Aggression and Anger
Written by Dr. Hao Huang
Updated at September 12th, 2025
Table of Contents
Aggression & Anger in Dementia
(For caregivers, family, and friends)
What it is
Aggression in dementia can be verbal (shouting, name-calling) or physical (hitting, pushing). It may happen suddenly or be triggered by frustration, discomfort, or environmental stress. The behavior is a symptom of the disease, not a choice. Understanding common causes and using calm, consistent responses can help.
Common causes (triggers)
| Triggers of Aggression/Agitation in Dementia |
|---|
| Pain |
| Infection (e.g., urinary tract infection) |
| Constipation |
| Hunger |
| Thirst |
| Being too hot or cold |
| Fatigue |
| Noise |
| Crowding |
| Unfamiliar places |
| Overstimulation |
| Feeling lost |
| Changes in routine |
| Not being understood |
| Unable to express needs |
| Medication side effects or interaction |
| Illness that cause agitation |
What to do in the moment (de-escalation)
Stay calm and give space. Keep your voice low and body language relaxed; avoid arguing or reasoning during escalation.
Validate feelings. “I can see you’re upset. I want to help.” Acknowledge emotion before trying to solve the problem.
Check basic needs. Offer the bathroom, water, a snack; assess for pain or discomfort.
Reduce stimulation. Turn down the TV, move to a quieter space, remove extra people.
Offer a simple choice or redirect. “Would you like to sit here or by the window?” Engage in a calming, familiar activity (fold towels, look at photos, listen to music).
Ensure safety. If there’s risk of harm, step back, remove hazards, and call for help.
Prevention tips (day-to-day)
Keep a routine for meals, medications, and sleep; avoid long, unstructured periods.
Track triggers with a simple log (what happened right before the aggression?). Adjust routines based on patterns.
Simplify communication: short sentences, one step at a time, allow extra time to respond.
Support comfort: regular pain checks, treat constipation, maintain hydration, comfortable clothing/temperature.
Create a calm environment: good lighting, familiar items, reduce background noise/clutter.
Meaningful, regular activity: light exercise, music, folding, safe chores to reduce restlessness.
Sleep: maintaining a regular sleep schedule and ensuring they get enough sleep
Remove or secure potential weapons: these can include tools or kitchen items
Keep track of emergency numbers: post them in plain view
When to seek urgent help
Immediate danger of harm to self or others: call 911 (U.S.) or local emergency services. If safe, move to a secure place and remove hazards.
About medications
Non-drug strategies come first (identify/treat causes, environment, routine). Medications may be considered if there’s severe, persistent risk despite these steps. However, note that medication treatment does have limitations in efficacy, and can also carry very serious side effects.
Sources & links
Alzheimer’s Association – Aggression & Anger
https://www.alz.org/help-support/caregiving/stages-behaviors/aggression-and-anger Alzheimer’s Association
Alzheimer’s Association – Anxiety & Agitation
https://www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation Alzheimer’s Association
NIA (NIH) – Coping with agitation, aggression & sundowning
https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning National Institute on Aging
NIA Tip Sheet – Managing agitation, aggression & sundowning
https://order.nia.nih.gov/publication/tips-for-managing-agitation-aggression-and-sundowning order.nia.nih.gov
Cleveland Clinic – Agitation (overview for patients)
https://my.clevelandclinic.org/health/symptoms/agitation Cleveland Clinic