The appearance of noises like moaning, constant calling out, or repetitive sounds from a person living with dementia can be unsettling for caregivers. These vocalizations are a common and challenging symptom, particularly in the moderate to late stages when verbal communication abilities decline significantly. The sounds, which can range from single words to screaming, are generally not intentional attempts to cause distress. Instead, they are a manifestation of an underlying need or neurological change. Understanding the root causes of these behaviors is the first step toward effective intervention.
Inability to Express Needs Verbally
The primary reason for vocalizations lies in the progressive neurological damage that affects language centers in the brain, a condition known as aphasia. Dementia gradually impairs the brain’s ability to decode information (receptive language) and express thoughts (expressive language).
This loss of complex communication prevents the person from asking for what they need, leading to frustration and isolation. When the ability to form coherent sentences diminishes, the person resorts to non-verbal sounds as a substitute for speech. These vocalizations become a raw form of communication, often conveying distress, confusion, or a desire for attention, even if the message is garbled. A repeated word or phrase may be an attempt to anchor themselves in a confusing reality or express a persistent, unmet desire.
Physical Discomfort and Unmet Needs
Vocalizations frequently act as the remaining signal for physical distress when verbal language capacity is gone. Caregivers should consider all physical discomforts as potential causes, as the person cannot articulate symptoms like pain. Acute or chronic pain from conditions such as arthritis, headaches, or dental problems can manifest as moaning, groaning, or increased agitation.
Unmet physiological needs are another significant trigger, including hunger, thirst, or the need for toileting due to bladder or bowel discomfort. Medication side effects, infections like a urinary tract infection, or an exacerbation of a pre-existing chronic condition can also lead to a sudden increase in vocalizations. These sounds serve as a distress signal, indicating an unaddressed physical need.
Environmental and Emotional Triggers
External factors in the environment can overwhelm a compromised brain, leading to vocalizations. Overstimulation is a common trigger, where excessive noise from a television, loud conversations, or a busy room can cause confusion and anxiety. Conversely, under-stimulation, such as boredom or a lack of meaningful activity, can also provoke repetitive calling out as the person seeks interaction.
Emotional distress is a powerful internal trigger, as dementia impairs the ability to process and regulate feelings. Anxiety, fear, frustration from failed tasks, or a general sense of insecurity can lead to verbal outbursts. The phenomenon of “sundowning,” where confusion and agitation increase in the late afternoon and evening, often involves heightened vocalizations due to confusion and changes in routine. The emotional state of caregivers, such as visible stress, can also be sensed by the person with dementia, contributing to their distress.
Identifying and Responding to Vocalizations
The most effective response to vocalizations is a systematic investigation to pinpoint the specific underlying cause. Caregivers should use a non-pharmacological, person-centered approach first, treating the vocalization as a valid attempt to communicate. The initial step involves a thorough check for physical discomfort, reviewing the medication list for new additions, and assessing for signs of infection or pain, such as wincing or guarding a body part.
Once physical causes are addressed, the focus shifts to emotional and environmental factors. If the person seems anxious, redirection—gently shifting their attention to a pleasant activity—can interrupt the repetitive behavior. Reducing ambient noise, simplifying the environment, and maintaining a consistent daily routine prevents overstimulation and confusion from escalating into verbal distress. Validating the person’s emotion, even if the words are nonsensical, by using a calm tone and gentle touch can reassure them and mitigate fear.
It is helpful to document the timing, type of vocalization, and the context to identify patterns and triggers. This documentation helps determine if the noise occurs during transitions, mealtimes, or when a specific caregiver is present, guiding future adjustments. Consulting a medical professional is important to rule out acute medical issues or discuss potential adjustments to existing medications. Non-pharmacological strategies like music therapy, gentle exercise, or reminiscence activities can provide sensory input and engagement, reducing the need to vocalize out of boredom or loneliness.