Aggression and Anger in Dementia

Anger and aggression are common in dementia, and they are a symptom of the disease, not a choice. The Alzheimer's Association points out that the person is not acting this way on purpose. Aggression can be verbal (shouting, swearing, accusing) or physical (hitting, pushing, grabbing), and it often has a trigger: pain, an infection, fear, a noisy room or a task that has become too hard. Finding and removing the trigger is usually the most effective thing you can do, and it is safer than reaching for medicine first.

This page explains why it happens, what to do in the moment, how to reduce outbursts, and when to call a doctor or 911.

Why does someone with dementia become angry or aggressive?

Dementia causes brain changes that affect communication, judgment and emotions. A person who can no longer explain that they are in pain, frightened or overwhelmed may show it through anger instead. The Alzheimer's Association, the National Institute on Aging (NIA) and the NHS describe the same common causes:

Physical causes

• Pain the person cannot describe
• Constipation
• Infections, especially urinary tract infections (UTIs)
• Hunger, thirst or tiredness, and too little sleep
• Side effects of medicines, or interactions between them, which are more likely when someone takes several
• Depression
• A soiled diaper or underwear

Surroundings

• Too much noise, clutter or too many people in the room
• Unfamiliar people, even visitors at home
• Sudden changes in place, routine or caregiver
• Feeling lost or not recognizing where they are

Communication and feelings

• Instructions that are too complicated, or too many questions at once
• Pressure to do a task the disease has made very hard
• Picking up on a caregiver's stress or irritation
• Loneliness, or grief over losses such as giving up driving

Aggression can happen at any stage, but the NHS lists it among the behavioral and psychological symptoms that tend to appear in the later stages. Anger that gets worse in the late afternoon or evening may be part of sundowning.

What to do during an outburst

Based on guidance from the Alzheimer's Association and NIA:

1. Make sure everyone is safe. Keep a safe distance until the person calms down, and try to stop them hurting themselves. If you can't calm the situation, get help from others.
2. Stay calm yourself. Speak slowly in a soft, reassuring voice. Don't argue, correct or try to reason with them.
3. Respond to the feeling, not the words. Saying "You seem worried" or "That sounds frustrating" often works better than disputing what they said.
4. Don't take it personally. Accusations and insults come from the disease. It's fine to accept blame, even when it isn't your fault, if that ends the conflict.
5. Reduce the pressure. Stop the task that triggered it, turn off the TV or radio, and ask other people to leave the room.
6. Redirect. Offer a favorite snack, music, a walk or a different activity.
7. Step away if it's safe. Leaving the room for a few minutes can help you both.

How to reduce outbursts

Look for the trigger. Afterward, think about what happened just before the outburst: the time of day, what you were asking them to do, who was there, and whether they could be in pain. Jotting these down can help you spot a pattern.

Keep a routine. NIA suggests keeping regular times for bathing, dressing and meals, and balancing activity with quiet periods. The Alzheimer's Association notes that most people do best in the morning, so plan appointments and harder tasks then.

Simplify. Give one short instruction at a time, cut down noise and clutter, and keep familiar objects and photos nearby.

Let them keep control over as much of daily life as they safely can.

Try calming activities such as music, gentle touch or massage, exercise and walks. NIA also suggests limiting caffeine, sugar and junk food.

Look after yourself. People with dementia often react to the mood around them. Taking regular breaks helps you and the person you care for. There is more on support in how to support someone with dementia.

When to see a doctor

Ask the person's doctor for a full checkup if aggression is new, sudden or getting worse. The Alzheimer's Association says anyone with behavior symptoms should be checked, especially when the change is sudden. The doctor can look for pain, infections such as a UTI, depression and medicine side effects, and review everything the person takes. Bring your notes on when the outbursts happen.

Are there medicines for aggression in dementia?

Medicines are usually tried only after the causes above have been checked and non-drug approaches haven't worked.

• In 2023 the US Food and Drug Administration (FDA) approved brexpiprazole (Rexulti) as the first treatment for agitation associated with dementia due to Alzheimer's disease.
• Brexpiprazole is an antipsychotic. Antipsychotics carry an FDA boxed warning that older people with dementia-related psychosis who take them have an increased risk of death.
• In the UK, the NHS says an antipsychotic may be prescribed as a short-term treatment if coping strategies don't work, and only by a consultant psychiatrist.

Because of these risks, ask the doctor what a medicine is meant to help with, how you will know if it is working, and when it will be reviewed.

When to call 911

Call 911 in an emergency, such as when anyone is in immediate danger. The Alzheimer's Association advises telling the dispatcher that the person has dementia, so responders understand the behavior. (In the UK, call 999.)

Related pages

• Symptoms of dementia, including behavior changes at each stage
• Sundowning in dementia
• Middle stage of dementia
• Dementia care options, if caring at home is becoming unsafe