Alzheimer’s disease is a form of dementia, and while there are various types of dementia, Alzheimer’s is the most prevalent.
According to the Centers for Disease Control and Prevention, approximately 5.8 million people in the United States were living with Alzheimer’s disease in 2020.
Individuals with Alzheimer’s may experience memory loss that disrupts their daily lives, such as becoming lost in familiar places. Other symptoms include difficulties with familiar tasks, managing finances, and retracing steps.
Changes in mood and personality are also common in Alzheimer’s patients. As the disease progresses, agitation and aggression can emerge as notable behavioral changes.
Agitation may manifest as restlessness or anxiety, whereas aggression can involve verbal or physical expressions of anger, sometimes occurring without warning.
Both caregivers and individuals with Alzheimer’s need support to manage agitation and aggression. Medication and therapeutic techniques can be beneficial in navigating these changes.
Causes of Agitation and Aggression
A 2021 research review describes aggression as part of the broader behavioral syndrome of agitation. It references older studies indicating that agitation occurs in 30-50% of people with Alzheimer’s disease.
While it can be helpful to think of agitation and aggression as related phenomena, many sources, including the Alzheimer’s Association, identify distinct potential causes and coping strategies for each.
Caregivers may observe various emotional and behavioral changes in their loved ones with Alzheimer’s, which can stem from one or multiple causes.
Causes of Agitation in Alzheimer’s
Individuals with Alzheimer’s often struggle to process new information, making changes especially unsettling. This difficulty can provoke agitation, particularly when changes occur at home or in medical care settings. Examples include:
- Moving to a new home
- Alterations in home routines or the introduction of new people into the home
- Changes involving healthcare professionals or caregivers
Agitation can also arise from fear, such as believing one is under threat.Some triggers of aggression in those with Alzheimer’s may likewise cause agitation.
Causes of Aggression in Alzheimer’s
Aggression in individuals with Alzheimer’s can stem from various environmental, physical, emotional, or cognitive factors. Some examples include:
- Physical pain that the individual finds difficult to express
- Physical discomforts like soiled underwear or constipation
- Lack of sleep
- Hunger or thirst
- Loneliness
- A sense of lost autonomy, such as no longer being able to drive or care for oneself independently
- Depression or stress
- Excessive noise or crowded environments
- Difficulty with communication, such as responding to multiple questions simultaneously
Aggression can also be a side effect of certain Alzheimer’s medications.
Treatment Options
Doctors recommend resorting to medication for treating agitation or aggression only after non-pharmacological interventions have proven ineffective. Monitoring for side effects is crucial.
Some potential treatments include:
- Sleep aids: These can help with rest but increase the risk of falls and are generally for occasional use.
- Anti-anxiety drugs: Medications like benzodiazepines can alleviate agitation but may cause dizziness and confusion, and are typically prescribed for short-term use.
- Antiseizure drugs: These may help manage severe aggression but can cause mood changes, dizziness, and confusion.
- Antipsychotics: These can be used to manage severe symptoms of agitation or aggression but carry serious side effects, including an increased risk of death in people with Alzheimer’s, and are thus used sparingly.
A healthcare professional specializing in Alzheimer’s can assist caregivers in recognizing side effects and evaluating the effectiveness of treatments for their loved one.
Tips for Coping with Agitation or Aggression
There are various techniques available to help you respond to and manage agitation and aggression in individuals with Alzheimer’s.
Creating a Secure Environment
Establishing a secure and comforting environment can often help a person with Alzheimer’s feel more at ease. Consider the following:
- Maintaining a consistent daily routine for activities such as bathing, eating, dressing, and quiet times
- Surrounding the home with familiar objects, such as photographs, that provide comfort
- Reducing physical clutter and minimizing excessive noise in the home
Managing and Responding to Agitation
- Speak calmly.
- Listen to their frustrations.
- Offer reassurance.
- Engage the person in activities like art and music.
- Create a quiet, calm environment, free of noise and distractions.
Managing and Responding to Aggression
- Identify triggers: Consider what occurred just before the outburst to pinpoint potential triggers.
- Check for pain: Determine if the person is in pain and see if you can assist or seek help from another caregiver.
- Speak in a calm, reassuring tone: Avoid responding with anger or irritation.
- Introduce a new activity: Sometimes, a new activity can serve as a distraction and alleviate aggression triggered by the previous activity.
If the safety of yourself, your loved one with Alzheimer’s, or another person is at risk, call 911 or your local emergency services immediately.
Caregiver Tips
Caregivers of individuals with Alzheimer’s also need support. Consider trying the following:
- Take a break: Explore options for respite care. Family members or healthcare professionals can provide resources to support this.
- Join a support network: Engage with online groups, such as the Alzheimer’s Association’s ALZConnected, to connect with other caregivers.
- Care for your mental health: Your mental well-being is critical for both you and your loved one with Alzheimer’s. You can access mental health resources by calling SAMHSA’s National Helpline at 800-662-HELP (4357).
- Momentary step away: During episodes of aggression or agitation, if the person with Alzheimer’s is safe, consider taking a short break to regroup.
The Takeaway
The later stages of Alzheimer’s disease can lead to increased aggression and agitation. These symptoms can be triggered by physical discomfort, pain, environmental changes, and communication difficulties.
To manage these challenges, caregivers can keep the home environment calm, maintain a consistent routine, and offer comfort and distraction. Don’t hesitate to seek advice and support from other caregivers through support groups or consult with medical professionals.