Preface ....................................................................................................................... ii

Acknowledgements ....................................................................................................iii

Common Behavioral and Psychological Symptoms of Dementia (BPSD) Cases and Potential Coping Strategies .................................................................................1

Illustration Descriptions ..............................................................................................2

Case 1: Resistance to Brushing Teeth .......................................................................3

Case 2: Refusal of Care from Nonfamily Caregivers..................................................5

Case 3: Repeated Requests for Food ...................................................................... 11

Case 4: Wandering ...................................................................................................14

Case 5: Decline in Self-Care Abilities .......................................................................17

Case 6: Delirium (Acute Brain Dysfunction) .............................................................19

Case 7: Hallucinations and Delusions ......................................................................22

Case 8: Inability to Tell Time and Date (1) ...............................................................25

Case 9: Inability to Tell Time and Date (2) ...............................................................26

Case 10: Irregular Daily Routines.............................................................................28

Case 11: Unusual Nighttime Behaviors ....................................................................29

Case 12: Repetitive Questioning ..............................................................................30

Case 13: Repeated Purchases.................................................................................31

Case 14: Loss of Interest..........................................................................................33

Case 15: Hoarding....................................................................................................36

Case 16: Refusal to Shower .....................................................................................39

Case 17: Suspicions of Theft (1) ..............................................................................41

Case 18: Suspicions of Theft (2) ..............................................................................42

Case 19: Forgetting Passwords and Insisting on Managing Personal Finances .....44

Case 20: Spitting Saliva ...........................................................................................47

Case 21: Smearing Feces ........................................................................................49

Case 22: Inability to Fasten Buttons .........................................................................51

Case 23: Complaints and Verbal Abuse ...................................................................53

Case 24: Easily Distracted .......................................................................................56

Case 25: Sundown Syndrome ..................................................................................58

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　　Since May 2022, in collaboration with the National Health Research Institutes (NHRI), we have conducted a series of training sessions on Program for Coping with Behavioral and Psychological Symptoms of Dementia (PCBPSD) across northern, central, and southern Taiwan. Through these courses, we met numerous family caregivers facing immense challenges due to behavioral symptoms exhibited by their loved ones with dementia. From the experiences and accounts shared by both family members, long-term care and healthcare professionals, we gained a deeper understanding of the wide range of behavioral issues that can emerge in home settings.



　　These encounters led us to consider whether behavioral symptoms might be better interpreted by exploring the individual’s personality, lifestyle habits, living environment, and the specific circumstances under which these symptoms occur—perhaps as attempts by the person with dementia to communicate unspoken needs or feelings. Over the past two years, we have collected many such behavioral cases. Drawing from the insights shared by family members and professional instructors during training sessions, we compiled 25 common case scenarios. Using accessible language and vivid illustrations, this handbook seeks to introduce readers to BPSD and possible coping strategies in a practical and engaging way.



　　Our training program has been well-received by both family members and professionals in the long-term care and healthcare sectors. One family caregiver shared, “I’ve gradually started applying the techniques I learned in everyday life. What I used to find frustrating now makes more sense, and I better understand my family member’s behavior. I no longer get stuck in a cycle of frustration, and this change has improved life for both me and my loved one.” (TV01, daughter caregiver, age 50). A care worker also noted, “I’ve learned a lot. It has helped me adopt a more positive and correct attitude toward caregiving.” (TV05, care attendant, age 64).



　　Inspired by this feedback, the Dementia Without Losing Spirit handbook was created in hopes of offering practical guidance on managing behavioral symptoms of dementia to family caregivers, professional care providers, and the general public alike.



　　I would like to express my sincere gratitude to every (family) caregiver who participated in our training courses. Without your strong motivation to learn and your commitment to improving the quality of life for both caregivers and care recipients, we would not have had access to such a rich collection of real-life cases and firsthand insights from the care setting. Finally, my heartfelt thanks go to the leadership of the NHRI for their continued support and dedication to dementia care.