Behavior Management Strategies - Understanding Dementia Behaviors: Repetitive Speech or Actions (Perseveration)

Perseveration is a common symptom of dementia, but a word you may not have heard before. It refers to the tendency of a person to repeatedly perform a behavior or activity without consciously intending to do so. In other words, getting stuck in a behavior or pattern. It can affect speech, emotions, actions, and thoughts. (Source) In this article, we will look at perseveration in detail, focusing specifically on its impact on dementia patients and how to deal with these repetitive actions as a caregiver. Let’s dive in.

Identifying Perseverative Behaviors in Someone With Dementia

When caring for someone with dementia, it can be challenging to identify and address their perseverative behaviors. This is because they aren’t all obvious, and they aren’t voluntary. Instead, these behaviors are often repetitive actions or statements that they engage in without any apparent purpose. (Source)

Some common examples include:

Pacing.
Asking the same question repeatedly.
Using the same answer to multiple questions in a row even if it doesn’t make sense. (for example, if someone asked “What is your name?” and he replied, “Bob.” The person continues with, “Where do you live, Bob?” and he answers, “Bob.”
Drawing the same thing repeatedly even when asked to move on to another task.
Staying stuck on a topic the conversation has long since moved on from.
Repetitive thoughts.

To identify perseverative behaviors, you can observe your loved one’s routines and communication patterns, taking note of any behaviors that seem stuck or out of place. If you have suspicions of perseverative behaviors, discussing them with a doctor is a great place to start.

What Can Trigger Perseveration?

Perseveration, as we’ve gone over, is a cognitive condition that involves the tendency to repeat specific behaviors, responses, or thoughts excessively. Think of it like a CD or record that gets stuck on a certain spot and keeps replaying that second over and over again. It usually can’t move on without help. The same may be true for your loved one.

When learning to manage the condition, it may be helpful to recognize whether there are certain environmental triggers linked to the behavior. Some common triggers of perseveration in people with dementia include:

An overstimulating environment
Lack of engaging stimuli
Anxiety
Depression
Medication side effects
Etc.

Strategies for Helping to Prevent or Reduce Repetitive Speech and Actions

As we touched on – while these behaviors are involuntary, they are often triggered or exasperated by the environment. As such, there are strategies that can help prevent or reduce these behaviors. Here are some examples:

Maintain a consistent routine and environment as much as possible. Changes can be confusing or triggering for someone with dementia.
Offer engaging activities and opportunities for social interaction. This can also help to redirect the person’s focus and reduce their need for repetitive speech and actions.
Try to find the root cause for the repetitive action. Is it happening because of an environmental issue or discomfort? Are they over- or under-stimulated?
Speak to a medical professional. This is always an important step for concerning behaviors or symptoms. The medical professional may be able to prescribe medication to help, or check out any currently prescribed medications to see if it’s a potential source/cause of the problem.

When to Seek Professional Help for an Individual Exhibiting Perseveration

If you notice that someone is exhibiting perseveration, it is probably time to seek professional help. Any symptom or behavior changes associated with dementia patients are important to report. This is because medical professionals can help diagnose the underlying condition and provide guidance on how to manage the behavior.

How to Provide Emotional Support to a Loved One With Dementia Who Is Experiencing These Behaviors

When your loved one is struggling with dementia, it can be hard to know what to do when they begin exhibiting difficult behaviors. It’s important to listen to them and be understanding of their point of view. Redirect their attention to something else, such as a favorite book or music, to divert any frustration they may be experiencing. Finally, it’s important to manage your own emotions too. Take breaks when necessary to prevent caregiver burnout and other long-term ramifications.

Perseverative Behaviors by Stage of Dementia

In this chart, we’ll break down how these behaviors may look as dementia progresses. It is important to note that these behaviors can vary widely among individuals with dementia and may not necessarily follow a linear progression. Finally, remember that perseverative behaviors may be exacerbated by certain environmental factors, such as stress or overstimulation.

Perseverative Behaviors by Stage of Dementia
Stage of Dementia	Description of Perseverative Behaviors
Early Stage	Repeatedly asking the same questionsRepeating stories or anecdotesFixating on a particular topic or ideaEngaging in repetitive behaviors (for example, tapping, pacing)
Middle Stage	Repeating the same words or phrasesEngaging in repetitive movements (for example, hand wringing)Hoarding or collecting objectsDifficulty shifting attention or focusing on a new task
Late Stage	Repeating actions or routines (for example, constantly rearranging objects)Performing a task repeatedly without achieving the desired outcomeRepeating words or phrases without apparent understandingEngaging in self-injurious behaviors (e.g., head-banging)

Closing Thoughts

We hope that this article has provided you with a better understanding of perseveration. It’s a challenging behavioral pattern common in certain types of dementia, and if you have questions, we encourage you to reach out to your local CRC and ask away. Our team is here to help.

Behavior Management Strategies – Understanding Dementia Behaviors: Repetitive Speech or Actions (Perseveration)