Your loved one is at the dinner table. The person next to them sets down their fork, and your loved one picks it up and starts eating with it.
Or they see pills on the counter and take them. Whether or not those pills are theirs. Whether or not they’ve already taken their medication for the day.
Careblazer, this is a symptom that can happen in dementia but rarely gets talked about. It can make everyday household objects dangerous, and it can lead to some pretty embarrassing situations in public. It’s called utilization behavior.
What Is Utilization Behavior in Dementia?
Utilization behavior is the compulsive, automatic use of objects that are within reach, regardless of the situation or context. You might also hear it called magnetic apraxia or compulsive utilization behavior. A related sign, imitation behavior, is usually described separately: that’s when someone copies another person’s gestures.
Basically, the person loses their ability to hold back a behavior when an object is in front of them.
How Most of Us Hold Back
Right now, most of us inhibit our behavior all day long. We control what we do and what comes out of our mouth.
Say a really good looking person walks past you. You don’t put your arms around them and hug them. You let them walk by.
Or you’re at a restaurant and a waiter walks by with a delicious looking plate of food, headed to another table. Even if it smells and looks delicious and you’d love a taste, you don’t put your hand on that plate and eat it. You know that’s not appropriate for the situation.
Or you’re at a formal function and your boss says something you don’t like. You can stop yourself from saying out loud what you’re thinking in your head.
That’s inhibition. We can control our urges.
What Happens in the Brain
In utilization behavior, there is damage to the frontal lobes of the brain. The person loses their ability to inhibit their behavior, so they do and say things in certain situations that they just can’t control.
It’s called utilization behavior because they’re utilizing whatever is in front of them, whatever is in their sight. It’s almost like a magnet drawing them in to do something with it. That’s why you sometimes hear it called magnetic apraxia. They see the object, they’re pulled to it, and they pick it up and begin to use it.
If you want to see where the frontal lobes sit and what each part of the brain does, I walk through it in what are the lobes of the brain (dementia edition).
How Utilization Behavior Shows Up
It can look two ways.
Using the Object the Wrong Way
They might use the object totally wrong. Say they’re sitting down to dinner. They pick up a fork and start running it through their hair.
That’s obviously not what a fork is for. But the fork was in their line of sight, so they picked it up and started using it.
Using the Object Right, at the Wrong Time
Or they know exactly what the object is for, and they use it correctly. It’s just not the right situation.
Back at the dinner table, the person next to them sets down their fork. It’s in their line of sight, so they pick up that other person’s fork and start eating with it.
Why It Can Be Embarrassing and Dangerous
You can imagine how hard this is for family members trying to explain or help, especially out in public, where strangers don’t know your loved one has this condition, or even that they have dementia.
It can also be quite dangerous. Say your loved one is walking through a hardware store, and there’s heavy machinery, or a saw, or a hammer. They can just pick it up and start using it.
Something more common is medication. They see pills on the counter, and they take them. Whether or not they’re theirs, whether or not they’ve already taken their pills for the day. They see it, they take it.
What to Do If You Think Your Loved One Has Utilization Behavior
It goes without saying: keep your loved one’s healthcare provider up to date and informed about any symptoms you’re noticing. Beyond that, there are two things we can do.
1. Change the Environment
The very first thing is environmental control. We modify the environment and do what we can to remove or secure anything potentially dangerous: hazardous materials, medications, sharp objects, anything we think could pose a danger to them.
The goal is to minimize their exposure to it.
2. Supervise and Keep Monitoring
The second thing, which of course is super difficult, is supervision and ongoing monitoring.
If your loved one has this condition, it’s probably quite dangerous for them to be alone in a room for any length of time, especially if there are dangerous things around. That’s especially true in kitchens, workshops and garages.
Why It Helps to Know This Has a Name
The frontal lobes and executive functioning are where a lot of the really challenging, strange, confusing, difficult behaviors come from, utilization behavior included. I go through that part of the brain in understanding executive functioning in dementia.
Learning all of this is a great first step. But knowing how to work through the emotions of responding to these behaviors is an entirely different thing. Inside the Care Collective, that’s what we do together every week, in support rooms and live Q&As with experts like me, elder law attorneys and board-certified neuropsychologists. You can learn more here.
Sources & References
Pandey S, Sarma N. Utilization behavior. Annals of Indian Academy of Neurology, 2015
