How to Respond to Anger and Aggression in Dementia

Understanding the Causes and Finding Ways to Cope

While some people living with Alzheimer's disease or other types of dementia remain pleasant and easy-going throughout their lives, others develop intense feelings of anger and aggression.

An angry man looking outside

When someone with dementia lashes out at you for seemingly no reason, it's normal to feel surprised, discouraged, hurt, irritated, and even angry at them. Learning what causes anger in dementia, and how best to respond, can help you cope.

Characteristic Behaviors

When persons with dementia become angry, they may raise their voice, throw things, display combative behavior such as hitting, kicking, or pushing, yell and scream at you or even try to physically attack you. Their language may become very colorful, even if they've never uttered a foul word before.

Sometimes, there are warning signs such as a loud voice, a scowl, or a swinging of the arm at empty space. But other times, it can be difficult to see the anger coming. It may seem to rise out of the blue. This "no-warning" anger can be the hardest to cope with because of its unpredictability.

Anger and aggression are the most likely to develop in the middle stages of dementia, along with other challenging behaviors such as wandering, hoarding, and obsessive-compulsive behaviors.

6 Common Causes of Aggression

There are many reasons why people with dementia may experience and express anger, some of which are related to the disease and others of which are associated with the emotional impact of dementia.

Loss of Recognition

People with dementia might not recognize their family members or friends, and this can cause fear, anxiety, and aggressive behavior. For example, a wife with dementia may try to attack her husband because she is afraid of the "strange man" in their house.

Paranoia, Delusion, and Hallucinations

Distortions of reality, such as paranoia, delusions, and hallucinations, can be another result of the disease process in dementia. Not everyone with dementia develops these symptoms, but they can make dementia much more difficult to handle.

Lewy body dementia, in particular, increases the likelihood of delusions and hallucinations, although they can occur in all types of dementia.

Progressive Brain Injury

If you're a caregiver for someone who has dementia, it can be helpful to remind yourself that their emotions are being affected by the disease. Dementia affects the brain, and the brain is responsible for more than just our memory and thought process.

The brain also controls our emotions and behaviors. So, depending on where the damage in the brain is, emotions may be affected as well.

People with frontotemporal dementia tend to display physically aggressive behavior far earlier than people with Alzheimer's (whose damage is situated nearer to the back of the brain).

The frontal parts of the brain are where the capacity for empathy, impulse control, personality, and judgment reside. The loss of these functions can lead to impulsive and unconstrained behaviors.

Poor Food Intake

Studies have shown an association between poor food intake, weight loss, and problematic behaviors in persons with dementia. Poor nutrition can affect mood, energy, and cognitive function in people without dementia. In people with dementia, the same deficiencies can fuel sudden outbursts and aggressive impulses.

Improving nutrition and ensuring that the dining space is calm can go a long way toward reducing angry outbursts.


Because dementia affects communication, the ability to understand what someone else is saying or doing is reduced. As a caregiver, you may mean only to be helpful, but the person with dementia might not understand why you're trying to help her or feel that you're trying to boss her around.

Caregiver Overload

If you as a caregiver are more frustrated, impatient, and angry, even if these feelings aren't verbalized, there's a good chance that the person with dementia will reflect these feelings back to you in their own behaviors.

Both your verbal and non-verbal communications can be picked up by the individual with dementia, and sometimes, like a mirror, projected back at you.

Catastrophic reactions, where a sudden and disproportionate reaction to a seemingly normal situation occurs, are often triggered by care. This "over-reaction" in emotions can cause anger and aggression.

Monitoring yourself for caregiver burnout and overload is important—not just for your own quality of life but also for your loved one.

8 Tips for Coping

Depending on the situation, try one of these strategies when faced with anger or aggression.

Give Space

Remember to give a little space to the person living with dementia. When you invade someone's personal space and they don't understand why, you can expect resistance or combativeness with care.

Don't Argue

You might be tempted to try to prove your point, but arguing with someone who has dementia is almost never effective. In fact, you normally will just make someone even angrier if you argue with them, and you won't "win."

Give Time

If you're trying to help someone brush her teeth and she becomes angry with you, make sure she's safe to leave alone and give her a little time. Trying the same task 20 minutes later can sometimes produce a completely different result.

Use Distraction

Sometimes, music can be a wonderful distraction. Try playing her favorite big band collection and singing with her for a few minutes before helping her get dressed. Or, play some Michael Jordan highlights while giving him a haircut.

One-on-One Interactions

Rather than having two or three people go to help you give someone a shower, use one person if at all possible. More than one person approaching someone with dementia can raise anxieties and trigger aggression.

Determine the Cause

When looking at causes of anger and aggression, don't forget to consider that pain, fatigue, hunger, or too much stimulation could contribute. Physical factors and environmental factors could affect behaviors and have to be carefully evaluated.

Look for patterns on timing (such as getting angry in the evening hours) as well as what happened before the outburst occurred. Was there a lot of noise, a flurry of visitors, or certain events (like bathing) that triggered a reaction? The more triggers you can identify, the better you will be at avoiding them.

Change Caregiver

If you're working in a nursing home or assisted living where there are other staff members present, try switching with a different caregiver if the person for whom you're caring becomes angry with you.

While it's more typical that routines (such as a consistent caregiver) are beneficial, it's also possible that a different face can sometimes bring a different result.

Ask the Doctor

Sometimes, dementia can provoke so much aggression and anger that those around the person just aren't safe, whether that's the caregivers or other residents.

If aggression and anger are putting the individual and those around him in danger, it's time to call the doctor. Medications should never be the first choice in responding to challenging behaviors, but there are times that they may be needed. The physician can evaluate this.

A Word From Verywell

It can be challenging to respond well when your loved one becomes angry with you. However, if you understand why it might be happening, you may find it a little easier to be patient and understanding, especially when you realize that it's likely that your loved one is feeling anxious and distressed during this time.

Frequently Asked Questions

  • What are common behavioral symptoms in dementia?

    Some of the most common signs are agitation, aggression, anxiety, depression, and psychosis. These behavioral and psychological symptoms affect about 90% of people with dementia.

  • How should you handle aggressive behavior from someone with dementia?

    Call 911 if you feel that you or someone else is in danger. If they are threatening you or physically lashing out, stay out of reach and close to an exit if possible. Try to stay calm and give them space to calm down as well. You can also get help by calling the Alzheimer's Association Helpline, 800-272-3900.

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6 Sources
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