Alzheimer’s can cause distressing behaviors for both the person living with it and caregivers. Not everyone with the condition will become aggressive or violent, but if it does, it’s important to know how to manage these symptoms.
Alzheimer’s disease is a brain disorder and type of dementia primarily characterized by memory loss and confusion.
Some people with Alzheimer’s or other dementias may experience significant personality changes, which may include irritable or aggressive behavior.
The earliest symptoms of Alzheimer’s are usually memory lapses and difficulty with everyday tasks.
If the disease begins to impact how someone usually acts and behaves, it’s often referred to as a change in personality. Initially, personality changes tend to include:
People with mild to moderate Alzheimer’s often become more impatient and less “filtered” in the things they say and do. They may deliver inappropriate comments or hurtful accusations that feel out of character.
As Alzheimer’s progresses, the likelihood of agitation and irritability increases. A 2021 study suggests that as many as 90% of Alzheimer’s cases may include these behavioral changes.
Shouting and, at times, physical violence such as pushing or kicking may occur. People with Alzheimer’s may physically resist help.
If you’re a caregiver, family member, or other looking after a person with Alzheimer’s, it’s important to remember that these behavior changes are the result of the disease and aren’t personally directed toward you. Try to not blame yourself for changes thatare beyond your control and the control of the individual with Alzheimer’s.
It’s not always clear why someone with Alzheimer’s disease may start to show aggressive behavior.
But some factors are widely considered to be common components of Alzheimer’s-related personality changes.
Physical factors
Cognitive changes caused by the disease can impact clear communication.
For example, someone with Alzheimer’s may be uncomfortable or in pain but unable to articulate this verbally. This may create further discomfort, anger, or frustration.
Difficulty sleeping, another common complication of Alzheimer’s, may make the individual irritable during the day.
A person with Alzheimer’s in these kinds of situations may lash out due to feeling out of control or unheard and may become resistant or aggressive.
Medication side effects
Individuals with Alzheimer’s disease often take dementia medications and drugs to treat other co-occurring health conditions, such as heart disease or arthritis.
Medications containing the antihistamine diphenhydramine, often used for pain and allergies, may worsen problems with memory and confusion.
In some cases, it may be the interaction of several medications that causes irritability or aggressive behavior.
Environmental factors
An individual’s ability to handle a crowded, noisy, bright, or otherwise stressful environment can change with the onset of Alzheimer’s or another type of dementia.
An overly stimulating environment can cause someone with Alzheimer’s to feel stressed, overwhelmed, or uncomfortable.
The disorientation created by Alzheimer’s can cause someone to feel lost or unsure of their surroundings, even in spaces they spend a lot of time in. This can lead to anxiety, fear, and outbursts of anger.
Time of day can also be a major factor influencing behavior in people with Alzheimer’s.
In many dementias, late afternoons and early evenings are associated with worsened symptoms and increased aggressiveness. This phenomenon is known as sundowning.
Mood changes
Depression and anxiety commonly follow the onset of Alzheimer’s as a response to the life changes it brings.
Early on in progression, a person may be aware that their condition is worsening and that they’re losing grasp of their sense of self. This may create feelings of grief, fear, and anger.
Someone with Alzheimer’s will likely miss being able to drive or engage in hobbies and other activities they once enjoyed.
Loss of independence due to a health condition can be traumatizing, especially when someone is still aware of that loss. Feeling helpless can cause people to lash out in frustration.
If you notice behavioral and personality changes in someone with Alzheimer’s disease, start looking at some of the more manageable causes. Take note of possible triggers and patterns.
If your loved one is in a skilled nursing or assisted living facility, talk with the facility’s healthcare professionals about any patterns or triggers they have noticed.
Ask about what strategies may be effective and whether medications or schedule changes may help.
Medications
There are currently no medications approved by the Food and Drug Administration (FDA) to treat neuropsychiatric symptoms of Alzheimer’s disease.
However, multiple medications can help treat other symptoms of Alzheimer’s and slow its progression:
A 2021 study examining the effects of cholinesterase inhibitors and memantine in people with moderate Alzheimer’s suggests that the combination of the two drugs
Further study is needed, as these results have yet to be replicated.
Medications designed for one purpose may help in other ways. Antidepressants, for example, can help treat depression but may also help ease insomnia and improve sleep quality and quantity.
Talk with a healthcare professional about your loved one’s medication regimen. Ask that it be reviewed to:
- look for possible interactions or instances in which a drug may be eliminated
- be given at a lower dose
- be given at a different time of day
Health checkups
You want to rule out pain or other medical concerns, such as nausea or dizziness, as soon as possible. Any physical discomfort can lead to angry and aggressive behavior.
Ask whether the individual has been tested for a urinary tract infection or other infection or injury, such as a bedsore.
Try to make sure that your loved one has regular health assessments, and be attuned to nonverbal signs of discomfort.
Schedule adjustments
In some cases, changing parts of a person’s daily routine is enough to make a difference:
- Adjust bedtime.
- Change the times at which meals are served.
- Schedule appointments or activities in the morning instead of the afternoon or evening.
It’s important to update other loved ones when a person with Alzheimer’s is experiencing serious personality and behavior changes. This can make sure that everyone is on the same page.
Calming surroundings and activities
Approaches to make someone with Alzheimer’s feel more secure and at home include:
- adding family photos and familiar items in a new environment, such as a care facility
- avoiding too much clutter in a person’s space
- playing the person’s favorite music
- making time for enjoyable activities, such as making art, walking, or spending time with a therapy dog
- scheduling time with loved ones
Be prepared to shift things around if one activity causes irritability or anxiety. It may take several attempts to figure out what times of the day are best for certain activities.
Using a calm, reassuring voice is important when spending time with or caring for someone with dementia. If in a tense situation, try not to yell or become physical, unless you need to protect yourself from harm.
While not everyone with Alzheimer’s displays aggressive behavior, these symptoms are possible as the disease progresses.
The mental effects of Alzheimer’s can cause people with Alzheimer’s to become frustrated and upset. Medications and environmental factors can also contribute to aggressive behavior.
It’s important you keep yourself safe if you’re a caregiver. If you no longer feel you can manage caregiving for a loved one with signs of aggression and violence, discuss this with a care team immediately.