How to Manage Agitation Related to Dementia

If you’re caring for a loved one who has Alzheimer’s or another form of dementia, and that person has reached a more advanced stage of the disease, you may by now be uncomfortably familiar with dementia-related agitation. 

Marked by aggressive behaviors (like kicking or yelling) as well as nonaggressive ones (like aimless pacing or repetitive questions), agitation can not only worry caregivers; it can sometimes frustrate them too.

And that’s okay. Caregiving for any loved one — including those with cognitive or memory declines — can take a toll on your own physical and mental well-being. It’s hard, long work. That’s why clinicians recommend that caregivers understand more about this kind of agitation so that they can mitigate triggers as much as they can. 

When Does Agitation Occur?

The Alzheimer’s Association breaks down three stages of Alzheimer’s disease: early, middle and late. 

People can progress through those stages at different paces, but in general, the middle stage can last the longest — years, even. This period is when people may start to need help for daily activities, and also when caregivers may start to recognize agitation.

What Does Agitation Look Like?

Agitation is never a standalone symptom, says Jasdeep S. Hundal, Psy.D. ABPP-CN., Director of Medical Psychology and Neuropsychology at Jersey Shore University Medical Center. 

“What’s considered ‘agitation’ is really a complex set of behaviors that overlap with being anxious and fearful,” he said. “And these actions can span a range of different things — sometimes rapidly turning on or off in a volatile fashion.”

• Aggressive physical agitation includes hitting, kicking, grabbing, pushing, throwing, biting, scratching or spitting.

• Nonaggressive physical agitation includes pacing, putting clothes on and off, wandering, putting non-edible objects in the mouth, hiding or hoarding things, doing repetitive movements or restlessness.

• Aggressive verbal agitation includes screaming, cursing, threatening or repeated sexual comments.

• Nonaggressive verbal agitation includes repeating themselves, asking the same questions, making strange noises or unusual laughter or crying.
  
  

How is Agitation Treated?

Treatment for dementia-related agitation can include a mix of behavioral support (like counseling) and pharmacology (like medicines).

• Behavioral support includes cognitive behavioral therapy and music therapy, such as singing, playing an instrument, or listening to music. It can also include communication skill-building for caregivers, which can teach caregivers how to communicate better with their loved ones.

• Pharmacology support can sometimes include medications such as antidepressants or antipsychotics. But while these and other medical treatments can help with symptoms in some cases, doctors caution against expecting too much from them.

“Often, a family will come to the clinic and say, ‘He or she's agitated, what can we do? Do you have a pill?’” said Robert G. Stern, M.D., Program Director of Geriatric Psychiatry at Hackensack Meridian Health. “But most of the time, really the solution is looking at environmental triggers and behavioral patterns.”

What are the Triggers and How Can Caregivers Reduce Them?

Triggers vary from person to person. In people with more moderate versus severe dementia, people can be triggered when told they’re forgetting something. 

“In this stage of disease, there’s still some degree of awareness,” Dr. Hundal said. “If you point out that they’re repeating themselves or they made some mistake, that can drive agitation.”

Basic requests can also trigger agitation, such as asking people to take their medicine. If caregivers force the issue — often when pressed for time or patience — it can make things worse.

In these situations, it’s best to avoid confrontation. 

• Try de-escalations and diversions, such as putting pills in a cup of apple juice or encouraging patients to sit down for a rest.
• Even a simple prompt, like “Remember, we’ve discussed this,” can help patients attach to a cue. At the same time, saying that may also cause some incomprehension and agitation, which emphasizes the importance of understanding your loved one’s unique triggers.

Triggers can also come from sensory overload, such as loud noises or bright lights. For example, if kids come home from school in a chaotic rush, consider moving your affected loved one to a quieter room.

Overall, Drs. Hundal and Stern recommend that caregivers learn as much as they can about this disease, so they can envision the world through the patients’ eyes and gain a deeper understanding of how environmental factors can trigger distress. Ask your loved one’s care team for education and resources to support your role as caregiver. They want to help you just as much as they want to help your loved one.

“This is a disease doctors are still learning about, but what we do know is that these patients have zero ability to store or recall information,” Dr. Stern said. “This is why love, patience and empathy are so important when taking care of dementia patients. Caregiver education can go a long way.”

Next Steps & Resources:

• Our sources: 
  • Robert Stern, M.D., Program Director, Geriatric Psychiatry Fellowship Training; Section Chief, Geriatric Psychiatry, Hackensack Meridian Health; and Professor, Department of Psychiatry, Hackensack Meridian School of Medicine
  • Jasdeep S. Hundal, Psy.D. ABPP-CN., associate professor of Psychiatry and Neurology & Director of Medical Psychology and Neuropsychology at Hackensack Meridian Neuroscience Institute at Jersey Shore University Medical Center

• To make an appointment with Drs. Stern, Hundal or another physician near you, call 800-822-8905 or visit our website.

• Learn more about our memory loss care.