Loss of cognitive function affects the way people with dementia see the world and the way they behave in response to what they experience. Understanding different impairments can help us understand why problems arise. This is especially the case when the person needs care in strange and threatening environments such as a hospital. The person with dementia may not understand or remember instructions, may be unable to communicate their needs including wanting the toilet, thirst or being in pain and may not recognise food or toilets. Planning and foresight may be impaired leading to unsafe behaviours. In some, fear and disinhibition may result in shouting or aggression. Others may be apathetic and withdrawn. But not everything is due to the dementia itself, how we relate and behave towards people with dementia also has an effect.
We make decisions all the time, some big, some small. A diagnosis of dementia does not mean the person does not have capacity to make any of their own decisions. It depends on understanding and the ability to use relevant information. Even if they lack capacity, people with dementia should be involved in decisions as much as possible.