Why Alzheimer’s and Dementia Cause Mood Swings, and What to Do About Them

By Frances Gatta | March 23rd, 2023

Mood changes can be a sign of dementia. What causes these behavioral symptoms? And how can dementia care partners help ease them? Here’s an explainer on the basics of mood swings brought about by Alzheimer’s and dementia.

Neuropsychiatric symptoms like agitation, anxiety, appetite changes, irritability, anger and aggression, depression, apathy, disinhibition, and excitement occur in 98 percent of people living with dementia. Grouped together, these behavioral changes are often referred to as mood swings. And for people with dementia and for those involved in their care, these Alzheimer’s mood swings can even be more disorienting than the disease’s well-known cognitive symptoms, like cognitive impairment or memory loss. 

Now and then, anyone might experience an unexpected change in mood or behavior — a mood swing. However, in a person with dementia, mood swings are more than just fleeting moodiness related to everyday stress or discomfort. 

A partner or caregiver may notice that the person occasionally becomes withdrawn, anxious, angry, sad, restless, or irritable. Their eating and sleeping patterns may change too. These symptoms may come and go, but they are unlikely to go away completely.

Other neuropsychiatric symptoms that a person may experience right alongside dementia-related mood swings include paranoia, wandering, sleep difficulties, and hallucinations or delusions

Can mood swings be a sign of dementia?

In older adults, the sudden appearance of frequent mood swings is worth mentioning to a care provider: It could be an early sign of dementia. 

“My rule of thumb is: When there’s a sudden behavior change, take a broad look at your loved one,” Dr. Bruce Miller, a behavioral neurologist at the University of California, San Francisco, told Being Patient of sudden mood or behavior changes. “Make sure they don’t have an infection. Make sure that nothing’s changed in the brain.” 

Other signs to look for include those aforementioned mood changes, i.e. depression, anxiety, apathy, restlessness, agitation, aggression. These changes do typically occur alongside cognitive decline spurred by Alzheimer’s disease or a related form of dementia.

Non-prescription treatments are usually the first-line option for managing dementia mood swings. These interventions aim to prevent mood swings, improve mood, and reduce caregiver stress and may be more effective than medications.

At what stage of dementia do mood swings happen?

Mood swings can happen in different stages of dementia. But people may start to show symptoms like depression, anxiety, disinhibition, and apathy in the early dementia stage. 

What causes mood swings in dementia?

Dementia happens due to changes in the brain that causes a progressive decline in brain function. This decline in brain function is accompanied by symptoms that include mood swings even in the early dementia stages. 

“It is very common to see a patient with early Alzheimer’s disease, sometimes even before they’ve manifested a memory disorder, to be anxious, hyper-reactive, and very concerned about things that are going on around them,” Miller said. 

“As a loved one loses their cognitive functions, we often hear about severe anxiety and agitation,” he added.

Mood swings may also happen when the person with dementia experiences health-related problems like infections, trouble sleeping, medication side effects, pain, constipation, or general discomfort with their environment. This is why experts recommend speaking with a doctor, who can then best determine why a person may be experiencing these changes. 

What helps with dementia mood swings?

Though mood swings start at the early stages of dementia, they’re often left unaddressed. Doctors also find them challenging to treat, in part because of a lack of safe and approved medications available for people with Alzheimer’s disease. However, untreated mood swings can spiral into further health problems; some of these behavioral changes are tied to diminished quality of life, early institutionalization, and higher care burden among other issues. 

Non-prescription treatments are usually the first-line option for managing dementia mood swings. These interventions aim to prevent mood swings, improve mood, and reduce caregiver stress and may be more effective than medications.

Non-prescription interventions for dementia’s mood changes may involve:

  1. Sensory stimulation therapy like acupressure, aromatherapy, touch therapy, light therapy, garden activities, massage, music therapy, and dance therapy.
  2. Cognitive and emotion-oriented approaches including cognitive behavioral therapy, mental stimulation, reminiscence therapy, and validation therapy.
  3. Behavior management strategies like the DICE approach — a pneumonic device for dementia care expert-vetted steps to take to manage behavioral changes and mood swings:

    D: Describe the behavior.
    I: Investigate potential causes of the behavior, like medication side effects, poor sleep, boredom, worry, or pain.
    C: Create a plan with the help of a doctor to manage the behavior.
    E: Evaluate if the plan works and is safe.

Are there drugs to treat dementia mood swings?

Are there FDA-approved drugs to treat dementia mood swings safely? The short answer is no. 

The Food and Drug Administration, which regulates the sale of drugs in the U.S., has yet to approve any medication for managing dementia mood swings. Meanwhile, certain prescription drugs designed to help address symptoms like depression, agitation, psychosis and more haven’t been tested in people living with Alzheimer’s or dementia. In fact, they carry special risks for this group and they may not help their symptoms. But many doctors are prescribing them anyway.

Theoretically, these prescriptions — like antipsychotics and mood-stabilizing drugs — are made after determining that the help and benefit in treating these mood swings with medications outweighs the risks of said prescription drugs. However, these drugs can be dangerous.

In the case of dementia-related psychosis, Acadia Pharmaceutical was hard at work studying the potential of a Parkinson’s drug for use in people with Alzheimer’s. But due to problems with the in trial data, the FDA rejected the drug company’s application in 2021. Drug companies are also looking at repurposing ADHD drugs to help people with Alzheimer’s-related apathy and developing a new drug for Alzheimer’s-related agitation. Antidepressants and antipsychotics are also being studied to help with cognitive symptoms. But again, none of these have yet been determined safe and effective for people living with Alzheimer’s.

If a doctor prescribes you or a loved one with a dementia diagnosis an antipsychotic or mood stabilizing drug to address Alzheimer’s or dementia mood swings or related neuropsychiatric symptoms, this is called an off-label prescription: a prescription for the use of the drug outside what studies have covered. Alzheimer’s care experts recommend reading up on the risks and getting a second opinion. These drugs can carry serious and debilitating side effects, and even lead to death. This is especially true when combined with certain other drugs. 

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