What to Do When Dementia Patients Lose Inhibitions

Carol Rippy of Van Nuys, California, first started noticing her neighbor Ruthie behaving oddly when on afternoon walks with a few other neighborhood women, Ruthie would lag behind and plaintively repeat, “I’m so hungry, I’m so hungry.” 

Concerned, Rippy and the others checked Ruthie’s refrigerator and cupboards, and found they were well stocked. Soon it was clear that Ruthie, who was in her late 70s and lived alone, was suffering from some form of dementia.

The turning point came when, one day, Ruthie abruptly lifted her blouse up over her head while standing on the sidewalk in front of her house —  wearing nothing underneath. “It was shocking and we said, ‘No, Ruthie, don’t do that,’ but we didn’t want to embarrass her,” said Rippy. She and other women quickly pulled Ruthie’s blouse down and notified her adult son, who arranged to move her into assisted living.

Embarrassing behavior such as Ruthie’s is called disinhibition, and it’s one of the most distressing changes that can occur in people with different types dementia, including frontotemporal lobe disease (FTD) and Alzheimer’s, according to a 2024 study published in the journal Brain Communications. Disinhibition can include inappropriately flirting with strangers, eating without stopping, and using coarse language or even racial slurs, leaving caregivers feeling flustered and embarrassed and unsure what to do. 

Some families react by isolating, keeping their loved one with dementia away from the public, said Kristen Romea, LCSW, director of supportive services at Alzheimer’s San Diego, a group that provides care coaches to caretakers and families of Alzheimer’s patients.  

But there are strategies to help families and caregivers deal with these situations, Romea said. And understanding what’s causing this behavior can help, too.  

“Anatomically, frontotemporal lobe disease compromises the frontal and temporal lobes of the brain, structures related to behavior and language,” explained Nahuel Magrath Guimet, M.D., a psychiatrist and Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute at University of California, San Francisco. 

Disinhibition behavior develops slowly over months, and usually occurs along with changes in the patient’s personality, according to Guimet, who is also a neuropsychiatrist at the Department of Cognitive Neurology, Neuropsychology and Neuropsychiatry, Fleni Memory Center in Buenos Aires. 

Unfortunately disinhibition never gets better, only worse for dementia patients. “But in many cases it is mitigated or ‘slowed down’ by the presence of another key symptom of the disease, apathy, which is almost invariably seen in all patients as the disease progresses,” said Guimet. 

Strategies for caregivers

When a person with dementia first shows signs of disinhibition behavior, the first step is to have them checked by their neurologist to see if adjustments need to be made in their medication, said Romea. Urinary tract infections can also cause cognitive problems such as confusion, she added, so patients should be checked for this by their doctors.

Romea also suggested the following strategies to prevent or deal with inappropriate behavior in a person with dementia:

• Carry a “companion card,” printed with information that says something along the lines of: “I’m caring for a person who has dementia and who may behave in ways that are unusual. Please be patient with them.” These can be downloaded and printed from samples provided on the Alzheimer’s Association website.

• Carry medical documents with  the dementia diagnosis. In the event that a dementia patient does something illegal, such as stealing, these papers can be shown to law enforcement if they become involved.

• When a dementia patient behaves inappropriately, validate their feelings before trying to coax them into a different direction. “Sometimes there is something that is bothering them that they can’t verbalize with you,” said Romea. “More important than challenging them on what’s happening is making them feel that you’re on their side.” 

• Prevent potential disrobing behavior by making sure the patient starts the day dressed in light clothing and has a cold beverage on hand, particularly during hot weather. “Sometimes they are just feeling too hot. Disrobing is more common in summer than winter,” said Romea.  

• In the home, caregivers should identify exit routes so they can remove themselves quickly if a patient becomes threatening or aggressive. Keeping a cell phone in a pocket enables a caregiver to call for help, if necessary.

It’s also important for caregivers to have a place to talk about these incidents, and a caregiver support group can help, said Romea. 

“It can be really tough to talk about these subjects,” she said. “A support group is the best source for emotional support and provides a space where caregivers can share openly about their situations.”  

Above all, Guimet emphasizes that families and caregivers must work with qualified professionals such as psychiatrists, geriatricians, or behavioral neurologists to get the best help possible for patients with dementia.

Nicole Gregory is a health writer who has contributed to many national publications and websites such as Forbes Health, UCLA Health, the Orange County Register among others.