I have not been able to find an answer to this question. Can someone with dementia who is angry and delusion at the beginning of the disease become gentle and compliant later as the disease progresses? I hear stories about how a gentle person can become angry and violent but I haven't heard of any longitudinal study of the opposite.
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People who "always had to be the one in-charge" tend to get more angry and frustrated in the mild stages as they feel they are loosing control. This can continue through the moderate stage but eventually tends to burn out as they understand less of what is going on.
What the caregivers do with the patient makes a big difference as well. If the caregiver uses good communication techniques and adapts the environment in a way to help the person have a sense of control they often calm down. Delusions are often a passing phase that may stick around for 3-6 months but are rarely static. They change with the disease and situation.
Sometimes you get a person who has always been a difficult person but as the disease progresses they get nicer. A good example of this is the mom in the movie "Confessions of a Dutiful Daughter". The mom had never accepted that the daughter was gay. As her disease progressed she became more accepting and came to adore her daughter's partner.
In the advanced stages of the disease most patients tend to withdrawal and become more quiet. It may be harder for them to follow instructions as they have more difficulty with comprehension. In general they are less likely to act out. Because of this you tend to see a peak of caregiver stress from difficult behaviors in the moderate stage.
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The book, "The 36 Hour Day", is a wonderful resource for caregivers of patients with dementia. In my own experience keeping days on a routine....predictable, being in their surroundings, and not changing routines....all of these things will go a long way. Frustration occurs more frequently when they feel stressed, or forget how to do everyday activities. Reminding them that it is no big deal and telling them how you forget things too also helps.
If you are the primary caregiver, have a backup person and take breaks...you will need it! Prayers for you.
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