Coping with Challenging Behaviors Caused by Cognitive Impairment

“My husband woke up in the middle of the night and thought it was time to go to work. He’s been retired for 10 years.”

“Since she was diagnosed with Alzheimer’s last year, my mom’s personality has changed. Sometimes she’s aggressive, and sometimes she’s very withdrawn. Both behaviors are unusual for her.”

If you know someone who is living with a cognitive impairment, these scenarios may sound all too familiar. Cognitive impairment is a broad term covering a range of conditions including dementia, Alzheimer’s, and other neurological disorders.

As families grapple with their loved one’s condition and changing abilities, they often also find themselves handling new and challenging behaviors. These behaviors can include forgetfulness, repetition, aggression, and more. Recognizing these behaviors is the first step in learning how to manage them. Here are some tips.

Forgetfulness and repetition

Individuals with cognitive impairment may ask the same questions repeatedly, forget familiar faces, or lose track of time, places or events.

What to do: Be patient. If the person is repeating questions, provide short, clear answers. Visual aids, reminders, or notes may also help.


Physical or verbal aggression is often caused by the frustration or fear accompanying a loss of control over thoughts, memories, and activities.

What to do: Remember that the aggression is not personal. The best approach is to stay calm, maintain a gentle tone, and redirect their attention toward more positive subjects or activities.


Wandering can pose a significant risk. People with cognitive impairment may leave familiar surroundings, becoming lost and confused.

What to do: Keeping a consistent routine can help prevent anxiety and restlessness. Use safety devices like alarms and locks when necessary, but also consider freedom of movement within a safe area at home. Alert neighbors and local law enforcement about the potential for wandering. Register with the Take Me Home program, run by the San Diego County Sheriff’s Department. This confidential registry gives law enforcement quick access to critical information about a registered person with disabilities or medical condition in case they get lost or wander away.


Disorientation involves confusion about time, place, identity, or the situation at hand. The individual may become anxious, upset, or agitated as they struggle to make sense of their surroundings or situation.

What to do: Avoid arguing. Instead, allow your loved one to live in their reality as long as it does not pose a threat to their safety. It might be helpful to use orientation tools such as a calendar or a clock. Keep the home environment simple and consistent, avoiding unnecessary changes in furniture placement or decor that may add confusion. Photographs of familiar places and people can provide a sense of reassurance and familiarity.

Sleep disturbances

Individuals with cognitive impairment may experience changes in sleep patterns, often staying awake or wandering during the night.

What to do: Ensure they get adequate physical activity during the day and limit daytime napping. Light therapy, which can be as simple as getting some sunlight during the morning hours, can also help regulate sleep-wake cycles.

Personality changes

You may notice your loved one developing new personality traits or exhibiting mood swings. They might become suspicious, fearful, or overly emotional.

What to do: Provide a calm and reassuring presence and try to engage them in activities they enjoy. Be sure to alert their doctor, as physical causes such as pain or discomfort may be contributing to the change.

Remember your own wellness

As always, don’t forget the importance of self-care. The physical and emotional toll of caregiving can be overwhelming, leading to burnout. Allocate time for your own health and relaxation, and don’t hesitate to seek professional help when needed, including respite care services or a healthcare provider. At Windward Life Care, we can provide respite care while you take a break, and our Aging Life Care Managers can help you manage all aspects of your loved one’s care. Please reach out for a complimentary consultation to discuss your unique situation.