Aggression in dementia is triggered by unmet needs, confusion, fear, or overstimulation, often stemming from physical discomfort (pain, hunger, infection), environmental factors (noise, crowds, routine changes), communication breakdowns, feelings of humiliation, or psychological distress like anxiety, with the person unable to clearly express their distress, leading to outbursts. Common triggers include infections (like UTIs), pain, medication side effects, feeling overwhelmed, or frustration with tasks they can't complete.
If your loved one becomes aggressive, stay at a safe distance until the behavior stops. Talk to a doctor if aggressive behaviors worsen and consider medications that may help. In an emergency, call 911 and explain that your loved one has dementia.
Possible causes of agitation
Ultimately, the person with dementia is biologically experiencing a profound loss of their ability to negotiate new information and stimulus. It is a direct result of the disease. Situations that may lead to agitation include: Moving to a new residence or nursing home.
Where do aggressive dementia patients go? They may remain in specialized memory care units or be transferred to nursing homes with greater medical support. The key is finding a facility that has the staff and training to handle aggression safely.
Communicating with people with dementia may become more difficult as they lose their ability to understand what others say. People with this condition may think their caregivers are wrong and misunderstand or misinterpret them. They may get frustrated, misinterpret, or feel frightened, leading to angry outbursts.
The answer isn't necessarily straightforward; anger can strike at any stage, but it's most acute in the middle stages of dementia. In middle to late dementia (stages 4-6 on the 7-stage scale), aggressive behaviors become most frequent.
The signs of caregiver stress include:
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.
Antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and uncooperativeness:
The term "sundowning" refers to a state of confusion that occurs in the late afternoon and lasts into the night. Sundowning can cause various behaviors, such as confusion, anxiety, aggression or ignoring directions. Sundowning also can lead to pacing or wandering. Sundowning isn't a disease.
They may fear their loss of memory and thinking skills, but they also fear the loss of who they are. They may also find they do not understand what's going on or why they feel they're not in control of what's happening around them or to them. All of this can affect their behaviour.
Factors that may contribute to trouble sleeping and sundowning
The off-label antipsychotics most often used for patients with dementia are: quetiapine and clozapine – These drugs are mostly used if a person has dementia with Lewy bodies or Parkinson's disease dementia. This is because they interfere less with drugs that treat other symptoms of these conditions.
The person's aggressive behaviour may be their response to feeling they're not able to contribute or are not valued by others. Try to encourage the person to have a daily routine and to do as much as they can for themselves. Support them to be as independent as they are able to be.
Donepezil (also known as Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are used to treat the symptoms of mild to moderate Alzheimer's disease. Donepezil is also used to treat more severe Alzheimer's disease.
Often when a person with dementia asks to go home it refers to the sense of 'home' rather than home itself. 'Home' may represent memories of a time or place that was comfortable and secure and where they felt relaxed and happier. It could also be an indefinable place that may not physically exist.
How to respond
Today, the U.S. Food and Drug Administration is announcing the supplemental approval of Rexulti (brexpiprazole) oral tablets for the treatment of agitation associated with dementia due to Alzheimer's disease. This is the first FDA-approved treatment option for this indication.
Common Drugs to Avoid
Benzodiazepine antianxiety drugs such as diazepam (Valium®); lorazepam (Ativan®); alprazolam (Xanax®); clonazepam (Klonopin®); temazepam (Restoril®); chlordiazepoxide (Librium®) and anticholinergic medications such as hydroxyzine (Atarax®).
Signs of the dying process
lose consciousness. be unable to swallow. become agitated or restless. develop an irregular breathing pattern.
Agitation and restlessness can manifest differently in different types of dementia. In Alzheimer's disease, people may show repetitive behaviours like pacing or fidgeting. They might also experience sundowning, where agitation worsens in the late afternoon or evening.
Creutzfeldt-Jakob disease causes a type of dementia that gets worse unusually fast. More common causes of dementia, such as Alzheimer's, dementia with Lewy bodies and frontotemporal dementia, typically progress more slowly.
The "42% rule" for burnout suggests dedicating roughly 42% of your day (about 10 hours) to rest and recovery activities like sleep, hobbies, exercise, and socializing to prevent mental and physical exhaustion, countering the "always on" culture that leads to burnout. It's a science-backed guideline emphasizing that sustainable success requires balancing intense work with sufficient downtime for your brain and body to recharge, not just a quick nap.
Some of the most common signs of caregiver burn out include:
Symptoms of stress