Agitation and Dementia: Prevention, Symptoms, and Treatment 

Read on to learn about the causes, treatments, and potential prevention methods of agitation in dementia, and see how you can help support your loved one.

Agitation is a behavioral syndrome characterized by increased motor activity, restlessness, aggressiveness, and emotional distress. It’s prevalent in even the earliest stages of Alzheimer’s and other types of dementia.^[01]Agitation is a common behavioral change affecting up to 90% of people living with dementia, according to Harvard Health Publishing.^[02] Watching a loved one experience this level of distress is unsettling, but find some peace in knowing there are ways to help.

Causes of agitation in a loved one with dementia

Agitation can be caused by a medical condition, medication interactions, or any circumstance that worsens your loved one’s ability to think. Loved ones with dementia often experience feelings of intense confusion, frustration, and anxiety as they attempt to navigate an unfamiliar world. Often, they become agitated simply because they can’t articulate their frustrations or identify their cause. Therefore, people with dementia are prone to agitation, with as many as 76% of patients with Alzheimer’s disease experiencing it.^[03] Common circumstances that can lead to agitation may include the following:

• Sleep disturbances are fairly common in people with dementia, as the condition can reduce sleep duration and cause fragmented sleep patterns. These frequent awakenings can lead to agitation behaviors like restlessness, screaming, and physical aggression.^[04]
• Sensory impairment, including decline in sight and hearing. Poor vision or hearing, or a combination of the two, might make your loved one feel detached from their surroundings. Sensory detachment is scary and can cause your loved one to feel confused, frustrated, and even isolated.
• Acute medical illnesses, including infections and respiratory diseases, can affect behavior. As Alzheimer’s progresses, the patient has increasing difficulty communicating their experience to others. Your loved one’s agitated behavior could be the result of unexpressed pain or discomfort due to an underlying illness.
• Acute or chronic pain, such as arthritis, can also be difficult for a dementia patient to communicate. Unresolved pain from arthritis may cause your loved one to feel restless and agitated.
• Changes in a familiar environment, such as hospitalization or moving to a new residence or nursing home. A move can be stressful on anyone, but for a person with dementia, the relocation stress and anxiety can be even more intense. They’re now surrounded by faces they don’t recognize and hallways they’ve not navigated before. This big of a change in environment can cause your loved one to feel left or forgotten, and, as a result, angry. This anger can result in verbal and physical aggression.
• Changes in caregiver arrangements, such as introducing a new caregiver or replacing an old one. New introductions may bewilder or even scare your loved one with dementia. Maybe they’re embarrassed to display their dementia symptoms to a stranger, or they’re worried they’ll forget a new person’s name. Your loved one may react with apathy, or they may act angry. Whatever the case may be, do your best to help them feel as comfortable as possible with their new caregiver.

Symptoms

Now that you have a better idea of what could be at the root of your loved one’s agitation, start looking for specific behaviors and symptoms. Consider tracking them for frequency and intensity, and keep notes for future reference. Knowing the signs of agitation can help you pinpoint the underlying issue and eventually find a solution. Symptoms of agitation in a dementia patient may include the following:

• Fidgeting, pacing, or restlessness, including nighttime wandering, tapping fingers, and repetitive gestures. You might notice your loved one repeats tasks they’ve already completed, like washing their hands or putting on lip balm. Maybe they get up from their bed at night and wander into another room, or even outdoors. These are common symptoms of agitation in dementia that should be noted.
• Incessant talking and constant vocalization, such as repeating words, sounds, questions, or phrases. Your loved one may not remember they’ve already asked a certain question, and they may ask it again. This repetition often tries caregivers’ patience, but it’s important to remain calm and supportive for your loved one. People who ask questions repeatedly may be trying to express a specific concern, ask for help, or cope with frustration, anxiety, or insecurity.^[05]
• Verbal and physical outbursts, perhaps due to emotional distress, which can include crying, cursing, and screaming. Sadly, there often comes a time as dementia progresses when the patient can no longer recognize their loved ones. They might also experience feelings of paranoia or hallucinations. These experiences can be scary and unnerving, and they can lead to inappropriate outbursts.
• Defensive language and behaviors, such as making threats, refusing to listen, making excuses, or putting blame on others. Dementia damages parts of the brain that controls language, and these language problems can vary from day to day. The problems may also worsen when your loved one is tired or sick. For this reason, communicating with your loved one may seem difficult or impossible at times.
• Trouble sleeping, which can include excessive movement during sleep and obstructive sleep apnea. You might also notice restless leg syndrome (RLS), or your loved one demonstrating an uncontrollable urge to move their leg. This can be caused by anxiety or general discomfort.
• Sundowning, or worsening of dementia symptoms as the day ends. In a person experiencing sundowning, you may notice things like rapid mood changes, restlessness or pacing, sadness, anger, and stubbornness toward the end of the day.

Let our care assessment guide you

Agitation is a direct result of dementia, according to the Alzheimer’s Association.^[06] However, there are things a caregiver can do to help calm a dementia patient with agitation. If you’re wondering how to calm a dementia patient at home, consider implementing agitation coping techniques suggested by the National Institute on Aging.^[07]

Do: Reassure your loved one by speaking calmly and listening to their frustrations.

Don’t: Raise your voice; lash out; or ignore, minimize, or mock their emotions.

Do: Support and acknowledge your loved one’s independence as much as possible by allowing them to make some choices each day. (E.g., “Would you like milk or juice?”)

Don’t: Attempt to dominate their life or manage every detail of their personal space.

Do: Try to keep a daily routine that incorporates quiet times. Include in the routine soothing music or time to read. Dementia-friendly activities, such as crafting or taking a walk in a familiar area, are also good ideas.

Don’t: Insist on activities they overtly dislike or that cause a rise in anxiety.

Do: Display objects and pictures they love throughout the house to help them feel more secure. Beloved pets, favorite vacation spots, and cherished family photos are great options. Be cautious if you choose to display a family heirloom or item of value, as people with dementia may develop tendencies to steal, hide, and misplace things.

Don’t: Put items on display thatmay bring up bad memories or feelings of sadness, anger, frustration, or anxiety.

Do: Modify their environment by reducing noise, clutter, or the number of people around at any one time. Additionally, try to stay calm if your loved one does lash out because of something that’s made them feel scared or uncomfortable.

Don’t: Ignore their triggers or reactions to uncomfortable environmental factors.

Do: Try to limit the amount of caffeine and alcohol your loved one consumes. Promote a healthy diet with brain-supporting foods.

Don’t: Scold or reprimand them for consuming caffeine or alcohol.

Talk with a Senior Living Advisor

Maybe you’re early in your caregiving journey and have only just begun to wonder if your loved one even has dementia. Perhaps they’ve become a little more agitated lately, or they’re more forgetful. Keep a discreet eye out for early signs, especially signs of agitation. If you’re unsure, sometimes an early doctor’s visit can help lay the groundwork for success before your loved one’s dementia has progressed significantly.

Anyone who develops behavioral changes should have a thorough medical evaluation, according to the Alzheimer’s Association.^[08] Even if the actual cause of the agitation and other behavior changes is the effect of dementia, a thorough examination could potentially reveal other dementia-like conditions related to the new behavior — ones that are treatable. 

A physician can conduct general or focused medical exams — or order necessary tests — to pinpoint medical problems that may be behind the agitation. They may also offer suggestions for environmental modifications and in-the-moment tactics that have been successful with other patients. In some cases, they may prescribe medications to help reduce a senior’s agitation.

Safety issues

Sadly, safety may become a concern. If your loved one’s agitation is causing them to become significantly aggressive, you must protect yourself and others. In the moment, if you can, try to also keep your loved one from hurting themself. However, you may need to keep a safe distance from them until the aggressive behavior stops. Remember that sometimes aggression is a signal that an individual wants others to leave them alone for a while.

Taking care of yourself

To provide good care to your loved one, you, too, need to be feeling well. Don’t ignore your own needs, goals, routines, and interests. You can avoid caregiver burnout by practicing mindfulness, resolving disputes, and setting clear boundaries. When self-care isn’t enough, consider joining a caregiver support group, either online or in-person.

Ultimately, agitation may be an indicator that needs are drastically changing and a senior may soon need extra help. In-home care services and memory care communities are great options for seniors with dementia and other cognitive impairments and can provide tremendous caregiver relief. Reach out to a Senior Living Advisor today. They can offer you free, local advice tailored to your loved one’s specific, individualized needs.