Agitation in Dementia: Causes, Symptoms, and Management Guide

Table of Content

Dementia often brings challenges, including agitation and restlessness among patients. This post delves into why these issues arise, what signs to look out for, and shares strategies, backed by experts, to help manage these difficult symptoms. Our aim is to offer insights and practical advice to those navigating the turbulent waters of dementia care, making the journey a bit smoother for everyone involved.

An Introduction to Dementia and Alzheimer's Disease

Dementia is a group of disorders that is characterized by cognitive decline and impacts millions of people across the world. Alzheimer’s is a common form of dementia where a person progressively loses memory and cognitive functioning, leading to challenges in daily life for both the person affected as well as the caregiver. 

Defining Dementia and Its Impact

Since dementia directly affects a person’s cognitive ability and memory, it takes a major emotional and mental toll on individuals and their families. It hampers a person’s ability to reason and carry out simple tasks that they were previously familiar with. Agitation and dementia often stem as a result of this lost ability and worsen the existing challenges. 

Understanding Agitation in Dementia Patients

Agitation is a common manifestation among those who cope with dementia for a prolonged period of time. Agitation isn’t just a temporary behavior, but a behavioral syndrome characterized by restlessness and emotional distress. Restlessness could be exhibited through fidgeting, excessive movements, fixation with certain activities and other disruptive behaviors. 

Identifying the Triggers of Agitation in Dementia Patients

While agitation isn’t uncommon, not everyone with dementia ends up with restless behaviors. Agitation and dementia are often caused by specific triggers based on the stage of dementia and specific interpersonal and social factors of the person affected by it. Some of these triggers include: 

Sensory Impairments in Dementia and Agitation

Dementia is most common among people above the age of 60 and is often accompanied by decline in hearing and sight. This makes it difficult for them to make sense of their surroundings. Sensory impairment can make one feel scared, disillusioned and confused, resulting in agitation, on top of existing cognitive decline. 

Sleep Disturbances 

Dementia is shown to cause disturbances in sleep patterns especially among the elderly, furthering restlessness and frustration. Constantly waking up at night or inability to sleep on time may directly contribute to long term behavioral changes including agitation. Usually, experts recommend practices to improve sleep quality to address this. 

Acute Medical Illnesses on Behavioral Changes

Much like dementia, acute medical conditions are also a common part of aging and potentially triggers agitation and dementia among patients. This combination of distress also makes it more difficult for the patient to communicate their struggles to others around them. It may also be difficult to tell if discomfort arises from the frustration of cognitive decline or acute conditions. 

Changes in a Familiar Environment

For someone dealing with dementia, it is crucial to feel comfortable in a familiar environment. A change of scenery, or even smaller alterations in this environment can cause disorientation and stress. Relocation, for example, can be both mentally and physically taxing for someone with dementia. Entering a new atmosphere, being surrounded by new faces and navigating paths they haven’t done before may lead to agitation. 

Changes New Caregiver Arrangements

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.

Recognizing the Symptoms of Agitation in Dementia

Since agitation often manifests in physical or verbal expressions, it can be spotted early and gives us a chance to prepare for it as well as mitigate in the long run. Some symptoms of agitation among patients include: 

Fidgeting, Pacing, or Restlessness

A person facing continuous cognitive decline is highly likely to show restlessness and exhibit this through constant movement, fidgeting or pacing. For example, they might repeat the same gestures, tasks or routine, constantly tap fingers or move around a lot. They may also show night time wandering or step out of their house. 

Repetitive Talking and Vocalization

A person facing agitation with dementia may repeat words, phrases, questions or even sounds. These repetitive vocalizations can be very challenging for caregivers to manage on a regular basis. That said, these repetitions often come out as a result of some inherent stressor or concern. Therefore, it is important to remain patient. 

Emotional and Physical Outbursts

One of the most common ways that agitation in dementia manifests is emotional and physical outbursts, which cause significant distress to both the individual and the caregiver. These outbursts come in forms of screaming, crying, throwing objects, damaging objects, cursing and more. Cognitive decline can worsen to a point where confusion and panic takes over, leading to such aggression. 

Defensive Language and Behaviors

Since a person with dementia struggles to reason as a result of cognitive impairment, they may express agitation through defensive language and behaviors. They may refuse to listen to their caregiver, make excuses, point blame at others or even threaten caregivers. Remember that these behaviors are not a reflection of their character, but a result of prolonged brain damage that impairs inward and outward communication. 

Trouble Sleeping

Poor sleep and dementia often go hand-in-hand, one exacerbating the other. When a person fails to find meaningful sleep, it can trigger agitations. Some troubles in sleep include sleep apnea, irregular movement and restlessness. This adds to the anxiety of dementia and makes it difficult to find peace and calm. 

Strategies for Managing Agitation in Dementia Care

Dementia care is multifaceted and requires a combination of expert backed approaches and personal compassion and care. From communication strategies to medication management, these strategies help patients manage their emotional distress. 

Effective Communication Techniques

Empathy is paramount when approaching someone with dementia. Change your communication styles to be more positive and supportive. Speak calmly, be reassuring, acknowledge their concerns, and try to be as accommodating towards them as possible. Avoid aggressive, loud or forceful language. 

Maintaining Routine and Familiarity

Establishing consistency and predictability is crucial to the life of a dementia patient. It brings a sense of security, reducing the need to adjust and avoiding confusion. Apart from maintaining a strict routine, try to incorporate some calming activities or quiet time into the routine. You could also include expert backed dementia activities that your loved one may be inclined to. 

Personalized Activity Engagement

Engaging individuals with dementia in personalized activities tailored to their unique interests has shown to enhance cognitive function and reduce agitation. The key is to make these activities meaningful. This encourages developing a sense of purpose and thus positively impacts their emotional state.

Environmental Modifications for Comfort

There is no ideal environment for dementia, but some modifications have shown to help those with dementia. Be thoughtful of how your environment can cause potential challenges for them and thoughtfully eliminate them. You can do this by reducing noise, adjusting lighting and organizing spaces to promote ease and comfort in movement and accessibility. 

Understanding and Responding to Unmet Needs

Unfortunately, people with dementia often cannot absorb information and process it appropriately as a result of the reduced cognitive function. This leads to repeated demands which are often not realistic. Despite being neither the person’s or the caregiver’s fault, this can cause agitation as they believe that they are being denied what they need or deserve. 

Professional and Medicinal Interventions

While caregivers provide the requisite compassion and support on a daily basis, medical and mental health professionals are best equipped to guide both the individual and caregiver with respect to the right kind of medication as well as mental health strategies to cope with agitation and its consequences in everyday life. This collaboration is key to ensuring comprehensive dementia care. 

Addressing Safety Concerns in Dementia and Agitation Care

Dementia patients are at higher risk of both physical injury and mental stress due to their unique challenges. This is why creating a personalized environment, ensuring safety and managing aggressive tendencies are important to help those with dementia. 

Home Safety Modifications

It is essential to ensure that your loved one with dementia does not encounter accidents or injuries even when indoors. Simple things like getting rid of tripping hazards and sharp edges, installing supportive equipment like handrails and facilitating easy movement can make a huge difference.

Dealing with Wandering

Dementia patients can struggle to have total control of their words and actions, and are thus prone to wandering. Look to install counter measures such as door alarms or simply engage them in meaningful, engaging activities to make them feel active and secure. It also provides them a sense of purpose. 

Managing Aggressive Behaviors

Aggressive behaviors can be difficult to tackle, since it comes from a place of frustration. Start with taking a preventive approach by understanding triggers and providing them positive reinforcement. Further, with expert backed de-escalation techniques, you can minimize aggressive tendencies and calm them down when required. 

Emergency Preparedness

Have a clear plan in case of emergencies. Keep your emergency contacts ready, ensure availability of necessary resources and medications and be prepared to get the patient to a healthcare facility when required. You may also need certain equipment or medical objects that can come handy during emergencies. 

Medication Management

It is common for medication to be prescribed for individuals with dementia but the amount and type of medicine may vary. In collaboration with healthcare professionals, ensure that you’re aware of the dosage and side effects of these medications. Monitor the patient regularly and update the professional for any further adjustment. 

Manage Dementia and Agitation with Cadabam's Expert Guidance

Managing dementia with agitation is a unique challenge that requires compassion and patience but also healthcare expertise. Patients expressing agitated behaviors are forced to undergo several mental hurdles due to their condition. To manage this delicate process, consider Cadabam’s Hospital. With over 30 years of experience aiding people with dementia induced mental health issues, our professionals can guide you through the path of dementia care and provide assistance in the face of stress. Speak to a professional today


1. What triggers agitation in dementia?

Agitation in dementia can be triggered by a variety of factors, including environmental changes, physical discomfort, communication difficulties, and changes in routine. It can also stem from the individual's inability to express their needs or understand what's happening around them. Recognizing and addressing these triggers can help in managing agitation.

2. How do you treat aggressive dementia patients?

Treating aggression in dementia patients involves non-pharmacological strategies first, such as creating a calm environment, ensuring a consistent routine, and using gentle, reassuring communication. Medications may be considered if these approaches are not effective, but they should be used cautiously and under close medical supervision.

3. Is agitation in dementia preventable?

While it may not be possible to prevent agitation entirely, its frequency and intensity can often be reduced. Strategies include maintaining a calm and structured environment, ensuring the individual's comfort, and employing activities that engage and soothe the person. Understanding and anticipating the needs of someone with dementia can also significantly help in preventing agitation episodes.

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