Alzheimer’s disease is a form of dementia. Although there are different types of dementia, Alzheimer’s often affects more people than any other.

According to the Centers for Disease Control and Prevention, in the United States, about 5.8 million people were living with Alzheimer’s disease in 2020.

People with Alzheimer’s may experience memory loss that interferes with their daily lives, such as getting lost in a place they know well. Symptoms also include challenges with familiar tasks, keeping track of finances, and retracing steps.

People with Alzheimer’s can also have changes in mood and personality. Agitation and aggression are examples of such changes that may happen as Alzheimer’s progresses.

Agitation can look like restlessness or worry. Aggression is when someone expresses anger verbally or physically, sometimes without warning.

Caregivers and the person with Alzheimer’s may need support to navigate changes that cause agitation and aggression. Medication and therapeutic techniques can help.

A research review from 2021 describes aggression as part of the behavioral syndrome of agitation. It cites older research stating that agitation has an occurrence rate of 30–50% among people with Alzheimer’s disease.

Although it may help to think of agitation and aggression as connected, many sources, such as the Alzheimer’s Association, identify separate possible causes and coping mechanisms for each.

Caregivers may see many emotional and behavioral changes in their loved one with Alzheimer’s that can have one or several causes.

Causes of agitation in Alzheimer’s

People with Alzheimer’s can experience difficulty processing new information. So, changes can be causes of agitation, specifically in the home or with medical care. Examples include:

  • a move to a new home
  • home routine changes or new people in the home
  • changes related to healthcare professionals or caregivers

Agitation can also come from fear, such as believing they’re under threat.

Some causes of aggression in those with Alzheimer’s may also cause a person to become agitated.

Causes of aggression in Alzheimer’s

Aggression can have environmental, physical, emotional, or cognitive causes. Some examples include:

  • physical pain, which the person may have challenges expressing
  • physical discomforts, such as soiled underwear or constipation
  • lack of sleep
  • hunger or thirst
  • loneliness
  • a sensation of a loss of agency, such as no longer being able to drive or care for oneself independently
  • depression or stress
  • excessive noise or a lot of people in a room
  • difficulty with communication, such as responding to many questions at once

Aggression can also be a side effect of some Alzheimer’s medications.

Doctors recommend treating agitation or aggression with medication only when nondrug treatments haven’t worked. It’s important to watch for side effects of any medications.

Some possible treatments include the following:

  • Sleep aids can help with rest, but these increase the risk of falls, and people may usually only take them occasionally.
  • Anti-anxiety drugs, such as benzodiazepines for agitation, can lead to dizziness and confusion and are typically for short-term use.
  • Antiseizure drugs may help with severe aggression. Side effects can include mood changes, dizziness, and confusion.
  • Antipsychotics may help manage severe symptoms of agitation or aggression. These can have serious side effects, such as an increased risk of death in people with Alzheimer’s, so people usually take them sparingly.

A doctor or nurse who specializes in Alzheimer’s can help caregivers learn what side effects to watch for and how to assess whether medications work for their loved one.

Some techniques are available that can help you respond to or manage agitation and aggression that comes from Alzheimer’s.

Creating a secure environment can often help a person with Alzheimer’s feel calmer. You may try:

  • keeping a consistent daily routine of bathing, eating, dressing, and quiet times
  • populating the home with objects such as photographs that give the person comfort
  • reducing physical clutter and excessive noise in the home

Ways to manage and respond to agitation:

  • Speak calmly.
  • Listen to their frustrations.
  • Offer reassurance.
  • Engage the person in activities, such as art and music.
  • Create a quiet, calm environment without noise or distractions.

Ways to manage and respond to aggression:

  • Try to identify what triggered the aggression: Sometimes, thinking about what just happened before an outburst can be an indicator.
  • Check whether the person is in pain: If they are, consider whether you can assist or get help from another caregiver.
  • Speak in a calm, reassuring tone: Try not to respond with anger or irritation.
  • Start a new activity: The aggression may have come from what the person did before the outburst, and a new activity may help provide distraction.

If you fear for the safety of yourself, your loved one with Alzheimer’s, or another person, call 911 or your local emergency services.

Caregivers of people with Alzheimer’s also need support. Here are some things you may want to try:

  • Take a break: Check whether getting a respite from caregiving is possible. Family members or healthcare professionals can offer resources to support this endeavor.
  • Join a support network: You can try online groups, such as the Alzheimer Association’s ALZConnected, to interact with other caregivers.
  • Care for your mental health: Your mental health is important for you and your loved one with Alzheimer’s. You can find mental health resources by calling SAMHSA’s National Helpline at 800-662-HELP (4357).

In moments of aggression or agitation, if the person with Alzheimer’s is safe, you can walk away for a few minutes for a break.

The later stages of Alzheimer’s disease can cause aggression and agitation. Physical discomfort, pain, environmental changes, and miscommunication can all trigger these symptoms.

Caregivers can respond by keeping the home calm, maintaining the person’s routine, and providing comfort and distraction. You can reach out for help from other caregivers in support groups or medical professionals for advice and guidance.