How does the personality of someone with dementia change?

A fellow caregiver asked...

How does dementia change someone's personality?

Expert Answer

Joanne Koenig Coste is a nationally recognized expert on Alzheimer's care and an outspoken advocate for patient and family care. She is the author of Learning to Speak Alzheimer's. Also, she currently is in private practice as an Alzheimer's family therapist. Ms. Koenig Coste also serves as President of Alzheimer Consulting Associates, implementing state-of-the-art Alzheimer care throughout the United States.

Most people with dementia retain the essence of their pre-disease personality. In fact their personality seems to be exaggerated - a sweet young person appears to be even more gentle with Alzheimer's and 'the boss' becomes more controlling. Many people however show drastic personality changes, particulary those folks with the dementias that effect the frontal lobe such as Pick's disease, while folks with Lewybody disease may be prone to visual hallucinations causing them to react uncharacteristically.

People often develop uncharacteristic behavioral symptoms in the middle stage of Alzheimer's disease, including agitation, aggression, delusions such as imagining they are being threatened, and paranoia believing that family members are stealing from them or hiding lost objects such as glasses or keys. As control and inhibition are lost, some people with AD do things that are totally uncharacteristic of personality before the disease. Swearing (yes, even precious sweet elderly ladies!), spitting, becoming socially inept and impulsive with innapropriate words or actions, and sexual advances may appear for some folks.

Other common personality changes include:

  • Apathy and loss of interest in former pleasures
  • Difficulty making decisions and iniating tasks
  • Social withdrawal
  • Impatience and a quick temper
  • Insensitivity to others
  • Accusations or paranoia

Most of these personality changes are short lived and are caused by the disease process and not by the person's intent to be different. It helps to repeat "it is the disease not my loved one" that is making these aberrent behaviors.