If you spend a lot of time with an older friend or family member, you might notice a gradual or sudden shift in personality.
Maybe your life-of-the-party grandmother retreats to her room when the family visits. Or your co-worker who recalls every baseball stat since Baby Ruth couldn’t care less about the World Series.
You might wonder if those changes are just part of normal aging, whether they’re significant enough to warrant medical intervention, or whether you just need to mind your own business.
It turns out personality can play a role in the diagnosis of dementia, and caregivers should be aware of the kinds of shifts that signify the need for screening and the benefits of early intervention, and should learn how to tactfully encourage individuals to seek help.
Behavior vs. personality
In the simplest terms, behavior is what you do; personality is who you are. Personality traits typically develop before the age of five and remain consistent throughout life, but behavior can change depending on age, experience and the situation.
Because personality is often reflected by action, personality and behavior are intertwined and work in concert to define the individual’s identity.
Over the years, psychologists and psychiatrists have created a variety of personality assessments to categorize basic personality attributes. While many traits are neither good nor bad – just characteristics particular to the individual – a change can indicate a significant shift in health status.
Can a change in personality be an early sign of dementia?
After more than 30 years in health care, Sandra Petersen, DNP, APRN, senior vice president of health and wellness for Pegasus Senior Living, advocates a comprehensive approach to Alzheimer’s and dementia screening—an approach that goes beyond just reviewing personality, cognitive and functional assessments:
“I like to interview individuals and the people who interact with them,” she explained, “to see how they’ve changed and what kinds of things are going on in the environment.”
That evaluation yields information about not only the potential presence and extent of dementia but the location of the brain damage it’s causing. That’s because changes in personality correspond to the region of the brain losing neurons (brain cells) due to dementia.
For example, the frontal lobe is the center for thinking, memory, movement and behavior, including impulsivity.
“People with frontotemporal dementia are sometimes like a Ferrari with no brakes,” said Petersen. “They lose that ability to reason and judge, so they just do whatever comes in their minds.”
Petersen recalled a patient with frontal lobe dementia who decided to change his car’s oil and bought 50 filters and cans of oil. Someone else might act completely unaware of the potential for alcohol poisoning and continue drinking until they black out.
That loss of the neurons can manifest in secondary issues:
Communication difficulty and isolation
“Many people who perceive something’s wrong or have trouble communicating with other people often become very isolated,” Petersen said.
Communication issues could easily be the culprit if a person who loves to spend time with friends suddenly becomes very quiet or declines invitations.
If an upbeat, positive person becomes apathetic and morose, depression may be setting in.
Inability to filter out noises and distractions
These days, the ability to stay on task and ignore constant distractions is essential. However, a person experiencing neurocognitive decline often loses the ability to cut through the sensory overload.
“As a result,” said Petersen, “they can become overwhelmed, irritable and even angry at others.”
Loss of perception
As dementia progresses, patients’ perception of the environment and the people around them becomes more warped. Petersen likens the situation to being alone in the foreign country unable to speak language.
“It’s not the old self you see,” Petersen said. “It’s a version of that person represented by the changing neurocognitive landscape in the brain.”
Increased mood instability
Mood instability often results from the individual misperceiving words or actions and reacting by becoming very angry or trying to flee. Even in the advanced stages of the disease, “The essence of that individual is still there, but it’s colored by how they perceive the environment,” Petersen said. “Their impaired reasoning and judgment and the inability to fully perceive what’s going on affect how they respond.”
Is a personality change alone significant enough to seek help?
A friend or relative’s occasional uncharacteristic, rude or eccentric behavior isn’t usually reason to call the doctor.
However, “If you notice sudden or dramatic changes in someone’s behaviors, how they’re interacting with others or a change in personality,” Petersen cautioned, “it’s time to find out the cause.”
In fact, the Alzheimer’s Association reports increased irritability, anxiety and depression are often the reason many families decide to pursue screening.
Seeking out medical help as soon as possible can:
- Avoid a looming medical crisis – A thorough physical exam and lab work can rule out everything from a brain tumor and normal pressure hydrocephalus to thyroid disease, vitamin deficiency or urinary tract infection, which can cause delirium in severe cases.
- Halt dangerous medication interactions – Some medications or their interactions cause behavioral changes.
- Begin planning a long-term strategy – With any illness, early diagnosis gives you an advantage for long-range planning, such as organizing finances, designating power of attorney or determining how to care for the individual when safety becomes an issue.
- Get a head start on intervention – Aricept, Namenda and other medications and cognitive behavioral therapies may slow the trajectory of Alzheimer’s and dementia for some patients.
How do you tactfully suggest a screening?
The subject of personality and behavioral changes can often be difficult to broach with a friend or family member—especially one who’s becoming increasingly agitated. To avoid confrontation, Petersen suggested scheduling a doctor’s appointment and explaining it’s simply time for an annual wellness visit, a follow-up visit for a prescription refill or routine lab work.
By understanding of the role personality plays in diagnosing dementia and other diseases, you’re poised to help family and friends seek out early and appropriate intervention for the healthiest future possible.