"Individuals with dementia often exhibit difficult behaviours. "

Although primarily associated with cognitive decline, dementia often results in a number of difficult behaviours. They are commonly referred to as the behavioral and psychological symptoms of dementia (BPSD) (Vickland, 2012: 1112). These behaviours range from anxiety and delusions to psychological and physical aggression and hoarding (Thuné-Boyle, 2012: 1046). The immediate cause of these behaviours is not always clear to the caregiver.

Cohen-Mansfield (2001: 362) identifies three common theoretical models used to explain difficult behaviours. These models, far from being mutually exclusive, provide a more comprehensive explanation of behaviours when used in conjunction with each other (Cohen-Mansfield, 2001: 362).

• The first model posits that difficult behaviours result from unmet needs that the individual with dementia has trouble expressing (Cohen-Mansfield, 2001: 362). Individuals who feel bored, lonely or isolated may exhibit agitation or aggression in an attempt to express these feelings (Cohen-Mansfield, 2001: 362).
• The second model suggests that difficult behaviours are reinforced and become habitual as the individual with dementia associate the behaviour with increased attention from the caregiver (Cohen-Mansfield, 2001: 362). If the individual with dementia is unable to express their need for social interaction in a constructive way, they will naturally rely on negative behaviours that achieve similar ends.
• The third model emphasizes that the cognitive effects of dementia result in greater susceptibility to environmental changes and a lowered ability to cope with stress (Cohen-Mansfield, 2001: 362). Difficult behaviours can often be a reaction to and an expression of the stress experienced by the individual with dementia. The form that these expressions take can greatly increase the stress levels of the individual's caregiver.