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Late Stage Symptom: Agitation

As Alzheimer’s disease progresses, symptoms can change and become more pronounced at each stage, particularly the behavioral symptoms. While the physical and cognitive changes can be challenging, the behavioral symptoms can be especially distressing to all parties involved. While there are treatments and strategies to help manage many of the behavioral symptoms, there is no cure, and no treatment will stop the symptoms or slow down the progression of the disease. Instead, the goal of these treatments is to help mitigate symptoms, and various lifestyle modifications can help minimize disruption and improve quality of life.

One such symptom is agitation, or not being able to settle down or being overly worried. Agitation 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 of the agitation and treating it early can help reduce many of the accompanying symptoms and effects of agitation. There are various types of treatments and strategies that can be used to help treat agitation, and although they won’t cure or slow down the progression of Alzheimer’s disease, they can help minimize symptoms.

Causes of agitation

Agitation usually arises for a reason; something typically triggers the agitation. If a cause for the agitation cannot be found, seeing the doctor is in order. Sometimes medication interactions or even other medical conditions can cause agitation. Find out the root cause so that it can be addressed, which will then relieve the agitation. 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

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 for the person 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 many symptoms of Alzheimer’s disease because many medications can increase the risk of cognitive impairment or falling in this population. Many times, non-drug treatments or strategies are effective, and drug treatment simply isn’t necessary. Treatments will not slow the progression of Alzheimer’s, but merely minimize symptoms for a period of time and help to increase quality of life.

Non-drug treatments and strategies can include1,3:

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

If a variety of non-drug treatments have been used consistently and repeatedly and don’t have a positive effect on the agitation, it might be time to try medication. Antidepressant, anti-anxiety, or antipsychotic medication may be used, although antipsychotics carry significant side effects for those with dementia.4 Talk with the doctor about the person’s specific symptoms of agitation and make sure there’s no underlying medical cause for the behavior. The doctor can work with loved ones to create a plan to treat agitation and to help minimize the symptom and its effect on the person’s life.

Written by: Jaime Rochelle Herndon | Last reviewed: June 2019
  1. Alzheimer’s Association. Anxiety and Agitation. 2019. https://www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation Accessed April 22, 2019.
  2. National Institute on Aging. Coping with Agitation and Aggression in Alzheimer’s Disease. 2017. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease Accessed April 22, 2019.
  3. Davies SJC, Burhan A, Kim D, Gerretsen P, Graff-Guerrerro A, Woo VL et al. Sequential drug treatment algorithm for agitation and aggression in Alzheimer’s and mixed dementia. J Psychopharmacol. 2018; 32(5): 509-523. Doi: 10.1177/0269881117744996 Accessed April 22, 2019.
  4. Alzheimer’s Association. Treatments for Behavior. 2019. https://www.alz.org/alzheimers-dementia/treatments/treatments-for-behavior Accessed April 22, 2019.