Aggression in Alzheimer's isn't a distinct stage but a symptom that often worsens in the middle to late stages, emerging from confusion, frustration, pain, or unmet needs, manifesting as shouting, hitting, or restlessness (sundowning), driven by brain changes that impair emotional control and communication, requiring caregivers to identify triggers like physical discomfort or environmental changes.
The person may be having delusions (strongly believing things that aren't true), or hallucinations (seeing things that aren't there). This can be confusing and frightening, so the person with dementia may respond in an aggressive way. The person may be sexually frustrated and become agitated as a result.
How to respond
There are many things that can trigger agitated or aggressive behaviour in people living with dementia. They might become overwhelmed in crowded or noisy places. Or they might get frustrated when they're doing a complex task. They could also be feeling unwell or in pain.
For those suffering from Alzheimer's, dementia can happen at any stage, but it is most common in the middle and later stages. Those in the middle stages can be aggressive between 2 to 4 years. This is seen when the individuals suffer from changes in behavior, and the later stages of aggression can last 1 to 2 years.
Known as terminal agitation, the behaviours may include disorientation, increased confusion, verbal and/or physical aggression, restlessness, agitation and perceptual disturbance (seeing or hearing things).
Once they reach moderate dementia (stage 5), anger and suspicion can become commonplace. Advanced Alzheimer's, or severe cognitive decline at stage 6, may include angry outbursts and violent behavior related to diminished independence and fear.
For example, they are no longer able to do daily tasks, like eating, without the support of another person. The person is no longer safe at home. For example, they keep having falls. This is likely to affect how well they can continue living at home, for instance if they have to use stairs to get to parts of the house.
For loved ones with Alzheimer's and other types of dementia, manipulation can be a frequent behavior for a variety of reasons ranging from bargaining for things they want to legitimate confusion.
Seroquel is the brand name for quetiapine, an atypical antipsychotic that is used off-label to treat severe behavioral signs of dementia. It can help with bad symptoms, including agitation, aggressiveness, and hallucinations, that other drugs don't help with.
For those with dementia or Alzheimer's disease, staying active and engaged is beneficial for both a person's physical and cognitive health. Exercise, outdoor activities, games, music, and art are just a few of the activities proven to be helpful for those with dementia or other cognitive disorders.
The drug with the most evidence to support its use in dementia is risperidone. It is licensed for short-term (up to six weeks) treatment of persistent aggression in people with moderate-to-severe Alzheimer's disease when there is risk of harm to the person or others.
Music therapy to reduce agitation and promote calm. Occupational therapy to build routines and reduce frustration. Behavioral therapy to address triggers and coping strategies. De-escalation training for staff to manage aggression safely and respectfully.
Use calming phrases such as: "You're safe here;" "I'm sorry that you are upset;" and "I will stay until you feel better." Let the person know you are there. Involve the person in activities. Try using art, music or other activities to help engage the person and divert attention away from the anxiety.
It's not uncommon for a person with dementia to say they want to go home. This may be caused by time-shifting, when a person believes they're living at an earlier time in their life, or general confusion stemming from memory loss. It can be distressing for everyone.
Patients with dementia or Alzheimer's are eligible for hospice care when they show all of the following characteristics: Unable to ambulate without assistance. Unable to dress without assistance. Unable to bathe properly.
The number one reason for admission into skilled nursing care is that someone is unable to safely return home and requires assistance and medical support during their recovery, and possibly for the long term. Recovery is different for everyone, depending on their injuries, support at home, or mental health.
A big study of people with dementia in the US found that about a quarter were sometimes either aggressive or agitated, and a UK study found about 1 in 5 people with Alzheimer's disease were sometimes aggressive. So it's a common symptom of the condition.
The late stage of Alzheimer's disease may also be called the “severe” or “advanced” stage. In this stage, the person living with Alzheimer's disease eventually becomes unable to communicate verbally or look after themselves. Nonverbal communication becomes more important.
Seniors with Alzheimer's typically experience combative behavior in the later stages of the disease, and aggression may occur suddenly.
Middle Stage (Moderate) Alzheimer's
Difficulty learning new things or handling new situations. Trouble completing tasks with multiple steps. Mood or behavioral changes. Forgetting common words or objects.
Terminal agitation generally occurs within the last two weeks of a person's life. But it's different for everyone. Restlessness often occurs with other end-of-life symptoms like mottled skin, lack of appetite or low blood pressure. As death approaches, signs of agitation usually fade.
Key signs 2 weeks before death at the end-of-life stages timeline: Extreme fatigue and increased sleep. A marked decrease in appetite and fluid intake. Irregular breathing patterns (Cheyne-Stokes breathing)
People with Alzheimer's disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless and worried, and they aren't able to settle down. Agitated people may pace a lot, not be able to sleep, or act aggressively toward others.