Unusual Behaviours in Dementia: Why They Happen and What to Do

Your parent is accusing you of stealing from them. Or they’ve become agitated every evening in a way that seems to come from nowhere. Or they’re doing something repetitive — folding and unfolding the same cloth, asking the same question, pacing the same path — for hours.

These behaviours are among the most frightening and disorienting parts of dementia for families. They’re also among the most misunderstood — because they look like personality or intention when they’re actually neurology.

Understanding why these behaviours happen doesn’t make them easy to manage. But it changes what they mean, which changes how you respond.

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Accusation and paranoia

What it looks like: Your parent insists that money is missing, that someone has been in the house, that caregivers or family members are stealing, lying, or conspiring against them.

Why it happens: When memory fails, the brain tries to make sense of gaps in its own record. If your parent can’t find their purse, the explanation that feels most logical to them isn’t “I forgot where I put it” — it’s “someone took it.” This isn’t chosen paranoia. It’s the brain filling in explanations for experiences it can no longer track accurately.

What helps: Don’t argue. Don’t defend yourself vigorously — this tends to escalate rather than resolve. Acknowledge the feeling: “I can hear you’re really worried about this.” Then help search. Keep duplicates of frequently lost items (a spare set of keys, an extra wallet) so the search can end successfully. Reduce the opportunity for loss where possible — simplify what’s kept and where.

What doesn’t help: presenting evidence, logical argument, asking them to “think about it.” The reasoning system that would process that evidence is impaired by the same disease causing the accusation.

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Sundowning — evening agitation and confusion

What it looks like: In the late afternoon or evening, your parent becomes more confused, agitated, anxious, or distressed than they are during the day. They may want to “go home” (even if they’re at home), become restless, or be harder to calm.

Why it happens: Sundowning is thought to involve disruption to the brain’s circadian rhythm — the internal clock that regulates alertness and sleep. Fatigue accumulation through the day, reduced light, and the transition into less structured evening time all contribute. It’s one of the most consistent patterns in dementia care.

What helps: Maintaining a consistent routine and consistent light levels in the late afternoon and evening. Reducing stimulation and activity demands as the day progresses rather than introducing them. Gentle physical activity earlier in the day. Ensuring afternoon and evening are calm and familiar rather than busy.

Some families find that a bright light lamp used during afternoon hours helps regulate the circadian signal. Speak with the family doctor about this — bright light therapy has reasonable evidence for sundowning and is worth discussing.

Evening caregiver support is one of the most high-value uses of professional home care time for families managing sundowning at home.

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Repetitive actions and questions

What it looks like: The same question asked every few minutes. The same story told repeatedly in a single conversation. Repetitive physical actions — folding laundry that doesn’t need folding, sorting objects repeatedly, pacing.

Why it happens: Short-term memory loss means the brain genuinely cannot register that the question was just asked or the action just completed. The repetition is the brain seeking comfort and information it cannot hold onto. For repetitive physical actions, there’s often an underlying need being expressed — for reassurance, for activity, for purpose — that the person can no longer articulate directly.

What helps: For repetitive questions, answer calmly each time. Place visual reminders where they can be seen — a whiteboard with the day’s schedule, a note with key information — so the person can find answers independently without needing to ask.

For repetitive physical actions, ask whether the action itself is harmful. If it isn’t, it doesn’t need to stop. Folding cloths or sorting objects can be genuinely calming. Redirect only when the repetition is causing distress or physical harm.

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Aggression and agitation

What it looks like: Verbal outbursts, refusing personal care with significant distress, physical resistance, or behaviour that seems out of character for who your parent has always been.

Why it happens: Aggression in dementia is almost always communication of something else — pain, fear, discomfort, confusion, or the experience of having something done to them that feels threatening. Personal care — bathing, dressing, grooming — is one of the most common triggers because it involves proximity, touch, and sometimes perceived intrusion by someone the person may not fully recognize in that moment.

What helps: Slow down. Narrate what you’re doing before you do it. Give the person time to process (the 90-second rule matters here — see our article on that). Ensure the environment is calm, warm, and private. Check whether there’s an underlying pain source — dental pain, urinary tract infections, and other physical discomforts are common triggers for sudden agitation in people who can no longer articulate what hurts.

If agitation is new, sudden, or significantly worse than before, rule out a physical cause first. A UTI, for example, can produce dramatic behavioural changes in older adults with dementia and resolves with treatment.

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Wandering

What it looks like: Leaving the home without apparent purpose or awareness of the risk, getting lost in familiar areas, being found somewhere unexpected.

Why it happens: Wandering often reflects an unmet need — for movement, for a sense of purpose, for a destination that felt important (going to work, going home) — without the ability to recognize that the need has already been met or that the context has changed.

What helps: Door alarms are the most important immediate safety measure. A GPS device worn as a watch or pendant allows tracking if wandering occurs. Registering with the RCMP’s Vulnerable Persons Registry in BC means that if your parent is found, police can identify them and contact your family. The Alzheimer Society of BC’s MedicAlert Safely Home program (1-800-432-5223) provides identification bracelets for people at risk of wandering.

Ensure that regular physical activity is part of the daily routine — this reduces the restlessness that often drives wandering.

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Hoarding and hiding things

What it looks like: Collecting and hiding objects in unusual places — food tucked under mattresses, papers saved compulsively, objects moved from their normal locations and stored somewhere that seems random.

Why it happens: Insecurity and the fear of loss can drive hoarding in dementia. The person may be trying to protect things they value in a world that has become unpredictable and confusing. Hiding objects may reflect the same impulse.

What helps: Don’t confront or remove hoarded items unless there’s a hygiene or safety issue. If food is being hoarded in ways that create spoilage risk, check regularly without making it a conflict. Approach hidden objects with curiosity rather than correction — they sometimes reveal what the person is most worried about losing.

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Inappropriate behaviour

What it looks like: Making comments that are embarrassing, rude, or sexual in ways that are out of character. Removing clothing in public. Reduced inhibition generally.

Why it happens: The frontal lobe, which regulates social inhibition, is often affected by dementia. Behaviours that were previously suppressed by social awareness may emerge because that filtering system is impaired. This is neurological, not moral.

What helps: Redirect rather than shame. Address the immediate situation calmly. If comments are being made to others, brief explanation to those involved (“my mother has dementia and sometimes says things she wouldn’t have said before — I’m sorry”) is usually sufficient. Don’t discuss the behaviour with your parent afterward as a correction.

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The most important thing to remember

Every unusual behaviour in dementia is a communication. The person cannot always tell you what they need, what they fear, or what hurts. The behaviour is how they’re telling you.

Approaching behaviour with curiosity — “what is this trying to tell me?” — rather than frustration or correction produces better outcomes for both of you.

If behaviours are escalating significantly, or if a particular behaviour is creating safety risks or making home care unsustainable, that’s worth discussing with the family doctor. Some behavioural symptoms of dementia respond to medication adjustment or treatment of underlying physical causes. Others respond to environmental or routine changes that a good care plan can address.

If you’re trying to figure out how to manage what you’re seeing at home, a care navigation call can help you think through it clearly.

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Free resource: Get the BC Dementia Caregiver Kit — 9 printable templates including daily care logs, conversation scripts, doctor visit prep sheets, and more.

This article is part of the Aging at Home series. Also see: What Not to Say to Someone with Dementia · What Is the 90-Second Rule for Dementia?