Agitation and Aggression

Why people with dementia sometimes become restless, angry or aggressive, how to find the trigger, what to say and do in the moment, and when medicine may help.

Last reviewed: October 2026

Few things shake a family more than seeing a gentle parent or spouse shout, push, or lash out. Agitation—restlessness, pacing, worry and an inability to settle—and aggression—verbal outbursts or physical hitting, pushing or grabbing—are common as dementia progresses, especially in the middle stage.

The most important thing to know: these behaviors are symptoms of brain disease, not deliberate meanness. And as the National Institute on Aging (NIA) puts it, most of the time agitation and aggression happen for a reason. Finding that reason is the key to helping.

Common triggers

Dementia damages the brain's ability to understand, communicate and cope. When a person can't explain what's wrong, distress may come out as agitation or anger. Look for:

Physical discomfort

Pain (arthritis, dental pain, constipation, headaches)
Hunger, thirst, a full bladder, tiredness
Infections—especially urinary tract infections, which can cause sudden behavior change
Medication side effects or interactions
Feeling too hot or too cold

Environment

Noise, clutter, crowds, glare or a TV that's too loud
A new place, new caregiver or change in routine
Late afternoon and evening—see Sundowning

Communication and emotions

Being rushed, corrected or argued with
Being pushed to do something that has become very hard, such as bathing, or to remember people and events (NIA)
Fear, loneliness, boredom or feeling a loss of control
Misunderstanding what's happening—for example, not recognizing a caregiver and thinking a stranger is in the house
Hallucinations or false beliefs—see Hallucinations and Delusions

In the moment: what to do

The Alzheimer's Association and NIA suggest:

Stay calm and speak softly. Your tone matters more than your words. Take a deep breath.
Don't argue, scold or try to reason. Logic rarely helps; reassurance does.
Back off and give space. If safe, step away for a few minutes.
Acknowledge feelings. "I can see you're upset. I'm here to help."
Reassure. "You're safe here." "I'll stay with you until you feel better."
Check for basic needs—pain, hunger, bathroom, temperature.
Redirect to something soothing: a snack, music, a walk, a familiar task, looking at photos.
Simplify the environment. Turn off the TV, reduce noise, add light.
Offer simple choices, such as two shirts instead of "What do you want to wear?"

Safety first. If you are in danger, leave the room and get help. Remove firearms from the home and lock up sharp objects and car keys. In an emergency, call 911 and tell the dispatcher the person has dementia.

Afterward: become a detective

Keep a simple log: What happened just before? What time? Who was there? What helped? Patterns often appear—such as agitation before lunch (hunger), during bathing (fear or cold), or after visitors (overstimulation). Changing the trigger often prevents the behavior.

Helpful long-term strategies include:

A predictable daily routine—see Daily Care and Routines
Daytime activity and exercise to use energy and improve sleep
Music, art and meaningful activities—see Non-Drug Treatments for Dementia
Limiting caffeine and keeping evenings calm
Better ways of approaching care tasks—see Communicating with Someone with Dementia

When to call the doctor

Contact a doctor promptly if:

Behavior changes suddenly—this can signal infection, pain, a medication problem or delirium
Aggression puts the person or others at risk
Agitation keeps happening despite your best efforts

The Alzheimer's Association emphasizes that anyone with behavioral symptoms should get a thorough medical checkup, especially when symptoms appear suddenly.

What about medication?

Non-drug approaches come first, and they work for many people. When symptoms are severe or dangerous, a doctor may consider medicine:

In 2023, the FDA approved brexpiprazole (Rexulti) as the first drug approved specifically for agitation associated with dementia due to Alzheimer's disease. In two 12-week studies, people taking 2 or 3 mg had meaningfully greater improvement in agitation scores than those on placebo.
Like other antipsychotic medicines, it carries a boxed warning that older adults with dementia-related psychosis treated with antipsychotics have an increased risk of death. It is not meant for "as-needed" use.
Other medicines—for pain, depression, anxiety or sleep—may help when they address the underlying cause.

Every medicine has risks, especially in older adults. Ask the doctor about goals, side effects and when to reassess. People with Lewy Body Dementia can be especially sensitive to antipsychotic drugs.

Take care of yourself

Living with aggression is exhausting and frightening. It is not your fault, and it doesn't mean you're failing. Talk with other caregivers, ask for respite, and seek counseling if you need it. See Caregiver Stress and Burnout and Helplines and Support Organizations—the Alzheimer's Association 24/7 Helpline is 800-272-3900.

Bottom line

Agitation and aggression in dementia usually have a cause—pain, fear, overstimulation, illness or unmet needs. Stay calm, reassure rather than argue, look for triggers, and keep everyone safe. Talk with a doctor about sudden changes and about whether treatment might help.

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.

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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.

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