Fatigue in Dementialand (aka Why the Dementia Brain Is So Tired)

dementia fatigue

Some Alzheimer’s and dementia symptoms can be tough to understand. One of these is fatigue. People with dementia may tire very easily, refuse to do even low-key activities, or sleep a lot more than they used to. Dr. Elaine Eshbaugh explains why this happens in a Q&A with one of her readers. Her relatable examples make it easy to understand why your older adult gets tired so easily.



My husband is very fatigued, and sleeps way more than he used to. There are no medication changes, and he is on the same medications he has been for years (low dose ramipril, Lipitor, and hydrochlorothiazide).

If we go for a very short walk, he is “exhausted” and will complain of his leg muscles being sore. All labs are within a normal range. Does anyone know the cause of increased fatigue associated with dementia?

— Carole



Dr. Eshbaugh’s answer

Dear Carole,

Because I have to do my due diligence, I’ll go through some things that can cause fatigue in someone with dementia – medications (and he might react to some medications differently as he progresses), sleep issues (it’s likely he’s not sleeping as well as he used to), poor nutrition (people with dementia sometimes crave less healthy food like sugary treats), and depression (which is not surprisingly common among those with dementia). Kudos to you for making sure those labs are in the normal range.

But you know what? Even if none of the above factors are in play, dementia makes people tired. In short, it is exhausting to have dementia.

We often look at people with dementia, and it seems like they’re not trying. Let me assure you they are actually working really hard to do things that us folks without dementia do quite effortlessly.

I’m going to give you an analogy here, and it’s a really awful one. I played several sports in high school. I looked pretty athletic. However, I was – and still am – a very slow sprinter. When we ran sprints in sports, I always got in trouble for not hustling. My coaches thought I wasn’t trying when I was running my heart out. I was just really slow. I’d look at my teammates, who were effortlessly running 100 yards in the time it took me to run 60. And it was frustrating as heck. I remember telling a basketball coach in high school, “I know I look fit and it seems like I should be able to run fast, but I’m trying my best and I’m just super slow.”

No, high school basketball and dementia are not the same. Yet we can all think of a time when we were putting a lot of effort into something that was difficult for us (but easy for others) and another person accused us of not trying. It’s maddening.

You probably see where I’m going here. People with dementia are often perceived as not trying when in fact they are working extremely hard. The dementia brain must work constantly to make sense of the world. It is struggling to interpret one’s environment in the way that the non-dementia brain might struggle to understand a calculus problem when one never took a calculus class.

And, Carole, when you mention a walk, I think of all the changing sights, smells, and sounds your husband’s brain must constantly interpret. An effortless chat (on your part) is probably quite challenging for him as he must filter all the stimuli he encounters to focus on your voice and interpret what you say. And that’s tiring.

I have a friend with dementia who told me she’d meet with friends that would say something like, “You don’t seem like you have dementia. You just seem normal.”

What they didn’t realize, she conveyed to me, was how hard her brain was working to carry on a “normal” conversation while they were together–and how tired she would be after their visit. The longer the visit lasted, the less likely she was able to be “normal.” Her brain just got too tired.

(Notice I put “normal” in quotes. I don’t like when we allude to people without dementia as normal and those with dementia as not normal. We’re all weird, anyway. It’s what I like about people.)

Mental energy is a precious resource for all of us, especially those with dementia, and mental energy isn’t independent of physical energy. Think about….When you are mentally exhausted from a long and stressful day at work, it’s hard to get yourself to the gym for a workout.

People with dementia often have high levels of anxiety. Here is the tricky thing about anxiety – being keyed up all the time makes you tired but makes it hard to sleep well. Then you end up exhausted but jittery and tense, which is an uncomfortable feeling that leads to more fatigue and more anxiety.

Sometimes my brain gets tired. Maybe I’ve been grading too long. Maybe I’ve been working on a tedious report for the university. Perhaps I’m looking at data for a research study. My brain, just like every brain, needs a break sometimes. And I can give it a break. In fact, I have to give my brain a break at some point or my productivity suffers.

It’s harder to give the dementia brain a break. I can stop doing something that is mentally strenuous and do something that is mindless. Unfortunately, for someone with dementia, it becomes harder to find something mindless. Even doing something seemingly simple (like watching TV, having a conversation, listening to the birds), isn’t a break for the advanced dementia brain. The person may feel an urge to sleep in an effort to protect their brain from being overwhelmed.

Carole, I hope that’s somewhat helpful. If you ask someone else, they might conceptualize the association between dementia and fatigue differently. My answer, really, is pretty simple.

Your husband is tired because having dementia is tiring.

— Elaine


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Guest contributor: Dr. Elaine Eshbaugh is the author of Welcome to Dementialand. She holds the Davis Professorship of Gerontology and chairs the Division of Family Services and Gerontology at the University of Northern Iowa. She’s on the executive board of the Northeast Iowa Agency on Aging and has collaborated with continuing care communities, adult day services, and hospices. Dr. Eshbaugh is also active in community outreach and does education on dementia for communities, families, and facilities. She often meets with families to provide support after a dementia diagnosis.


Image: Precedence Home Healthcare


This article wasn’t sponsored and doesn’t contain affiliate links. For more information, see How We Make Money.


  • Reply May 24, 2018

    Stacey E.

    I have to say that getting worked up about the title of this is a waste of time. The only real way to handle dealing with this disease is to be able to have a sense of humor about it. Everyone commenting has to deal with this situation. Being uptight and upset about something as trivial as the title of this article doesn’t help anyone. I’m glad to know that my father’s sudden constant sleeping is to be expected. I thought that maybe something was going wrong.
    My main message is to people “from the outside” that are coming in to help would likely do the patient and their families a favor by not painting a constant gloom and doom picture. I’ve been told by multitudes of people that he’s got about 6 months to live, or “things are getting worse”. That sort of thing. It doesn’t help, and it’s actually rather cruel. I don’t think anyone should be living in a fantasy land of rainbows, but telling people that sort of thing could get someone to give up completely. Make what time they have left a little more pleasant by not inflicting negativity into the situation. I’ve had people from the council on aging and hospice deliver those sorts of messages. It’s unwanted and unnecessary. They don’t want the reputation for just wanting people to die, yet I get the impression their ultimate goal is to send him to a home where he’ll be unhappy and rot away to nothing. This is not someone they care about. It doesn’t matter to them if he lives or dies. It matters to me.

    • Reply May 24, 2018


      That’s a wonderful perspective! And it’s fantastic that you’re focusing on the positive whenever possible. I’m so glad it’s helpful to know that the added sleeping could be caused by fatigue. Although, that’s assuming that he otherwise seems well. If there are other troubling symptoms like loss of appetite, pain, etc. it might be good to check with the doctor to make sure he doesn’t have an infection or another treatable condition. Sometimes a urinary tract infection (UTI) can cause a sudden change in behavior, so it may be helpful to rule that out.

  • Reply May 10, 2018


    Thank you for this article. It describes my experience of fatigue exactly. I have tried to explain this to friends who repeatedly tell me that I don’t appear to have dementia, although it is now over 3 years since I was diagnosed. As your article explains….it is hard work trying to maintain the ability to do what should be part of everyday living. (As Sarah earlier commented, “Dementialand” has the feel of making light of the situation, but the information itself was good, thank you)

    • Reply May 11, 2018


      I’m so glad this is helpful! I hope this article can also help your friends better understand your experience. It’s extra challenging to have an “”invisible illness”” that people don’t know enough about. Sending hugs and positive wishes that you’re supported in getting enough rest for your body and mind 💜

      I’m so sorry the term Dementia bothers you 😢 I know that the author means no disrespect at all. She works extensively with people who have dementia and their families to provide help and support. My impression is that she’s trying to help people understand that the reality of someone with dementia can be very different than for those without it.

  • Reply February 5, 2018

    Tape Lady

    Thank you VERY much for this article! You wrote it so that it was easy to understand for those of us who have never dealt with a dementia patient before. Thank you!

    • Reply February 5, 2018


      You’re very welcome! We’re so glad it’s helpful!

  • Reply October 29, 2017

    Sarah Ashton

    I am sorry but I continue not to understand how a doctor (of all people) does not get that the expression “Dementialand” is a total insult to the likes of myself who are facing and dealing with the symptoms of progressive cognitive decline (the symptoms of dementia) on a daily 24/7 basis.

    Dealing with ‘this illness is not like a day out in Disneyland, it is more like a life time confinement in hell that we are never ever allowed out of’. It is utterly condescending and demeaning to all patients (as well as the families who love and care for them) experiencing the symptoms of this catastrophic and devastating condition. Please stop using it and to the sites thinking of publishing these articles, if the writers refuse to cease using this utterly denigrating term, please stop calling upon the services of the contributor.

    • Reply October 29, 2017


      I’m very sorry 😢 I can’t know how hard it is to live with dementia, but I’m sure it’s an incredibly tough challenge on so many levels 💔 I know Dr. Eshbaugh means no offense by it and is not trivializing dementia. She works tirelessly in her community with people who have dementia and their caregivers. I think she’s trying to help people without dementia understand that it’s a disease with far more complex symptoms than just memory loss, which is often the public’s assumption. As you well know, having dementia means that everything in your life is affected, your entire world. When people have no idea what that’s like or how it translates to everyday life, it’s difficult for them to understand and interact kindly and appropriately with people who have dementia. Without that deeper understanding, it can also be tough for caregivers to understand common symptoms and find ways to help the person they’re caring for without accidentally causing additional stress. The entire world needs more information, awareness, and education about dementia so everyone can be more supportive of people who have dementia and their families. I think that’s the goal of Dr. Eshbaugh’s writing — to bring more support to the dementia community by making the disease easier to understand for those who haven’t been affected by it.

  • Reply August 7, 2017

    Tyler Jensen

    Great article. My father has an dementia and during this one disease he has developed another unfortunately, which is incontinence. I’m really sad for him, I know that he is quite old already, but still this is not something that should be happening to anyone and also everything is on my plate now and my wife’s as my mother has passed away recently unfortunately. I have ordered him something to help him get past his IT problem, but I think it’s time to ask for professional help as both me and my wife have jobs so it’s getting very hard to help him all the time.
    I’m sorry for such an long post, but as I feel pretty good for writing I just wanted to express my feelings somewhere.

    • Reply August 8, 2017


      I’m so glad the article is helpful! I’m so sorry about your father. Incontinence is unfortunately a common symptom as dementia advances. I’m very sorry for the loss of your mother 🙁 It sounds like a good idea to hire some help to give you and your wife some relief.

  • Reply July 29, 2017


    Hi Daily Caring. Thank you for this informative article. It is a wonderful reminder to stop, shut up, and listen. And observe. And wait. And all of that is hard to do too.

    After thirteen years caring for my Alzheimer’s inflicted wife, I did learn something about patience. You cannot hurry the Alzheimer’s inflicted.

    I will share this article.

    • Reply July 29, 2017


      That’s so true! It takes time to learn the patience that’s needed for someone with Alzheimer’s or dementia. I’m so glad this article is helpful! Thank you for sharing 💜

    • Reply August 1, 2017

      Debra Wilson

      Can you explain how schizoaffective disorder have some of the same symtems as dementia and Alzheimer. Also resperidal and olanzapine med for these symtems?

      • Reply August 5, 2017


        Hi Debra — We’re not doctors, but there’s some helpful information about schizoaffective disorder at Mayo Clinic (http://www.mayoclinic.org/diseases-conditions/schizoaffective-disorder/home/ovc-20258872). Basically, it says that schizoaffective disorder is a mental disorder in which a person experiences a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania. This is different from Alzheimer’s and dementia, where nerve cells and the connections between them are dying. In terms of any medications for schizoaffective disorder, it’s essential to consult with a qualified doctor.

  • Reply July 26, 2017


    First, I want to say it is somewhat spooky the types of email I receive from this site….every one is just what I needed as I experience dealing with my senior mom. This one on tiring dementia is really helpful….I had been very worried and distracted about why she wanted to sleep ALL the time. The article has helped me to better understand and will help me manage our activities going forward. It just makes such a difference when you better understand why. Keep them coming…..😊and a HUGE THANK YOU!!!!!

    • Reply July 26, 2017


      Thank you for the kind feedback, Vicky!! We’re so happy to hear that our articles have been helpful and relevant to the things you’ve been thinking about 🙂 Understanding what could be causing certain behaviors is definitely helpful in managing them and relieving worry. Big hugs ❤

  • Reply July 24, 2017

    Donohue, Michaela

    That is a beautiful answer to a complex question. Thank you so much. It is helpful to me, the caregiver.

    • Reply July 24, 2017


      I’m so glad this article is helpful! Dr. Eshbaugh’s explanation is so insightful.

  • Reply July 24, 2017


    Thank you so much for explaining this. It makes so much more sense to me now. I am trying hard to read all I can to make dementia’s intrusion into our lives as easy as possible for my husband. He is in the early stages, but I hope the more prepared I can be, the easier it will be to give him what he needs.

    • Reply July 24, 2017


      I’m so glad this article is helpful! Dementia symptoms are often tough to understand because they’re not intuitive to us. We love Dr. Eshbaugh’s straightforward explanation and examples!

      In case it could help make life easier for you and your husband, we have an extensive section of information about Alzheimer’s and dementia — http://dailycaring.com/category/health-conditions/alzheimers-dementia/

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