Agitation is a common yet unsettling symptom of Alzheimer’s disease. But there are ways to help prevent and manage it.

If you care for someone with Alzheimer’s disease, you’ve likely noticed some mood and personality changes. One change that can be particularly surprising is the agitation that seems to come out of nowhere. If you’ve witnessed it, you’re not alone: Agitation affects as many as 30–50% of people with Alzheimer’s disease, which is the most common type of dementia.

Agitation can involve excessive restlessness and physical movements. And through no fault of their own, agitation can make a person lash out at whoever is nearby. They may become verbally or physically aggressive — or both — which can complicate your ability to care for them.

But working with a doctor can make a difference. There may be a physical cause, such as drug interactions, pain, or sleep problems that can be addressed. Emotional upsets can also lead to agitation. Together, you can create a plan to handle agitation when it arises.

The Food and Drug Administration (FDA) approved the first medication to treat Alzheimer’s-associated agitation in May 2023. The drug, brexpiprazole (Rexulti), is an atypical antipsychotic. Atypical antipsychotics work by targeting serotonin and dopamine pathways in the brain.

In clinical trials, people who took 2 or 3 milligrams of brexiprazole per day for 12 weeks showed significant improvement over those who took a placebo. While the drug was reported to be generally well-tolerated, common side effects may include headache, dizziness, and sleep disturbances.

It’s an oral medication with a starting dosage of 0.5 milligrams daily for 7 days. After that first week, depending on response and tolerance, a doctor may slowly increase the dosage to 2 or 3 milligrams.

Doctors sometimes prescribe other antipsychotics off-label to help manage agitation. These medications have FDA approval but are for different conditions.

It’s important to note that antipsychotics have a black box warning that states: “Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.” The most common causes of death are heart failure and or infections like pneumonia.

Medications are generally considered a second-line therapy for agitation in Alzheimer’s disease. A doctor will likely recommend trying other methods first.

Aside from brexpiprazole, no other drugs are approved specifically for treating agitation related to Alzheimer’s disease. But other medications might help someone with Alzheimer’s, including:

  • Sleep aids: These medications can help someone go to sleep and stay asleep. However, people with Alzheimer’s disease shouldn’t take sleep aids on a regular basis because they may increase the risks of falls and confusion.
  • Anti-anxiety meds: Some anti-anxiety drugs, such as benzodiazepines, can help treat agitation. They also increase the risks of falls, sleepiness, and confusion, so they’re best for short-term use only.
  • Anticonvulsants: Some anticonvulsants can help with severe aggression. Side effects can include confusion, mood swings, and sleepiness.

These drugs can have serious side effects and drug interactions and should be used with caution. Be sure to inform the doctor of all prescription and nonprescription medications and supplements that are being taken.

It can be challenging, but do your best to stay calm. Here are some ways to respond in the moment:

  • Try to identify the trigger: Consider what happened that could have been upsetting. Ask and listen carefully, as emotions can often reveal more than facts.
  • Provide acknowledgment: Let them know that you understand. Do this without correcting, criticizing, or blaming — even if they get details wrong.
  • Meet their needs: Address any triggers such as hunger, thirst, or pain.
  • Offer reassurance: Speak softly and move slowly. Tell the person that they’re in a safe space and everything is under control. Let them know you’ll stay until they feel better.
  • Give gentle guidance: Offer choices, but not more than two simple options at a time.
  • Dial down stimulation: Choose softer lighting, less noise, and fewer people.
  • Use relaxation techniques: If possible, use gentle touch, mild exercise, soft music, or time with a pet to calm and soothe. Or ask if they’d like to lie down and rest.
  • Redirect: If a particular activity provoked the agitation, try to shift focus to something else.

If you or anyone else is in physical danger, stay a safe distance away and call for help. Be sure to let first responders know that the person has agitation due to dementia.

Someone who has Alzheimer’s might become agitated simply because they’re having trouble making sense of the world. Or this symptom can occur when there’s a break in routine, such as having to move to a new home or change caregivers. Overstimulation or anything else that leads to more fear and confusion may also trigger an episode.

Taking steps to avoid these types of triggers may help prevent agitation:

  • Create a routine so that everyday things such as meals, dressing, and bathing are predictable. Try to stick to it as closely as possible.
  • Build in time for quiet activities and time for physical movement.
  • Take care of issues like hunger, thirst, and pain as quickly as possible.
  • Allow the person to have some control, but provide clear, easy choices.
  • Keep tasks as simple as possible.
  • Decorate with photographs and familiar, comforting objects. But clear away unnecessary clutter.
  • Keep noise to a minimum.
  • Avoid crowds and discourage too many visitors at once.
  • Limit their caffeine intake.

Agitation is a common symptom of Alzheimer’s disease. If someone you care for is showing signs of agitation, reach out to a doctor who specializes in Alzheimer’s disease. Discuss steps you can take to help treat, manage, and prevent this troubling symptom.

If you’re struggling to cope, reach out to the Alzheimer’s Association helpline. It’s free and available around the clock.