When Behavior Speaks: Understanding What Your Loved One With Dementia Is Trying to Tell You

It’s 6:15 in the evening, and your mother won’t sit down. She’s pacing between the kitchen and the hallway, wringing a dish towel in her hands, and when you gently ask her to come eat dinner, she pulls away and says she needs to “get home.” You’ve had this exact conversation a hundred times. You know, logically, that she is home. But logic isn’t what’s needed here – understanding is.

For families caring for a loved one with dementia, moments like this are familiar. So is the exhaustion that comes with them. These moments can feel like defiance, a problem to manage, or a behavior to correct. There’s another way to understand what’s happening: your loved one is communicating. The behavior carries a message, and learning to read it changes everything about how the moment unfolds.

Why Behavior Becomes the Message

As dementia progresses, the parts of the brain responsible for language – finding words, forming sentences, expressing abstract feelings – are often among the first affected. According to the National Institute on Aging, difficulty communicating verbally is one of the most common and distressing changes families notice, and it tends to worsen well before other symptoms become obvious. When words become harder to access, the brain finds another channel.

That channel is often behavior. Pacing, resistance to bathing or dressing, repeated questions, restlessness in the late afternoon – researchers describe these as forms of expression. A widely cited framework in dementia care, the “unmet needs” model, proposes that many behavioral changes are the person’s best available attempt to signal something is wrong: pain, fear, boredom, overstimulation, or a need not being met. Reading the behavior as a signal, rather than a symptom to manage, is often the first step toward understanding what’s really being asked.

What the Behavior Might Actually Mean

Clinical guidance published in The BMJ on managing behavioral symptoms in dementia points to several common underlying causes behind agitation, resistance, and repetition:

Discomfort or pain that can’t be named or located – a full bladder, hunger, a tight shoe, an infection.

Fear or confusion about what’s happening, especially during transitions like bathing or getting dressed, when a person may not understand or anticipate what’s coming next.

Overstimulation from noise, clutter, or too many people talking at once, which can overwhelm a brain working harder to process the same information.

Unmet needs for connection, purpose, or routine – pacing before dinner, for instance, may reflect a lifetime of associating early evening with an activity, like coming home from work or starting a familiar task.

These are possibilities worth holding gently – a starting point for asking, “What might this be telling me?”

Reading the Signal Changes the Outcome

This shift, from reacting to the behavior to responding to the need behind it, is one of the most well-supported approaches in dementia care. The Alzheimer’s Association notes that behavioral symptoms often ease through identifying and addressing the trigger – offering a snack before someone realizes they’re hungry, simplifying a stressful moment, or building in quiet time before it’s needed.

“Dementia exists on a spectrum, and no two people experience it in exactly the same way,” said Derek Harris, MBA, BSN, RN, Vice President of Health & Wellness at Artis Senior Living. “One of the most important things we can do is meet each person where they are and be their eyes, ears, voice, cheerleader, and advocate when they need us.”

Harris added, “That’s also why I prefer the word ‘expression’ over ‘behavior.’ An expression invites us to look beyond what we see and ask what the person may be trying to communicate. When a person is having a difficult moment, our first question shouldn’t be, ‘How do we stop this?’ It should be, ‘What unmet need might be behind this, and how can we support that need in a way that is meaningful and individualized to this person?’”

Interpretation is a skill built through observation, one moment at a time, available to any caregiver willing to watch closely. Over time, many families start to notice patterns: Dad gets restless before meals when he’s overtired. Mom resists showers most when the water sounds run first. These patterns are clues, and each one makes the next moment a little easier to read.

At Artis Senior Living, we’ve walked alongside enough families to know this moment well – the pacing, the resistance, the exhaustion of not knowing what’s being asked of you. Learning to read behavior as communication can turn guesswork into partnership. And that shift, small as it sounds, changes the experience for both of you.

Sources: National Institute on Aging; Alzheimer’s Association; Kales, Gitlin & Lyketsos, “Assessment and management of behavioral and psychological symptoms of dementia,” BMJ (British Medical Journal), 2015.