If you’re caring for someone with dementia, you’ve probably had moments where you just don’t know what to do anymore. They’re pacing again. They won’t eat. They’re convinced there’s someone in the room who isn’t there. And by 5 p.m., it feels like a different person has walked in.
Here’s the thing nobody tells you early enough: none of this is random, and none of it is “them being difficult.” A dementia-affected brain is working overtime just to make sense of a world that keeps slipping out of focus. What looks like bad behaviour is usually the closest thing to a message the person can still send you.
This guide walks through four behaviours that trip up even experienced caregivers depression, agitation, sundowning, and hallucinations and what tends to actually help, based on how these things typically play out.
If you want the bigger picture first, our dementia care at home guide covers the day-to-day basics this article builds on.
The short version, if you’re short on time
- Depression in dementia rarely looks like sadness. It looks like withdrawal, flatness, going quiet. It’s treatable routine and connection help, and sometimes medication does too.
- Agitation almost always has a trigger. Pain, noise, confusion, being rushed find the trigger, and the behaviour usually eases.
- Sundowning is that late-afternoon spiral into confusion and restlessness. It’s linked to tiredness and a body clock that’s stopped keeping good time.
- Hallucinations become more common as dementia progresses. Arguing about whether they’re “real” almost never helps comforting the fear behind them does.
1. Depression
Here’s a statistic that surprises a lot of families: somewhere around 40 to 50% of people with dementia also experience depression. And it’s often missed, because the symptoms blend right into what people assume is “just the dementia.”
Watch for:
- Pulling away from things they used to enjoy
- Long stretches of silence, more withdrawn than usual
- Eating or sleeping less (or more) than before
- A flatness to their expression, or crying that seems to come from nowhere
- Comments like “what’s the point” or “why bother”
What actually helps:
Routine matters more than people expect it takes some of the mental load off a brain that’s already working hard just to keep up. Beyond that, connection tends to do more than conversation ever could. Sitting with them, playing a familiar song, holding a hand none of that requires words, and often it reaches them when words don’t.
It’s also worth getting a real medical assessment. Depression in dementia isn’t something to just live with a GP can check for other causes (thyroid issues, medication side effects, undiagnosed pain) and figure out whether therapy or medication makes sense.
And one thing caregivers tend to forget: your own steadiness is part of the treatment. A calm, present caregiver does more good than almost anything else but that’s hard to offer when you’re depleted yourself. Our dementia care at home guide has some practical thoughts on pacing yourself so you’re not running on fumes.
2. Agitation
Pacing, shouting, asking the same question for the tenth time, pushing back against help with dressing or bathing agitation shows up in a lot of forms, but it’s almost never “just because.” There’s usually something underneath it.
| What’s going on | Might look like |
|---|---|
| Physical | Pain, hunger, thirst, needing the bathroom, an infection, exhaustion |
| Environment | Too much noise, too many people, clutter, an unfamiliar space |
| Emotional | Fear, confusion, feeling pushed or rushed |
| Communication | Not being understood or not understanding what’s being asked of them |
A rough approach that works for a lot of families:
First, reassure soften your voice, slow down, let them know you’re not going anywhere. Then reduce whatever’s overwhelming them: turn off the TV, clear the room, step outside if you need to. Then redirect a familiar song, folding towels together, flipping through old photos.
What doesn’t help: arguing, correcting, or trying to reason someone out of a feeling. In the moment, a distressed brain isn’t really listening to logic. It’s listening to your tone.
3. Sundowning
If you’ve noticed things get harder right around dusk more confusion, more restlessness, more anxiety you’re not imagining it. This is sundowning, and it’s one of the more predictable patterns in dementia care, even if the exact cause isn’t fully understood.
A few things seem to feed into it: a body clock that’s drifted out of sync, the fatigue that’s built up over the day, shadows and dimming light making the world harder to read, and in care settings the shift change that happens right around that time.
Things that tend to help:
Getting them outside or near natural light earlier in the day seems to help reset that internal clock. In the evenings, keep things low-keysoft lighting instead of a sudden switch to darkness, quiet music rather than the TV. Save anything demanding, like a bath or a doctor’s visit, for the morning, when they’ve got more in the tank. And try to keep bedtime roughly the same every night, so at least that part of the evening is predictable. Skip the late-day coffee and the long afternoon nap if you can both tend to make the night worse.
4. Hallucinations
As dementia progresses especially with Lewy Body dementia, and later-stage Alzheimer’s hallucinations become more common. Someone might see a person who isn’t there, hear voices, or feel like something’s crawling on them.
The instinct to correct them is natural. Resist it. Telling someone “there’s nobody there” rarely calms them down it usually just adds confusion or makes them feel unheard.
Instead: check if there’s something real feeding it first bad lighting, a mirror throwing a reflection, a patterned rug that looks like it’s moving, or an undiagnosed vision problem. Then focus on the feeling, not the content. If they’re scared, comfort the fear “that sounds frightening, I’m right here” rather than debating what’s real. Often, just gently moving to another room is enough to break the spell.
One thing worth flagging: if hallucinations show up suddenly or get noticeably worse, that’s worth a call to the doctor. It can point to an infection (a UTI is a classic culprit), a medication issue, or a shift in the disease itself.
A word for you, the caregiver
Every behaviour in this list is a form of communication not defiance, not stubbornness. The person isn’t choosing this. Their brain is doing its best with a world that keeps not making sense, and these behaviours are often the only way left to tell you that.
But you matter here too. Burnout is real, and it doesn’t make you a worse caregiver to admit you need a break if anything, it’s part of doing this well. Respite care, a support group, a friend who’ll just listen none of that is weakness. For more on building sustainable routines and knowing when to ask for help, take a look at our dementia care at home guide.
Questions people often ask
Q.1 Is agitation a normal part of dementia?
Yes, it’s one of the most common behavioural symptoms, and it usually points to an unmet need rather than intentional behaviour.
Q.2 What time of day is sundowning usually worst?
Most often late afternoon into early evening, roughly 4 to 8 p.m., though it varies from person to person.
Q.3 Should I correct someone with dementia who's hallucinating?
Generally, no. Correcting them tends to increase distress. Acknowledging the emotion and gently redirecting works better.
Q.4 Can depression in dementia actually be treated?
Yes, through a mix of routine, connection, therapy, and sometimes medication, under a doctor’s guidance.
Q.5 When should I call a doctor about hallucinations?
Any time they’re new, sudden, or getting worse, it could signal an infection, a medication problem, or disease progression.
This article is for general informational and caregiving-support purposes and isn’t a substitute for medical advice. Always check with a doctor or dementia care specialist about your specific situation.
