People with dementia often have good days when they seem more like themselves and bad days when confusion or agitation takes over. These ups and downs can puzzle families, but they stem from a mix of brain changes, daily triggers, and health factors.
The brain in dementia does not work steadily. In types like dementia with Lewy bodies, alertness and attention shift quickly, sometimes hourly or daily, leading to clear spells followed by confusion.[3] This means a person might chat happily in the morning but struggle to recognize family by afternoon. Mood swings add to it, with rapid changes from calm to irritable for no obvious reason.[2][3]
Sleep plays a big role. Poor rest at night, common in dementia, leaves someone foggy and restless the next day. Vivid dreams or shouting during sleep disrupt patterns further, making bad days more likely after rough nights.[3] Daytime naps can throw off the rhythm too.
Physical health swings matter a lot. Infections like urinary tract issues, pain from arthritis, or constipation can spark bad days with extra confusion or withdrawal.[3] Hunger, dehydration, or skipped medications do the same by stressing the body and brain. Even bowel or bladder changes heighten discomfort.[3]
The world around them influences everything. A quiet routine with familiar faces often brings good days, as busy noise, new places, or too many choices overwhelm and cause anxiety or suspicion.[1][2] Changes in personality show up more on tough days, like sudden suspicion or loss of interest in hobbies.[1][2]
Caregiver actions help balance things. Gentle reassurance eases agitation, while structured days with simple tasks support better moods. Depression or lack of motivation responds to encouragement and sometimes treatment.[3] Spotting patterns, like bad days after poor sleep, lets families adjust.
Sources:
https://nowincluded.com/health-resources/recognize-healthy-aging-dementia-signs/
https://australiancarersguide.com.au/myths-of-warning-signs-of-dementia/
https://www.alzheimersresearchuk.org/dementia-information/types-of-dementia/dementia-with-lewy-bodies/symptoms/
