Late Stage Symptom: Managing Agitation in Alzheimer's

Reviewed by: HU Medical Review Board | Last reviewed: June 2019 | Last updated: January 2023

As Alzheimer's disease progresses, behavioral symptoms can change and become more pronounced at each stage. While the physical and cognitive changes can be challenging, the behavioral symptoms can be especially distressing. There are treatments and strategies to help manage many of the behavioral symptoms, including agitation, but there is no cure for Alzheimer's yet.

Instead, the goal of treatment is to help mitigate symptoms, and various lifestyle modifications can help minimize disruption and improve quality of life.

Alzheimer's behavioral symptoms

Agitation is not being able to settle down or being overly worried. Agitation in Alzheimer's can lead to other behavioral symptoms like sleep disturbances and aggression, so address the agitation as it arises. As Alzheimer's disease progresses, a person with Alzheimer's may become agitated more often.

Finding the root causes or triggers of the agitation and addressing it can help reduce many of the accompanying symptoms and effects. There are various types of treatments and strategies that can be used to help manage agitation.

Causes of agitation

Agitation usually arises for a reason - something typically triggers it. If a cause for the agitation cannot be found, a visit to the doctor is in order. Sometimes medication interactions or even other medical conditions can cause agitation. Find out so that it can be addressed, which will then relieve the agitation or better prepare you when a situation does arise. Common causes of agitation in Alzheimer’s disease can include1,2:

  • Pain, depression, or stress;
  • Exhaustion from not enough sleep;
  • Changing of caregivers;
  • Moving to a new home or residence;
  • Change in everyday routine;
  • Soiled undergarments;
  • Overstimulation, ie. too much noise, too bright, too many people;
  • Loneliness

Preventing agitation in Alzheimer's patients

Preventing agitation before it begins can be very helpful. Avoiding known triggers is a big step in reducing the likelihood of agitation. Stay away from places or situations that are known to be too much and simplify the daily routine. Try to find a way to get some physical activity every day, and work to create a calm home environment. Keeping tabs on the person's basic needs like hunger, thirst, toileting, and fatigue can also go a long way in keeping their emotions and behavior stable.1

Treating agitation

It is typically preferable to try non-drug treatments first for some symptoms of Alzheimer's disease. If a person is on a heavy regimen of many medications, this can increase the risk of cognitive impairment or falls in this population. Many times, non-drug treatments or strategies are effective, and drug treatment isn’t necessary. Treatments, whether prescription or more holistic, will minimize symptoms for a period of time and help to increase the quality of life.

Non-drug treatments and strategies can include1,3:

  • Modifying the environment;
  • Providing reassurance and calming support;
  • Using distraction like art, exercise, helping with tasks;
  • Sensory enhancement - hand massage, sensory modulation;
  • Pet therapy;
  • Spending time with a trusted friend in a quiet environment;
  • Progressive muscle relaxation;
  • Meditation

If all else fails, it may be time to bring in the doctor

If a variety of non-drug treatments have been used consistently and repeatedly without rendering a positive effect on the agitation, it might be time to try medication. Antidepressant, anti-anxiety, or antipsychotic medication may be recommended by your doctor. Antipsychotics carry significant side effects for those with dementia.4

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