Managing Challenging Behaviors

Why people with dementia may become agitated, suspicious, restless or aggressive, how to look for the cause, and calm, practical ways to respond and keep everyone safe.

Last reviewed: October 2026

Many families say the hardest part of dementia isn't the memory loss—it's the behavior changes. A gentle parent may snap, accuse a spouse of stealing, pace for hours, or refuse a bath. These moments can be upsetting, exhausting and sometimes frightening.

The single most helpful thing to remember comes straight from the National Institute on Aging (NIA): the disease, not the person, causes these changes. Behaviors are often a way of communicating a need the person can no longer put into words. With some detective work and a few calm strategies, many situations can be eased.

Common behavior changes

According to the NIA and the Alzheimer's Association, behavior changes in Alzheimer's and other dementias can include:

Anxiety, fear, or getting upset, worried and angry more easily
Seeming depressed or losing interest in things
Hiding things, or believing others are hiding or stealing things
Seeing or hearing things that aren't there (see Hallucinations and Delusions)
Feeling suspicious or threatened for little or no reason
Pacing, restlessness and Wandering
Asking the same question again and again (see Repetitive Questions and Behaviors)
Unusual sexual behavior
Hitting or lashing out (see Agitation and Aggression)
Trouble sleeping, or confusion that gets worse late in the day (Sundowning)

The NIA notes that behavior can vary a lot from day to day: some days the person may seem like themselves, and other days not. That is common.

First, look for the cause

The NIA says that most of the time, agitation and aggression happen for a reason. Before reacting to the behavior, try to find what is behind it. Common triggers listed by the NIA and the Alzheimer's Association include:

Physical discomfort: pain, hunger, thirst, constipation, a full bladder, tiredness, an infection, skin irritation, or a room that is too hot or cold
Problems seeing or hearing
Medicines: side effects of new medicines, or interactions between two medicines
Too much going on: noise, glare, a loud TV, many people talking at once, clutter
Change: a move, travel, a hospital stay, houseguests, or a new caregiver
Feeling rushed or pushed to do something that the disease has made very hard, such as bathing or remembering names
Emotions: sadness, fear, loneliness, boredom or a sense of loss—for example, missing the freedom to drive
Misreading the situation: the Alzheimer's Association describes "misperceived threats," such as mistaking a caregiver for a stranger

Keep a simple behavior diary

The NIA suggests that tracking behavior changes can help you and the doctor spot a pattern. Jot down:

What happened, and when
Who was there and what was going on just before
What helped—or made it worse

After a week or two, you may notice that outbursts happen at bath time, before lunch, or when the TV is loud.

How to respond in the moment

These tips come from the NIA and the Alzheimer's Association:

Stay calm and patient. Speak slowly and softly. Take a deep breath, or count to 10, if you feel yourself getting upset.
Don't argue or correct. You can't win an argument with dementia. Trying to reason usually adds to the distress.
Reassure. Simple phrases help: "You're safe here." "I'm sorry you're upset." "I'll stay with you until you feel better."
Listen to the feeling behind the words. If the person says someone stole their purse, the real feeling may be fear or loss of control. Respond to the feeling, then help "look for" the purse together.
Back off and give space. The Alzheimer's Association advises not to crowd, corner, restrain, criticize or ignore the person, and to avoid sudden movements out of their view.
Redirect. Offer a snack or drink, a favorite song, a walk, a photo album, or a simple task like folding laundry.
Offer simple choices. Two options ("the blue sweater or the red one?") give a sense of control without overwhelming.
Try gentle touch, if the person welcomes it.
Come back later. If a task like bathing is causing upset, stop and try again a little later or at another time of day.

More ideas are in Communicating with Someone with Dementia.

Prevent problems before they start

Keep a routine. The NIA recommends bathing, dressing and eating at about the same times each day.
Create a calm home. Reduce noise and clutter, and keep well-loved objects and photos around.
Let in daylight and plan time outdoors or by a window, which can help with late-day confusion.
Keep the person active. The NIA notes that physical activity can improve mood and sleep. Walking, gardening or dancing to music all count.
Simplify tasks. Break jobs into one step at a time.
Limit caffeine and alcohol, especially later in the day, and discourage long late-afternoon naps.
Watch your own stress. People with dementia often pick up on a caregiver's tension.

Safety comes first

Some behaviors can put the person or others at risk. The NIA advises:

Lock up or hide car keys, guns, kitchen knives and other items that could be used to cause harm.
Make sure the person carries ID or wears a medical bracelet in case they wander. See Wandering and Home Safety.
If the person becomes aggressive, stay at a safe distance until the behavior stops.
In an emergency, call 911 and tell the dispatcher the person has dementia.

What about medicines?

The Alzheimer's Association recommends non-drug approaches first, such as changes to the environment, structured routines and engaging activities. Medicines may help in some cases, but they carry real risks. For example, the Association notes that the FDA requires all atypical antipsychotics to carry a warning about an increased risk of death in older adults with dementia-related psychosis.

The Association lists two medicines that are FDA-approved specifically for agitation associated with dementia due to Alzheimer's: brexpiprazole (Rexulti) and dextromethorphan-bupropion (Auvelity), approved in April 2026. Any medicine decision should be made with the person's doctor, weighing benefits and side effects. See Treating Behavioral Symptoms and Antipsychotics and Dementia: Risks.

Take care of yourself, too

Living with challenging behaviors day after day wears down even the most loving caregiver. It's normal to feel frustrated, hurt or guilty. Taking breaks, joining a support group and asking for help are not signs of failure. See Caregiver Stress and Burnout and Respite Care.

When to see a doctor

The NIA says sudden or rapidly changing behavior—especially after an infection or a medicine change—should be brought to a doctor's attention right away. An infection, pain or a medicine problem can cause sudden confusion or agitation; sometimes this is delirium, which needs prompt medical care.
Ask for a checkup whenever behavior changes a lot, to rule out physical causes and medicine side effects.
Talk with the doctor if aggressive behaviors are getting worse or you no longer feel safe.

Help is available: the Alzheimer's Association 24/7 Helpline at 800-272-3900 and the NIA's ADEAR Center at 800-438-4380 can talk you through difficult situations and point you to local support.

Sources

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Ask a question

Have a question about memory, Alzheimer's, or caregiving? Email us at:

[email protected]

Open in my email app · Write in Gmail (opens in a new tab)

We may answer common questions in future updates (we won't share your name). We can't give personal medical advice; for urgent help call the Alzheimer's Association Helpline at 800-272-3900.

Memory Digest