According to some researchers, most often, behavioral "problems" in elderly patients with dementia are not directly caused by cognitive decline, but instead may arise as a result of many other factors, such as health, medication, and physical and social environment. Coexisting illnesses, impaired vision or hearing, mood-altering medications, understimulation or overstimulation, lack of familiarity with the environment, and lack of meaningful activities and social relationships may cause a wide variety of responses in individuals with dementia—including wandering, anxiety, paranoia, difficulty with personal care, incontinence, sleep problems, and aggression. However this "problem" behavior is often an attempt to communicate by patients who are losing language and reasoning skills. Researchers maintain that instead of prescribing dangerous neuroleptics, many nonpharmacologic strategies may be used for managing behavioral disturbances in the elderly.