Behavior changes, such as anger and aggression, can make caring for someone with dementia challenging. Understanding what might contribute to changes in behavior can help a person cope and respond appropriately.

Changes in personality and behavior are common in people with dementia. These changes may involve angry outbursts and aggressive behaviors such as shouting verbal threats, physical violence, and damaging property.

Understanding the reasons for their behavior can help prevent the behaviors from happening again and help caregivers respond and cope better.

This article explores anger in people with dementia and explores its causes. It also offers several tips to help caregivers cope with this behavior.

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There may sometimes be warning signs, such as changes in voice and facial expressions, when a person with dementia becomes angry. However, this anger may also occur spontaneously without apparent cause or due to seemingly small things.

Anger in people with dementia may present in physical or verbal forms:

  • yelling, screaming, and calling out
  • attempting to attack physically
  • verbal abuse such as making threats and insults
  • physical abuse such as pinching, biting, scratching, pinching, and pulling hair
  • throwing things

Learn about the early signs of dementia here.

According to the Alzheimer’s Society, aggression may have links to a person’s personality before dementia. However, people not known to be aggressive before having this condition can also change.

These behavior changes may begin in the middle to later stages of most types of dementia. They may become more noticeable as a person needs more hands-on help to perform daily activities such as dressing and eating. It increases with time and is observable more in older adults within institutions.

Learn more about the different stages of dementia and its progression.

Dementia occurs when once-healthy neurons and nerve cells in the brain stop working and die. This results in the loss of cognitive functions such as reasoning, memory, problem-solving, and judgment.

These symptoms may make a person with dementia feel embarrassed, frustrated, and patronized, causing them to react with meanness and anger.

Below are some potential causes of anger relating to symptoms of dementia.

Lack of recognition

People with dementia may no longer remember people, even those close to them. This may cause fear and anxiety and may make them feel threatened.

Learn more about short- and long-term memory loss.

Misunderstanding

Communicating with people with dementia may become more difficult as they lose their ability to understand what others say.

People with this condition may think their caregivers are wrong and misunderstand or misinterpret them. They may get frustrated, misinterpret, or feel frightened, leading to angry outbursts.

Confusion

As the disease progresses, a person may no longer be able to identify people and places. This can make someone feel confused and lead to anger or aggression.

Learn more about what causes confusion.

Paranoia and delusions

A person with dementia may hold irrational thoughts that can make them feel fearful and anxious. They may become paranoid and become suspicious of the people around them.

Without resolution of these thoughts, they may progress into delusions. When others challenge these delusions or paranoid behaviors, a person may react aggressively.

Hallucinations

Hallucinations are false perceptions affecting the senses that appear real but originate from the mind.

Tactile hallucinations, such as the feeling of insects crawling on their skin, or visual hallucinations, such as seeing dead loved ones, may cause fear and confusion that can lead to angry outbursts.

Environmental factors

According to the Alzheimer’s Association, many people with dementia function better in the mornings and are more alert at certain times. They may feel overwhelmed with unfamiliar surroundings and people or when there are loud noises, physical clutter, or an overactive environment.

Many factors can also trigger it, such as:

  • physical discomfort, including pain, hunger, and a lack of sleep
  • frustration from the inability to do simple tasks
  • side effects from medications
  • emotional triggers such as feeling overwhelmed, lonely, or bored
  • mental triggers, such as the loss of train of thought and mixed-up memories

Individuals may also lose their ability to control their impulses and regulate their emotions. This makes them express their anger in outbursts instead of showing it in other ways, such as withdrawal or silence.

Caregiver burnout

Sometimes, a person with dementia may pick up on their caregiver’s frustration, impatience, and anger despite not verbalizing them. They may reflect their feelings to their caregiver.

A 2020 study on the association between caregivers’ burden and neuropsychiatric symptoms in people with Alzheimer’s disease found that crying spells and agitation have specific associations with moderate to severe caregiver burden.

Although anger and aggression can be distressing and frustrating for caregivers, there are steps people can take to cope with these behaviors.

Below are several tips from the Alzheimer’s Association to help caregivers respond to angry outbursts and changing behaviors.

Try to identify the origin or cause

Caregivers should try to recall what happened before the reaction that may have triggered someone’s behavior. There may also be patterns when they become angry, such as during a certain time. It is also essential to rule out pain, hunger, boredom, and lack of sleep.

Discover the link between sleep and dementia here.

Distract them

Distraction can help take a person’s mind off a trigger, such as confusion or a fixation on an irrational thought. Changing the scenery, doing an activity, playing music, or telling a story can help divert the person’s attention.

Respond appropriately

A caregiver should not try to talk the person with dementia out of their beliefs or argue with them. It may be best to ask questions to allow them to express their feelings.

If they try to attack physically, a person should avoid physical contact and never react to the violence with force. If they threaten the safety of themselves, their caregiver, or someone else, then seek the help of others, such as calling 911. If a person calls 911, they should tell them that the individual has dementia.

Give them space and time

Caregivers may take a step back or remove themselves from the situation or the room to give the person time to calm down. This may help dispel their anger.

Respond calmly

People with dementia can detect distress and anger in others and may mirror these emotions or worsen their anger. Caregivers should always respond with a calm tone of voice and be aware of their reactions.

Do not take attacks personally

The things a person with dementia says in anger are often due to triggers or confusion. They are not trying to intentionally hurt others.

Caregivers can be understanding and patient with what they are trying to express.

Read more on how to care for a person with dementia.

Talk with a healthcare professional

Their behavior may be secondary to an infection or a painful condition, sleep problems, side effects of medications, and constipation.

A medical examination can help identify any underlying issues.

Several nonmedical treatments may help caregivers manage anger in people with dementia. They include:

  • improving communication strategies
  • placing them in a familiar and calm environment
  • using signs and labels
  • doing activities such as crafts and looking through their memory book
  • establishing a consistent routine
  • scheduling visits during their “good days”
  • doing regular physical activity and exercise

Antipsychotics and other drugs may help alleviate their aggression but do not address their underlying cause. They may also come with side effects and increased mortality.

Anger and aggressive behavior belong to a group of symptoms that doctors call behavioral and psychological symptoms of dementia.

According to the National Institute on Aging, other behavior changes that may accompany anger include:

  • pacing, wandering, and fidgeting
  • hoarding
  • hiding things or believing other people are hiding things
  • restlessness, such as continuous pacing
  • delusions and hallucinations
  • depression or apathy, which refers to disinterest in their usual activities
  • misunderstanding what they see or hear

When outbursts become out of control, a person may become unsafe to themselves and those around them. When this happens, it is best to speak with a healthcare professional.

Medications may not be the first choice in managing challenging behaviors. However, when caregivers cannot identify the cause of the anger and it remains persistent, a doctor may evaluate if medications can help.

Here are some answers to common questions about dementia and anger.

How long does the angry stage of dementia last?

There is no specific “angry stage” in dementia. However, pronounced mood, personality, and cognitive function changes often appear during the middle or moderate stage of dementia.

This middle stage of dementia is the longest and can last many years.

How can I explain something to someone with dementia without them getting angry?

Caregivers may need to manage their expectations and know what kinds of conversations a person with dementia can hold. Holding complex and lengthy discussions with a person with the condition may only trigger frustration or anger.

It is essential to use a calm tone of voice and be aware of a person’s body language and facial expressions. Speak slowly and clearly, using short and simple sentences. Talk with them with respect, not as children.

Because a person with dementia has short-term memory loss, it is important not to include information about the recent past when explaining it to them. Do not bombard them with information. Instead, ask questions one at a time and give them time to process and respond.

Additionally, explain with “I” statements, such as “I think we could take a break and sit down,” versus “You should stop doing that because you might hurt yourself.”

What are signs that dementia is getting worse?

The progression of dementia and its symptoms vary from person to person. However, these signs generally indicate that the condition is progressing and getting worse:

  • significant personality and behavior changes
  • increasing need for assistance to total dependence on daily tasks
  • more substantial loss of memory, including memories in the distant past such as names of people, birthdays, weddings
  • loss of physical capabilities, such as walking, head control, swallowing, and bladder and bowel function
  • increased vulnerability to infections

As the disease progresses, people with dementia may behave differently and act aggressively or become angry. It is helpful for caregivers to be understanding and compassionate.

Dementia symptoms, such as hallucinations, paranoia, confusion, and a lack of awareness, can contribute to aggressive behavior. Other factors, such as physical illness, caregiver burnout, and sudden environmental changes, can also play a role.

Learning about possible triggers and adopting strategies, including not arguing, giving them space, and responding calmly, may help caregivers prevent angry outbursts and better manage them.