Dementia profoundly affects emotional regulation, altering how individuals experience, express, and manage their emotions. Emotional regulation refers to the processes by which people influence their emotions, when they have them, and how they experience and express these emotions. In dementia, this capacity is disrupted due to changes in brain structures and networks responsible for emotion control.
At the core of emotional regulation difficulties in dementia are neurodegenerative changes, particularly in brain regions such as the prefrontal cortex (PFC), amygdala, and limbic system. The frontal-limbic circuit, which includes the PFC and amygdala, plays a critical role in managing emotions and self-esteem. Damage to this circuit, common in Alzheimer’s disease and other dementias, is linked to mood disturbances such as depression and anxiety. For example, impairment in the frontal-limbic circuit can lead to depressive symptoms, while dysfunction in the amygdala circuitry increases susceptibility to anxiety[2].
One key mechanism involves the locus coeruleus (LC), a brainstem nucleus that modulates both heart rate variability (HRV) and self-regulatory networks. HRV is an index of emotion regulation capacity, reflecting the balance between sympathetic and parasympathetic nervous system activity. In healthy adults, higher HRV is associated with better emotion regulation. However, in aging and dementia, LC integrity declines, which may impair this relationship. Reduced LC integrity can weaken the positive association between HRV and emotion regulation, leading to poorer emotional control. Early Alzheimer’s disease-related neuropsychiatric symptoms have been linked to changes in LC function and stress-related decreases in HRV[1].
The prefrontal cortex, especially its ventromedial (vmPFC) and dorsomedial (dmPFC) subregions, is crucial for cognitive control of emotions, including reappraisal strategies that help regulate emotional responses. In dementia, these areas show altered connectivity and function, which undermines the ability to modulate emotional reactions effectively. This can result in heightened emotional reactivity or inappropriate emotional responses, such as sudden anger, sadness, or anxiety, which are common behavioral symptoms in dementia patients[1][2].
Mood symptoms in dementia are not merely secondary effects but may also contribute to disease progression. Depression is more pronounced in Alzheimer’s disease, while anxiety is often more prominent in individuals with subjective cognitive decline. These mood disturbances correlate with biomarkers of neurodegeneration, such as plasma neurofilament light chain (NFL) and phosphorylated tau (p-tau 181), indicating a biological link between emotional dysregulation and dementia pathology[2].
The emotional impact of dementia extends beyond the affected individuals to their caregivers. Family caregivers often experience significant psychological distress, including emotional exhaustion, anxiety, and depression, due to the emotional and physical demands of caregiving. This caregiving burden can create a cycle of emotional strain, where the patient’s emotional dysregulation exacerbates caregiver stress, which in turn affects the quality of care and emotional environment[3]. Interventions aimed at enhancing caregiver resilience and coping strategies have shown promise in reducing caregiver burden and improving emotional outcomes for both caregivers and patients[4].
Interestingly, activities such as music engagement have been found to support emotional regulation and cognitive health in older adults, potentially delaying dementia onset. Musical activities stimulate multiple brain areas involved in memory, attention, and emotional regulation. Studies have shown that regular engagement in music, whether listening or playing an instrument, is associated with a significantly reduced risk of dementia and cognitive impairment. These activities may help maintain emotional stability and cognitive function by promoting brain plasticity and enhancing neural networks involved in emotion regulation[5].
In summary, dementia disrupts emotional regulation through neurodegenerative changes in brain circuits responsible for emotion control, particularly the frontal-limbic system and locus coeruleus. This leads to mood disturbances such as depression and anxiety, which are biologically linked to disease progression. The emotional challenges extend to caregivers, who face significant psychological burdens. Interventions that support emotional regulation, including resilience training for caregivers and engagement in music, offer promising avenues to mitigate these effects.
Sources:
[1] Brain Communications, 2023
[2] NIH PMC, 2013
[3] NIH PMC, 2003
[4] Frontiers in Psychiatry, 2025
[5] European Medical Journal Neurology, 2025
