:15):
other thing is, there are somany things that can trigger
sudden mood changes orbehavioral changes. So that's
what we're talking about today.On this episode, I'm going to go
over the top 10 triggers forsudden behavioral changes with
dementia, and I'm going to giveyou some tips for de escalating

(02:36):
the situation, effectiveresponses and strategies, as
well as other helpfulinformation that will help you
turn these situations aroundinto positive outcomes. Now
there are more than 10 triggers,but I'm just going to go over
probably the top 10 that we knowthat would you know cause a

(03:00):
sudden behavioral change in theperson you're caring for, or
family member. So you want tolook to see if they are somehow
in pain or they're experiencingdiscomfort. But dementia can
make it hard for them to expresspain. So what you want to do is

(03:24):
look for nonverbal cues. Thereare they grimacing? Are they
resisting movement? Do they seemwithdrawn? Then there could be
one another. Trigger, commonlyis hunger, thirst, or they have
a physical need. Do they need togo the bathroom? Is the
temperature of the room too hot,too cold? Are they sleepy? So

(03:50):
one example is a full bladder,being hungry or being too hot or
cold. Does cause agitation, orcan cause agitation and or
aggression. A change in theirroutine or their environment can
trigger a behavioral change,such as a sudden schedule

(04:14):
change, bringing in a newcaregiver, relocating them to an
unfamiliar place or unfamiliarsurroundings can trigger
confusion and also distress.Number four is it's a medical
issue, or has to do with amedication there on infections

(04:38):
such as urinary tractinfections, pneumonia,
dehydration, constipation andside effects of medications can
and do alter moods and behavior.Number five is over stimulation
or sensory overload can triggerbehavior. Neural changes. So

(05:03):
what does that look like? Noisebeing in a crowded space, the
lights are too bright or busyenvironments, these things can
all overwhelm people living withdementia. Also number six is

(05:23):
under stimulation or beingbored, so too little engagement
can lead to restlessness, pacingand repeating type behaviors.
Fidgeting can also show up whenthey're bored or over
stimulated. Number seven iscommunication gaps or

(05:47):
frustration with expression, andthat would look like difficulty
finding words on their part orunderstanding their symptoms
that would inevitably causefrustration and outbursts a
recent loss or or emotionaltrigger. So anniversary

(06:10):
reactions, grief or reminders oftheir cognitive decline can
definitely provoke mood changes,fatigue and or sleep disruption,
if you remember me telling youin one of the previous episodes,
when people live with dementia,their circadian rhythm is

(06:31):
completely thrown off. So a lotof people with dementia think
they're supposed to sleep duringthe day and they're wide awake
and wandering around andrestless at night because their
bodies can't tell the differenceanymore. So poor sleep
definitely can worsen memory,cause confusion and

(06:56):
irritability, and then number 10is they feel unsafe or that
something is a perceived threatto them, perceived danger or
lack of control can trigger fearbased reactions. So keep that in

(07:16):
mind. They could becomeaggressive. They can become, you
know, guarded, and lash out. Sothese are all things that you
want to kind of go through aprocess of elimination and see
if it's any of these. Now, as Imentioned, there are so many
triggers that are out there, butthese are the top 10 Things to

(07:41):
probably start with. So now I'mgoing to offer you some de
escalation and responsestrategies for caregivers and
family members who might bevisiting or or, you know,
spending time with their lovedone, and then these mood changes
occur, and you're not reallysure what just happened. So

(08:04):
identify and address theirunderlying need. Look for signs
of pain. Do they need to go tothe bathroom? Are they hungry?
Are they thirsty? Are theytired? Check for medical issues
or medication effects with theircare team always create a calm,

(08:28):
safe environment. So some of thethings you can do is reduce
noise, reduce clutter, use soft,soothing, calming lighting,
minimize competing stimuli, turndown the TV or the radio if it's
way too loud, or you're noticingthat, you know based on their

(08:52):
body language and the waythey're acting, that they're
over stimulated, and then alwaysensure that the person has a
comfortable temperature in theroom that they are in. Use clear
communication and be patient.Speak slowly. They don't process

(09:13):
information the way they used toone idea at a time and use
simple words, ask yes or noquestions and give options.
Would you like to sit here orwould you like to sit here?
Validate their feelings? I cansee you're upset, and I'm here

(09:35):
to help
redirect rather than confront.So what does that look like?
Offer a simple, engagingactivity for them to do to, you
know, help them get their mindoff of whatever it is that's
bothering them. You can ask themto help you full towels, sort

(09:57):
things. Let's go for a shortwalk. But the key is avoid
arguing about who is right,acknowledge their emotion first.
There is no right. Establishpredictable routines, maintain
consistent daily schedules formeals, activities and rest. This

(10:21):
makes a huge difference in theday of a person living with
dementia. Trust me, prepare inadvance for changes, and use
visual schedules or calendars ifthose are helpful. So learn to
manage these triggersproactively. If a known trigger
is present like you walk into aroom and the music is obviously

(10:45):
loud. Modify it, remove it, turnit off. Prepare for predictable
events. So in other words, yougot to go the doc, take your
loved one to the doctor or theperson you're caring for. So
preparation for that is to showthem or give them a familiar

(11:06):
object, provide them withreassurance, and make sure you
allow plenty of time and thenusing soothing techniques like
gentle reassuring touch, ifappropriate, and welcome on
their end, you saw a soft voice,slow breathing exercises,

(11:31):
playing familiar music for themis very common and triggers most
of the time, very fond memories,familiar routines or reminiscing
with them, looking at photos,telling Simple Stories. Now
there's safety considerations.Also monitor for aggression,

(11:55):
safely give space if someoneneeds it, move to a safe, quiet
area if the aggressionescalates, remove the trigger
that you believe is causing thisaggression and allow time for

(12:15):
them to calm down, avoidphysical restraint, unless
necessary for safety, and then,of course, always allow for time
and patience. Allow pauses, givethe person time to process, be
consistent and calm. Youremotional state communicates a

(12:37):
lot. They pick up on youremotions and they emulate your
emotions. This is a known factplan for difficult episodes. So
what one of the things that werecommend is that you have what
we call a comm kit ready. What'sin your comm kit? Well, you can

(12:59):
be creative with that. But someof the suggestions are to have a
favorite snack, readilyavailable, or a comforting item,
a familiar blanket and a waterbottle. And then the other thing
that you can do whenever thesebehavioral changes happen.

(13:22):
Document the patterns. Soinclude what happened, the
triggers you identified, whatcalmed the person in that given
situation, and of course, youalways want to share this
information with the care team.So if the exact similar

(13:43):
situation arises, you will havethe have documented what de
escalated that particularsituation. But I just want to
tell you that the strategy thatworked for this particular
situation may not work for thenext time it happens, even
though the circumstances arepretty much the same. So this is

(14:08):
why we really emphasize having atoolbox that you've assembled
with different strategies,skills and techniques. So if one
strategy doesn't work for asituation you have something
else to pull from, or others topull from. So I'm going to give
you this quick checklist to keephandy of all the things that I

(14:32):
just went over, so you can writethese down and have a checklist.
Number one, check the basicneeds. Are they hungry, thirsty?
Do they need to go the bathroom?Could they be in pain? Is the
temperature surroundingtemperature in the room
comfortable for them? Have theyhad enough sleep? Number two,

(14:55):
eliminate or reduce triggers? Inthe environment number three,
Speak calmly, using simplesentences and validate their
feelings. Always recognize andacknowledge the emotion first

(15:16):
and then the problem. Numberfour offer a distraction or
gentle redirection. Let's go fora walk. It's a beautiful day
outside. The next one use afamiliar, comforting routine or
object. Next ensure safety foryourself and the person you are

(15:44):
caring for or your loved one. Inother words, make sure that
they're in a safe space, thatthey can't exit the building or
the environment, and they'reproperly supervised. Record what
happened and what helped forfuture reference. And then the

(16:08):
last one is communicate withhealthcare providers about
recurring or severe changes. Oneof the questions that comes up
quite often is, well, whenshould I seek medical advice?
When these things arise? Ouradvice is if sudden, new or

(16:32):
escalating aggression orconfusion occurs, signs of
infection, dehydration or newmedications that are causing
these occurrences to happen,severe withdrawal, you thinking

(16:53):
they may be at risk of self harmor harming others. And then here
are some additional tips for youuse meaningful activities tied
to their past interests. Do theylike to garden? Or did they like
to garden? Were they a baker intheir earlier years, the younger

(17:17):
years? Were they a craft person?So you can offer these types of
activities and limit thesessions to 10 to 15 minutes to
avoid fatigue, because that cancreate a mood change, build a

(17:38):
simple choice board with threeeasy options for activities to
reduce their decision makingfatigue, they just can't process
information very easily anymore,so too many choices is
overwhelmed for people livingwith dementia, use nonverbal

(18:00):
cues such as nodding, gentlefacial expressions and hand
gestures to support your spokenwords validate briefly then
offer concrete options. Sohere's an example. I know you're
upset. So would you like to sithere next to me? Or would you

(18:24):
like to sit in the chair rightthere? Create a stimulation map
of your home zones that arequiet, predictable and safe,
label rooms with photos orwords, use familiar smells,
vanilla, lemon, chocolate chipcookies coming out of the oven,

(18:50):
bread, anything that you knowthey really resonate with. The
other thing you can do is playsoft music to create calm,
establish a predictable rhythmfor mornings and evenings, but

(19:10):
allow wiggle room for days whenit's obvious that they're just
feeling Off. Build build in,built in buffer times between
activities to reduce rushing andfrustration,
maintain an up to datemedication list, including the

(19:31):
vitamins and over the counteritems that they're currently
taking, and review them on aregular basis with their doctor.
Schedule regular check ins, evenif they're short and brief, with
their primary care provider orgeriatrician to catch evolving
needs, early, track symptoms ina simple diary, moods, sleep

(19:59):
patterns. Is appetite patterns,pain indicators and any new
medications that they have beenprescribed. You can use a simple
pain scale adapted for dementia.For example, you might have a
category facial expressions. Andare you noticing from on a scale

(20:21):
from zero to three, what istheir current facial expression,
and what is it trying to tellyou? And you want to note this
during uncomfortable moments,and then check always this is
part of your process ofelimination, check for subtle
signs of constipation,dehydration or urinary issues,

(20:47):
which are extremely commontriggers. Now it is very common
for people living with dementiato become dehydrated, and part
of the reason is they can't tellthey get to a point in their
decline, they can't evaluate ortell when they're thirsty. So

(21:08):
they're probably not going toindicate to you that they need
something to drink. That's goingto be the responsibility of the
caregiver and or the familymember to, on a regular basis,
offer hydration. It doesn'talways have to be water. It can
be other forms of liquids, orpopsicles, things like that, but

(21:30):
they do become dehydrated veryeasily and quickly remove any
trip hazards and ensure goodlighting at night, consider grab
bars and non slip mats whereneeded. Keep a list of emergency
contacts and a copy of keymedical information available at

(21:54):
all times. Schedule regularbreaks for yourselves as
caregivers, use respite carewhen possible, I recommend
joining a caregiver supportgroup, either in person or
online. It is always so nice tofeel that you are not alone in

(22:14):
this journey, and that otherpeople are experiencing a lot of
the same situations that youface on a day to day basis, and
you can share your strategiesand be supportive emotionally
for one another, set boundariesfor yourself and realistic
expectations. Acknowledge when asituation is beyond your

(22:40):
capacity and seek help a lot oftimes, family members and
caregivers believe that they'resuper human beings and they can
do it all, and that is a recipefor Quick caregiver burnout.
Consider reminders on a simpletimer or watch for medications

(23:04):
and routines, use big buttonphones or tablets with easy
navigation for reminders or forcommunication. And then there
are door monitoring devices thatcan provide alert cues for
safety while preservingindependence. You can visit on

(23:26):
my website, mining dementia.com,and there is a products list
there that you can find thesedoor and monitoring devices.
Maintain a care plan documentwith typical triggers, effective
de escalation approaches as youcontinue to collect them and

(23:50):
learn them, the medical historyof the person that you're caring
for and preferred objects,things that they really seem to
take to create an advanced caredirective and discuss future
wishes early when possible. Sowhen do we involve professionals

(24:17):
if the behavioral changes areabrupt, severe, or are
increasing in frequency. Ifthere are new safety concerns,
you've seen an increase insignificant memory decline or
confusion. And as a caregiver,if you're feeling overwhelmed or

(24:39):
you're feeling that you're atrisk in some way, and then some
of the resources that are outthere that you can tap into, our
local dementia and Alzheimer'sAssociation chapters, geriatric
care managers and socialworkers, home health aides or
respite. Care Services,palliative or comfort care

(25:04):
specialists, if you feel that'sapplicable. And then there are
cognitive rehabilitation andalso occupational therapy
providers for engagementstrategies, if you'd like, share
the details about the person'sliving situation, their typical

(25:24):
routines and the currentchallenges that you're noticing,
like the time of day that theyseem to become more agitated, or
when some of these behaviorsspike, and what specific
triggers you've noticed, bringthese on. So that is what I have

(25:49):
for everybody today. I hope thishas been extremely helpful. I
will share other triggers in thefuture on future episodes,
because there are a lot toconsider, but these, let's start
with these 10 so we don't getyou too overwhelmed and put you

(26:11):
in information overload mode.Okay, so again, I want to thank
everybody for spending part ofyour day with me here on the
truth, lies and Alzheimer'sshow. I'm Lisa Skinner, your
host, I'll be back next weekwith another brand new episode
for you. I hope you'll bejoining us, and hope you enjoy

(26:35):
the rest of your day and alwaystry to stay happy and healthy.
Okay, talk to you soon. Bye,bye.