Alzheimer’s Agitation: Why It Happens and What Can Help

Occasional annoyance or restlessness is part of life. But agitation related to Alzheimer’s disease goes beyond that.

Maybe you’ve noticed that small frustrations seem bigger than they used to. A change in plans throws off your entire day. A noisy room feels overwhelming. Or you feel upset and on edge without fully understanding why.

When you’re living with Alzheimer’s disease, agitation can be one of the most difficult symptoms to deal with — both for you and for the loved ones who care about you.

Neuropsychiatrist Dylan Wint, MD, explains what agitation is, why it happens and what may help.

What is agitation related to Alzheimer’s?

Agitation is one of many behavioral and emotional changes that can happen in Alzheimer’s disease. It’s a feeling of severe restlessness or emotional distress. You might feel unsettled, frustrated or unable to relax, without a clear reason why.

It can show up physically, too. You may:

• Pace around
• Fidget with objects
• Feel unusually irritable
• Have trouble sitting still
• Become upset more easily than before
• Repeat questions or concerns

“The majority of people with Alzheimer’s exhibit agitation sometime in the course of the disease,” Dr. Wint says. “And as the disease progresses, it becomes more common and more likely.”

Agitation can also escalate to aggression or cause other safety issues.

“If you’re agitated and pacing and there’s an unlocked door nearby, your pacing might lead you out the door,” he continues. “Then, without the cognitive ability to get back to the door you started from, you can end up lost.”

Examples of Alzheimer’s agitation

There’s no single experience of agitation. Everyone is different, and how one person experiences Alzheimer’s-related agitation may differ from how someone else experiences it. But in general, it may feel like:

• Emotional tension that won’t go away
• Being overwhelmed in busy environments
• Distress when routines change
• Becoming upset when you can’t remember something
• Feeling frustrated when performing tasks that used to be easy
• The need to keep moving

You may have days when you feel calm, confident and relatively clearheaded, followed by days when ordinary activities and challenges feel much harder to manage.

Why does it happen?

Researchers are still learning exactly why agitation develops. But experts believe it’s connected to Alzheimer’s-related changes in brain areas that manage the way you feel, behave and process information.

Many people think of Alzheimer’s as a disease that only affects thinking and memory. But even early on, it can also make it harder for you to manage emotions and deal with stress.

“The simplest way to put it is that all behavior originates in the brain — so when cognition is impaired because of brain changes, we shouldn’t be surprised when behavior is impaired, too,” Dr. Wint notes.

Memory changes likely play a role, too. When your brain has trouble accessing information, everyday situations can become confusing. That confusion can cause frustration, anxiety or agitation.

Imagine, for example, that your spouse tells you they’re going grocery shopping. You forget the conversation. As the hours pass, you’re left wondering where they are and why they didn’t tell you where they were going. That uncertainty can feel upsetting, which can quickly turn into agitation.

“Agitation is often a response of both fear and self-protection,” Dr. Wint explains. “If someone is living in a world that’s constantly filled with uncertainty and gaps, the human tendency is to try to fill those gaps.”

Other types of triggers that can contribute to agitation may include:

• Changes in routine
• Pain, discomfort or illness
• Biological needs, like being tired, hungry or having to use the bathroom
• Frustration, like about a task you can’t do or an idea you can’t express
• Environmental stressors, like being someplace very loud or crowded
• “Sundowning,” behavioral changes toward the end of the day
• Side effects of certain medications

What can help with Alzheimer’s agitation?

Dr. Wint shares strategies that can help you and your caregivers cope with — and maybe even fend off — agitation related to Alzheimer’s:

• Exercise. Staying physically active offers the brain extra protection. “It tends to reduce behavioral problems, particularly agitation and aggression,” Dr. Wint says.
• Spend time in nature. Outdoor activities have been shown to be especially beneficial to people with dementia. Going for walks, watering the plants and raking the leaves can all help give your brain a boost.
• Stay social. Spending time with others can help reduce behavioral issues associated with Alzheimer’s. “Social withdrawal is damaging to the brain,” Dr. Wint states, “whereas increasing social activity can help protect it.”
• Try touch therapy. Research shows that massage and other forms of gentle touch therapy may help reduce depression symptoms and agitation in people with Alzheimer’s.
• Ask about medication. In some cases, providers may recommend medication, some of which are specifically approved for this purpose, to help reduce agitation and improve overall well-being.

Caregivers can also play a critical role in managing and minimizing agitation. So, it’s important that your loved ones get the education and support they need.

“We try to help caregivers understand that agitation is often caused by an absence of information,” Dr. Wint explains. “That way, at times when your brain doesn’t allow you to access the information you need, they can step in to explain things and fill in some of those gaps.”

When to talk to your doctor

If you’ve been diagnosed with Alzheimer’s disease and you’re experiencing agitation, you’re not alone. Talk to your healthcare provider if you’re experiencing agitation that:

• Happens often
• Has become more intense
• Starts to affect your daily activities
• Causes you significant distress
• Puts you or others at risk of harm

Your doctor can help determine what’s contributing to your agitation and discuss possible treatment options.

“Medications aren’t typically the first approach to address agitation,” Dr. Wint clarifies. “But they may be considered when symptoms are severe or create safety concerns.”

Final thoughts

Many people with Alzheimer’s experience moments of restlessness, frustration or emotional distress. These feelings can be difficult, but they’re also a recognized part of the disease.

“Most importantly, they’re not your fault,” Dr. Wint emphasizes.

Understanding what’s happening is an important first step. The more you know about agitation, the better prepared you’ll be to manage it, ask for help when you need it and stay connected to the people who support you.