The repetitive action of a person with dementia rubbing or touching their head is a common, non-verbal behavior that can be perplexing for caregivers. This action is a form of repetitive movement, often categorized as a stereotypy or general restlessness, known as a behavioral and psychological symptom of dementia (BPSD). Since the disease impairs the ability to communicate needs verbally, the individual’s body often finds another outlet to express an internal state. Understanding the complex reasons behind this specific action—whether physical, emotional, or environmental—is the first step toward providing appropriate support.
Underlying Physical Causes
The head-rubbing behavior may originate from physical discomfort that the person cannot clearly vocalize. Dementia often leads to an inability to articulate pain, making physical gestures the primary method of signaling distress. Caregivers should first consider the possibility of an undetected headache, muscle tension in the neck, or dental problems radiating discomfort to the head and jaw area.
Skin irritation or an internal sense of itching can also manifest as head rubbing. This may be due to a dry scalp, an allergic reaction, or a form of neuropathic itch—the sensation of itching without a clear rash. Certain medications can also induce movements that resemble restlessness or agitation.
One significant medication-related cause is Akathisia, a movement disorder characterized by an intense, inner sense of restlessness and a compulsion to move. This can be a side effect of some antipsychotic or neurological medications. While Akathisia typically involves the lower limbs, the overwhelming need for movement can translate into repetitive actions involving the upper body and head to relieve the profound physical unease.
Psychological and Emotional Drivers
When physical causes are ruled out, the repetitive motion often points to an internal, non-physical need, functioning as a coping mechanism. The rhythmic, predictable action of head rubbing can serve as a form of self-soothing, providing comfort and stability in a confusing and unpredictable world. This behavior is similar to how a person might fidget or rock themselves when anxious.
Feelings of anxiety, fear, or general unease are powerful emotional drivers for repetitive behaviors. As cognitive function declines, the person may constantly feel insecurity or loss, and the repetitive action helps to ground them. The brain attempts to self-regulate by creating a simple, predictable stimulus when processing complex information becomes too difficult.
Boredom or under-stimulation can also trigger the need for repetitive movement. When the person is no longer able to engage in former hobbies or follow complex routines, they may use head rubbing to occupy themselves. Conversely, sensory overload—such as too much noise, activity, or light—can cause profound distress. The repetitive action is then used to block out or ground themselves against the overwhelming sensory input.
The Role of Communication and Environmental Triggers
The repetitive behavior can be a profound form of non-verbal communication, signaling an unmet need or external discomfort when verbal skills have diminished. Since the person may struggle with aphasia—the loss of verbal communication ability—body language becomes the main way they signal internal states. The head rubbing might signal a basic need like thirst, hunger, or the need to use the restroom, which they can no longer express verbally.
External environmental factors can also directly trigger the behavior. These triggers are often sensory, such as loud noises, harsh lighting, or a room that is too hot or cold. A chaotic or cluttered environment can be overstimulating, causing confusion and anxiety, which the person may try to manage through the repetitive motion. Adjusting the environment to be calmer and more predictable is necessary to reduce this form of agitation.
Strategies for Management and Intervention
The most effective response begins with a systematic assessment to determine the root cause of the behavior. Caregivers should first check for and address potential physical causes, such as pain, skin irritation, or discomfort from clothing or environmental factors. If the behavior is new or worsening, a medical consultation is necessary to review medications for potential side effects like Akathisia.
Non-pharmacological interventions are the first-line approach for managing these behaviors. Distraction techniques, such as offering a simple, engaging task or a favorite activity, can help shift the person’s focus away from the repetitive action. Providing a comfort object, like a textured blanket or a simple fidget tool, gives the hands an alternative, purposeful activity.
Environmental adjustments are also effective, focusing on creating a peaceful and predictable setting. Reducing noise and clutter can minimize overstimulation, and maintaining a consistent daily routine offers security and stability. If the head rubbing is aggressive, causes skin damage, or if the behavior is sudden and severe, contacting a physician is necessary to rule out acute medical issues or adjust medication regimens.