When dementia turns mean, it's usually not intentional but a sign of distress from brain changes, confusion, fear, unmet needs (pain, hunger, tiredness), or environmental triggers, leading to agitation, aggression (swearing, hitting, yelling), or inappropriate behavior (disinhibition) as the person struggles to communicate, making it crucial for caregivers to identify the underlying cause (like a UTI, loud noise, or frustration) and respond calmly with empathy, validation, and redirection rather than confrontation, explains.
To prevent or reduce agitation:
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.
In middle to late dementia (stages 4-6 on the 7-stage scale), aggressive behaviors become most frequent. Research found that behavioral symptoms, including anger and aggression, peak during these middle stages when your loved one is experiencing a significant cognitive decline but is still aware of their losses.
The person with dementia is no longer managing at home as well as they used to. 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.
Patients with advanced dementia usually reside in a nursing home for 1.5 to 2.5 years before death. However, this duration may vary. Families should get ready for the end if their loved one has severe cognitive impairment, trouble eating and swallowing, frequent infections, weakness, and bed rest.
It shouldn't also rob them of their homes. Research has shown that dementia patients who are able to remain in their homes live healthier, happier, and longer lives. It also allows caregivers to maintain close bonds with their family member.
Signs of late-stage dementia
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.
Individuals living with Alzheimer's or other dementia may experience mood and personality changes. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, with friends or when out of their comfort zone.
What do we mean by loss of inhibition? Sometimes a person with dementia can lose their inhibitions and may behave in ways that others find embarrassing. This can include: being rude.
Overall, dementia reduced life expectancy by about two years for people with a diagnosis at age 85, 3-4 years with a diagnosis at age 80, and up to 13 years with a diagnosis at age 65.
Aggressive behaviour in dementia
In the later stages of dementia, some people with dementia will develop what's known as behavioural and psychological symptoms of dementia (BPSD). The symptoms of BPSD can include: increased agitation. aggression (shouting or screaming, verbal abuse, and sometimes physical abuse)
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).
Antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and uncooperativeness:
They can occur suddenly, with no apparent reason, or result from a frustrating situation. While aggression can be hard to cope with, understanding that the person with Alzheimer's or dementia is not acting this way on purpose can help.
To caregivers, this behavior may come across as intentionally manipulative, but this is rarely the case. “Dementia patients lose cognitive skills like logic, reasoning, problem-solving and decision-making,” explains Poiley. “So beyond the very beginning stages, a patient really couldn't be truly manipulative.”
Most people who have dementia continue to be interested in the same things they were interested in before their diagnosis. The way they express their interests may be different, and they may not be able to remember as much. But they likely think about the same things they did before they were diagnosed.
Smoking, low physical activity, and a poor diet are all lifestyle and environmental influences that have been linked to rapid dementia decline. Physical activity promotes cardiovascular health, which in turn improves brain function. Those who lead a sedentary lifestyle may experience faster cognitive decline.
The "2-finger test" for dementia involves an examiner showing a hand gesture (like interlocking index and middle fingers) and asking the patient to copy it, testing motor skills, visual memory, and coordination, as difficulties can signal early cognitive decline, but it's a screening tool, not a definitive diagnosis, prompting further medical evaluation. Other related tests include finger-tapping and finger-to-nose, looking for hesitation or misjudgment in movement.
The Unique Impact of Dementia
At the same time, approximately one-third of people living with dementia report feeling lonely, and two-thirds of people living alone with dementia report feeling isolated. Living with or caring for someone with dementia can also increase the risk of social isolation and loneliness.
Playing music, having objects to touch and interact with, and hand massage can all help people with dementia in the later stages. Playlist for Life is a music and dementia charity. It promotes how music with personal meaning can help people with dementia. You can find and listen to existing playlists, or make your own.