How to Respond to Anger and Aggression in Dementia

Understanding the Causes and Finding Ways to Cope

Some people living with Alzheimer's disease or other types of dementia remain easy-going. Others develop intense feelings of anger and aggression.

An angry man looking outside
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It's normal to feel surprised, discouraged, hurt, or even angry when someone with dementia lashes out at you for no obvious reason.

It's important to understand what causes anger in dementia. This will help you learn how to respond and cope in these situations.

This article looks at some of the reasons for anger and aggression in people with dementia. It also offers some coping tips for caregivers.

Angry Behavior in People with Dementia

When someone with dementia gets angry, they may:

  • Raise their voice
  • Throw things
  • Display combative behavior such as hitting, kicking, or pushing
  • Yell and scream
  • Try to physically attack you
  • Use foul language

Sometimes, there are warning signs. The person may raise their voice, scowl, or swing their arm at empty space.

Other times, you may not see it coming. This "no-warning" anger can be hard to cope with because it is unpredictable.

Anger and aggression are most likely to develop in the middle stages of dementia. At the same time, there may be other challenging behaviors like wandering, hoarding, and obsessive-compulsive behaviors.

6 Common Causes of Aggression

There are many reasons why people with dementia may become angry. Some are related to the disease itself. Others have to do with the emotional toll of dementia.

Loss of Recognition

People with dementia may not recognize their loved ones. This can cause fear, anxiety, and aggression.

For example, a wife with dementia may try to attack her husband. She may not do this out of anger but because she is afraid of the "strange man" in the house.

Paranoia, Delusion, and Hallucinations

People with dementia may also experience distortions of reality. For example, a person may have:

Not everyone with dementia has these symptoms. When they do, though, it can be difficult to handle.

People with lewy body dementia are more prone to having these symptoms. They can occur in all types of dementia, though.

People with frontotemporal dementia may become physically aggressive much sooner than people with Alzheimer's. This is because people with Alzheimer's have damage nearer to the back of the brain.

The frontal parts of the brain are responsible for:

  • Empathy
  • Impulse control
  • Personality
  • Judgment

The loss of these functions can lead to impulsive behaviors.

Poor Food Intake

Studies suggest poor eating habits and weight loss may be related to behavior problems in people with dementia.

In people without dementia, poor nutrition can affect mood, energy, and cognitive function. In people with dementia, it can fuel sudden outbursts and aggressive impulses.

You can help reduce angry outbursts by making sure the person you're caring for is eating the right foods. It will also help to keep the dining space calm.

Misunderstandings

Dementia affects communication. Someone with dementia may have trouble understanding what their caregiver is saying or doing.

The person you are caring for may not understand why you're trying to help. They may feel like you're just bossing them around. This can lead to conflict.

Caregiver Overload

As a caregiver, it's natural to have strong feelings from time to time. You may feel frustrated, angry, or impatient. Even if you aren't verbalizing those feelings, the person you are caring for may pick up on them. Sometimes they may reflect those feelings back to you.

A person with dementia may have catastrophic reactions. This is a sudden and disproportionate reaction to a seemingly normal situation. These reactions are often triggered by care. They can lead to anger and aggression.

Monitoring yourself for caregiver burnout and overload is important. This will help improve your own quality of life and also your loved one's.

8 Tips for Coping

One of these strategies may help you face the anger or aggression of the person you're caring for. Which one you choose will depend on the situation.

Give Space

Give the person a little space. Their resistance may be because they feel their personal space has been invaded and they don't know why.

Don't Argue

Arguing with someone who was dementia almost never works. This is true even if you think you have a clear point.

If you argue, you may just make the person angrier. You won't "win," and the situation may become worse.

Give Time

If you're helping the person complete a task and they become angry, back off for a few minutes. Make sure the person is safe to leave alone and give them some time.

You may find that trying the same task 20 minutes later will produce a completely different result.

Recap

It can help to give the person you're caring for some time and space. Avoid arguing with them and practice patience.

Use Distraction

Music can be a good distraction. Try playing some of your loved one's favorite songs. It may help lighten the mood and get the person in the right frame of mind to accept help.

You can also try other distractions, like favorite TV shows or sports moments.

One-on-One Interactions

Some people with dementia feel overwhelmed or threatened by multiple caregivers. It may help to limit interactions to one person at a time. More than one person can raise anxiety and trigger aggression.

Change Caregivers

People with dementia often benefit from routines. They may prefer a consistent caregiver. Sometimes, though, a different face can bring a different result.

If you're working in a care home and there are other staff present, try switching caregivers.

Recap

Try not to overwhelm the person with too many caregivers at once. If you are working in a care home, it may even help to switch caregivers.

Find the Cause

Look for a cause. Environment and physical factors can affect behavior. Pain, fatigue, hunger, or too much stimulation can trigger anger and aggression.

Look for patterns in behavior. For example, the person may tend to get angry in the evening.

Think about what happened before the outburst. Was there noise? A lot of visitors? Certain events or activities that triggered the reaction? The more triggers you can identify, the easier it will be to avoid them.

Ask the Doctor

Sometimes, dementia can provoke so much aggression and anger that the person and those around them are no longer safe. If this happens, it's time to call a doctor.

Medication should never be the first choice in dealing with challenging behaviors. There are times, though, when it may be needed. A doctor can evaluate this.

Summary

People with dementia sometimes become angry and aggressive. As a caregiver, you'll find it helpful to understand why this happens.

People with dementia may not recognize their loved ones. They may also have feelings of paranoia or hallucinations. These things can contribute to aggressive behavior.

Other factors like poor food intake, problems with communication, and caregiver overload can also play a role.

There are a few strategies that can help you cope with these situations. Give the person space and time, don't argue, and try to find distractions.

Don't overload the person with too many caregivers at once. It may also help to change caregivers.

It's important to determine the cause of an angry outburst. In some cases, you may need to ask a doctor for help.

A Word From Verywell

When your loved one gets angry, it can be hard to know how to respond. If you understand why it might be happening, you may find it easier to deal with.

Remember that your loved one is feeling anxious and distressed during this time. Patience and understanding will help you manage and respond to these challenging situations.

Frequently Asked Questions

  • What are common behavioral symptoms in dementia?

    Some of the most common signs are:

    • Agitation
    • Aggression
    • Anxiety
    • Depression
    • Psychosis

    These 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 the person is 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 at 800-272-3900.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Dettmore D, Kolanowski A, Boustani M. Aggression in persons with dementia: use of nursing theory to guide clinical practiceGeriatr Nurs. 2009;30(1):8‐17. doi:10.1016/j.gerinurse.2008.03.001

  2. Cerejeira J, Lagarto L, Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol. 2012;3:73. doi:10.3389/fneur.2012.00073

  3. Tzeng RC, Tsai CF, Wang CT, Wang TY, Chiu PY. Delusions in patients with dementia with Lewy bodies and the associated factors. Behav Neurol. 2018;2018:6707291. doi:10.1155/2018/6707291

  4. Liljegren M, Waldö ML, Englund E. Physical aggression among patients with dementia, neuropathologically confirmed post-mortemInt J Geriatric Psych. 2017;33(2):e242-8. doi:10.1002/gps.4777

  5. Collier S. What's the best way to manage agitation related to dementia? Harvard Health Publishing.

  6. UCSF Weill Institute for Neurosciences. Memory and Aging Center. Behavior & personality changes.