Changes in the brain’s structure and function as Alzheimer’s progresses can lead to aggression or sudden outbursts. These symptoms can also indicate discomfort, pain, or overstimulation.

Alzheimer’s disease is a progressive brain disorder caused by neuron loss and the buildup of unusual protein deposits in the brain.

It’s the most common form of dementia, the umbrella term for clinically significant declines in cognitive functions like memory, reasoning, and learning.

Many people may think of memory loss when a loved one has Alzheimer’s. While it’s true that memory loss is often a primary symptom, many changes in personality and behavior can develop over time.

As the ability to communicate diminishes and parts of the brain that regulate emotions and behavior change, physical and verbal outbursts may become common.

Aggression and outbursts in Alzheimer’s can occur due to the natural progression of the condition as well as barriers in communication that create frustration and prevent having needs met.

Brain causes

Many personality and behavioral changes in Alzheimer’s disease arise from progressive inflammation and damage in the brain.

In Alzheimer’s, unusual protein formations called amyloid plaques and tau tangles accumulate within neuronal cells in the brain, disrupting typical communication and function and promoting cell death.

Over time, significant neuronal loss can cause the brain tissue to shrink or atrophy, and as protein deposits continue to build, neurons become less able to transmit signals and communicate.

Initially, Alzheimer’s usually affects areas of the brain responsible for memory, like the hippocampus and entorhinal cortex.

In the later stages of Alzheimer’s, however, the condition spreads to areas of the brain that control social behavior, language, emotional regulation, and reasoning.

Aggression and outbursts are typically seen in the mid to late stages of Alzheimer’s disease.

According to a systematic review and meta-analysis from 2019, people living with Alzheimer’s are five times more likely than the larger population to have aggressive behaviors.

Researchers found that out of more than 8,000 cases across nine countries, 27.8% of people living with Alzheimer’s displayed aggressive behaviors.

Communication causes

Sometimes, outbursts and aggression in Alzheimer’s are an attempt to communicate. As Alzheimer’s progresses, a person’s ability to speak and write may decline significantly.

If they’re unable to express their feelings in words, emotions may be the only way they can get your attention.

Pain and discomfort are common reasons for aggression and outbursts. Your loved one may be trying to communicate that they’re hungry, thirsty, stressed, or uncomfortable in some way.

Frustration at the inability to communicate can be a trigger of aggression or outbursts on its own.

Common triggers

If your loved one is displaying aggression or an outburst, the following are possible triggers to consider:

  • uncomfortable position
  • infection
  • illness
  • hunger
  • thirst
  • physical pain
  • fatigue
  • overstimulation
  • fear
  • anxiety
  • feeling lost or confused about their surroundings
  • frustration with instructions or expectations
  • delusional thinking
  • miscommunication
  • feeling misunderstood
  • being pushed to do something
  • medication effects

Once you understand the various reasons behind aggression and outbursts in Alzheimer’s disease, prevention becomes easier.

For example, taking proactive steps toward keeping your loved one comfortable and feeling secure can go a long way in reducing how frequently outbursts occur.

Consider these tips to help avoid aggressive outbursts:

  • Make sure all basic needs are met and that your loved one isn’t hungry, thirsty, tired, or in need of the restroom.
  • Keep daily schedules consistent to reduce confusion and anxiety.
  • Have plenty of restful time during the day to avoid overwhelm and exhaustion.
  • Gradually introduce changes in daily routine or caregiving staff.
  • Regularly ask your loved one “yes” or “no” questions about being comfortable or in pain.
  • Keep instructions simple and tasks small.
  • Avoid places of overstimulation with loud noises or unfamiliar people.
  • Keep track of what times of day your loved one is prone to outbursts.
  • Have a support item on hand to provide familiarity and comfort.
  • Engage in daily relaxation activities, like listening to music or looking through pictures.
  • Encourage multiple forms of communication, like gestures or using image cards.
  • Keep your own emotions of frustration or anger controlled. Taking care of your own needs can help with this.

Aggression in Alzheimer’s can’t always be prevented, but it can often be de-escalated when it occurs.

Each person is unique. What works for your loved one may not be as effective for someone else. With time and experience, you’ll learn the most effective options for your individual caregiving situation.

Immediate response strategies to try include:

  • Address the underlying cause if possible (pain, hunger, thirst, frustration, etc.).
  • Remove any items that could be dangerous (pens, utensils, breakable dishes, etc.).
  • Speak calmly and provide reassurance. For example: “I understand you’re upset. I’m going to help you.”
  • Move to a calmer, quieter space with soothing lighting and no background noise.
  • Shift focus to a new activity, like walking, watering plants, or looking at pictures.
  • Provide a support item, like a favorite stuffed animal or photograph.
  • Distract with a favorite snack, activity, or object.
  • If appropriate, provide physical comfort, like hand-holding or a supportive pat on the back.

If your loved one is having an aggressive outburst, the safety of yourself and others is important. You may need to remain a safe distance away until the behavior stops. Physical restraint is a last resort if your loved one is causing harm to themselves.

A healthcare professional can teach safe holding techniques for use in extreme circumstances. It’s always OK to call 911 if you’re worried about the safety of your loved one or yourself.

Predicting an outburst

Aggressive behaviors and outbursts in Alzheimer’s may follow a predictable pattern. Most people, for example, have certain times of the day when they function and feel their best.

Keeping a journal that logs behaviors and triggers throughout the day can help you anticipate when an outburst might occur.

Early signs your loved one may be on the verge of an outburst include:

  • negative shifts in mood, like sudden irritability
  • restlessness, pacing, or fidgeting
  • agitated or unhappy facial expressions, like lip pursing, lip chewing, frowning, or grimacing
  • head shaking or repeating “no”
  • loud, angry vocalizations
  • gesturing, like clenching fists or waving arms
  • anxious watching or fixation toward a person or object

You might also be able to predict an outburst by assessing the current environment. If your loved one does not respond well to situations with unfamiliar people, for example, you can be watchful for aggressive behaviors when visiting a new doctor’s office or when changing care facilities.

Long-term management strategies for aggression and outbursts in Alzheimer’s can help reduce symptoms as the condition progresses.

Professional support

Professional support for Alzheimer’s comes in a variety of forms, including:

  • occupational therapy, which helps with developing and maintaining life skills
  • behavioral therapy, which can identify triggers and provide coping skills
  • home health medical care, such as at-home medical therapies
  • functional home care to support everyday tasks

By setting up these professional services, you can ensure that your loved one has the best support possible across important areas of function. The right support can help reduce scenarios and situations that may lead to outbursts.

Consistency

Lack of consistency can create anxiety, frustration, and fear in Alzheimer’s. Long-term consistency is important because it creates familiarity and a sense of trust and comfort.

Consistency can be applied to all parts of the day, including:

Medication management

Medication management can help aggression and outbursts in Alzheimer’s long term.

If symptoms have become challenging to manage with traditional, nonpharmacological methods, doctors may recommend medications like anti-anxiety drugs or antipsychotics.

Comprehensive care plan

Working closely with your loved one’s medical team is another essential component of long-term emotional and behavioral management.

Comprehensive care includes keeping up with regular appointments, monitoring symptom severity, tracking the condition’s progression, and screening the effectiveness of medications — among many other things.

Sticking to a comprehensive care plan helps doctors catch changes in Alzheimer’s disease or medication effectiveness as soon as possible. The more quickly changes are noticed, the sooner adjustments can be made that improve overall quality of life.

Resources and support

To learn more about aggression and outbursts in Alzheimer’s disease or to find support resources near you, visit:

Managing aggression and outbursts in Alzheimer’s can be challenging. Understanding why these symptoms develop can help you cultivate the skills to prevent or de-escalate them.

Remember, these experiences don’t necessarily mean your loved one is mad or frustrated at you. They can’t control these behaviors and may be doing their best to communicate about pain or discomfort.

Focusing on preventing and predicting aggression triggers, as well as initiating long-term management strategies, can improve your loved one’s overall quality of life and reduce the frequency of outbursts.