Many people living with dementia go through times of restlessness, anger or fear. Some pace, shout or swear. Some push, grab or hit, often during personal care like bathing. This can be frightening and painful for families, especially when the person was always gentle before.

The good news is that agitation usually has a cause you can find. This page explains common triggers, gives calm steps to use in the moment, and tells you when to get urgent help.

Key points

The disease causes these changes. The person is not choosing to be cruel or difficult.²
Look for a trigger first: pain, infection, constipation, hunger, tiredness, noise, or a rushed task.^1,3
In the moment, keep everyone safe, stay calm, do not argue, and respond to the feeling, not the facts.^1,4
A sudden change in behavior can mean an infection or a medicine problem. Call the doctor the same day.^2,8
Call 911 if anyone is in danger. Tell the dispatcher the person has dementia.¹

What agitation and aggression look like

Agitation is a broad word for restless, upset behavior. The FDA describes it as anything from pacing or restlessness to verbal and physical aggression.⁷ You might see:

Restlessness: pacing, fidgeting, trying to leave, or not being able to settle
Verbal agitation: yelling, calling out again and again, swearing, or making threats
Physical aggression: pushing, grabbing, hitting, kicking, biting or throwing things

Nearly everyone with dementia has some change in behavior or mood over the course of the illness.⁶ The FDA calls agitation one of the most common and hardest parts of dementia care. It is also a leading reason people move into assisted living or a nursing home.⁷

Aggression often comes on quickly and may seem to come from nowhere. But there is usually a reason, even if the person cannot tell you what it is.¹

Why it happens

The main cause is the steady loss of brain cells.³ As the brain changes, it gets harder to make sense of what is happening, find words, and control strong feelings. So a small problem can feel huge, and the person may react with fear or anger.

Most episodes have a trigger. The table shows the common ones.

Kind of trigger	Examples
Body and health	Pain, infection (bladder, ear, sinus, chest), constipation, a full bladder, hunger, thirst, poor sleep, being too hot or cold, skin irritation, side effects of a new medicine^1,2,3
Senses	Hearing or vision loss that has not been corrected, such as missing glasses or hearing aids^2,3
Surroundings	Loud noise, a blaring TV, glare, clutter, crowds, unfamiliar people, a new home, a hospital stay, a new caregiver^1,3,4
Tasks and talk	Bathing or changing clothes, instructions with too many steps, many questions at once, being rushed or corrected^1,3,4
Feelings	Fear, feeling lost, misreading a helper as a threat, sadness, stress or boredom^1,2,4

Time of day matters too. Most people with dementia do best in the morning.¹ If agitation builds in the late afternoon or evening, read our page on sundowning.

Your own mood also counts. A person with dementia often picks up on a caregiver's stress or irritation, even without words.¹

Pain is often the hidden cause

A person with dementia may not be able to say "my hip hurts." Instead, they may strike out when you help them stand or dress.¹ Look for clues such as a tense or grimacing face, moaning, rubbing one spot, or pulling away when touched in a certain place.

Treating pain can calm agitation. In a Norwegian study of 352 nursing home residents with moderate to severe dementia, a step-by-step pain treatment plan lowered agitation scores by about 17% in eight weeks compared with usual care.⁵ Moderate evidence

Ask the doctor to check for pain, dental problems, constipation and infection whenever aggression is new or getting worse. Do not give pain medicine on your own without asking the doctor or pharmacist first. See Comfort in the final months for more on spotting pain in people who cannot describe it.

A sudden change is a medical warning sign. If agitation, confusion or drowsiness gets much worse over hours or a few days, the person may have delirium. Delirium is sudden, severe confusion caused by an illness or a medicine. It can swing between sleepiness and agitation.⁸ Common causes include bladder infections, pneumonia, and medicines such as sedatives, some pain medicines and anticholinergics (drugs that block a brain chemical, such as Benadryl).⁸ Call the doctor the same day, especially after a recent illness or medicine change.² Call 911 if the person cannot be woken, has trouble breathing, or shows stroke signs.

What to do in the moment

When the person is upset, your goal is calm and safety, not winning an argument. These steps come from Alzheimer's Association and National Institute on Aging advice.

Make sure everyone is safe. Step back and give the person space. Stand to the side, out of reach. Do not corner, crowd or hold them down.^1,4
Stay calm and slow. Speak softly and slowly. Keep your face and hands relaxed. Avoid sudden moves where the person cannot see you.^1,4
Do not argue or correct. Respond to the feeling behind the words. Try "You seem scared. I'm right here," or "You're safe. I'll stay with you."^1,4
Remove the trigger. Turn off the TV, ask visitors to step out, or move to a quieter room. If a task like bathing set it off, stop and try later.^1,4
Check basic needs. Could the person be in pain, hungry, thirsty, cold, tired, or need the toilet?³
Gently redirect. Offer a favorite song, a snack, a short walk, or a simple job like folding towels. Offer two easy choices instead of open questions.^1,2,4
Take a break if you need one. If the person is safe, it is okay to step away for a few minutes to calm yourself.¹
Write it down afterward. Note the time, place, what happened just before, and what helped. Patterns point to the cause.^1,2

Things that often help

A calm, low voice and a relaxed face
Short, simple sentences, one step at a time
Naming the feeling: "This is frustrating"
Music, gentle touch if welcome, a walk^1,4
A quiet room with soft light

Things that often make it worse

Raising your voice or showing alarm
Arguing about facts or saying "you already asked"
Rushing or giving many instructions at once
Grabbing, blocking the way, or restraining⁴
A noisy room, a loud TV, or many people talking

Use our behavior diary to track episodes. Bring it to the doctor. It works well with the DICE and ABC methods on our symptoms and behaviors page.

Preventing episodes

Many episodes can be avoided once you learn the person's triggers. Ideas that help:^1,2,3,4

Keep a steady routine for meals, bathing, dressing and bedtime. See Building a good daily routine.
Plan hard tasks for the best time of day, often the morning.
Break tasks into small steps and give one instruction at a time.
Build in rest between outings, visits and other busy times.
Keep the person moving. Physical activity can improve mood and sleep. See Meaningful activities.
Make the home calm. Cut background noise and clutter. Keep familiar photos and objects nearby.
Limit caffeine, especially later in the day.
Keep glasses and hearing aids clean, working and in use.

If bathing or dressing is the main flashpoint, see Refusing baths, help or medicine and Bathing, dressing and grooming. If the person is angry because they believe someone stole from them or is out to hurt them, see Hallucinations, delusions and paranoia.

Safety for everyone in the home

Most agitation passes without anyone getting hurt. But it is wise to plan ahead, especially if there has been hitting or threats.

Lock up or remove dangerous items, such as knives, tools and medicines.² Remove guns from the home or store them locked and unloaded, with ammunition kept apart. See Guns in the home.
Know your way out. When the person is upset, stay between them and an open door, not in a corner.
Keep your phone with you, with emergency numbers saved.
Protect others. Keep young children and pets away during an episode.
Ask for help if the person cannot calm down. Call a family member, neighbor or friend.¹
Make a plan with the doctor if aggression keeps happening. Ask about extra help at home or a break through respite care or adult day care.

If you call 911, tell the dispatcher right away that the person has dementia and that the behavior may be caused by the illness.¹ This helps responders approach calmly. Our page When a family member is in a mental health crisis explains crisis teams and other options in Virginia.

Where medicines fit

Non-drug steps come first for most people, and they should be tried consistently before medicine is added.^3,6 Treating a hidden cause, such as pain, can also ease agitation.⁵

A doctor may consider medicine when non-drug steps have been tried and have not worked, or when the person is at risk of harming themselves or others.³ In May 2023, the FDA approved brexpiprazole (Rexulti) as the first medicine for agitation linked to dementia due to Alzheimer's disease.⁷

All antipsychotic medicines, including brexpiprazole, carry a boxed warning. This is the FDA's strongest warning. Older adults with dementia who take them have a higher risk of death.⁷ They are also linked to a higher risk of stroke. They should never be used just to sedate or restrain a person.³ If medicine is used, the doctor starts low, watches closely for side effects, and uses it for the shortest time that helps.³

Never start, stop or change a medicine on your own. Talk with your doctor or pharmacist first. Read more in Medicines for agitation and behavior and Medicines that can worsen memory.

Taking care of yourself

Being yelled at or hit by someone you love hurts, even when you know the illness is to blame. Try not to take it personally.³ It is normal to feel shaken, sad or angry afterward.

If you ever feel close to losing control, put the person somewhere safe and step away. Get support before you reach that point. The Alzheimer's Association 24/7 Helpline at 800-272-3900 offers advice and referrals in more than 200 languages.³ See Caregiver stress and burnout and Caregiver training and support programs.

When to get help

Call 911 if anyone is in immediate danger, if someone is hurt, if there is a weapon, or if the person cannot be calmed and you cannot stay safe. Say the person has dementia.¹
Call 911 if the person suddenly cannot be woken, has trouble breathing, or shows signs of a stroke.
Call or text 988 (the Suicide and Crisis Lifeline) if the person talks about wanting to die, or if you feel hopeless or afraid you might hurt yourself or someone else. It is free, confidential and open 24/7, and it helps family members too.⁹
Call the doctor the same day for any sudden change in behavior, confusion or alertness.^2,8
Book a doctor visit if aggression is new, happening more often, or wearing you down. Ask for a full check for pain and other medical causes.³

Is the person doing this on purpose?

No. Dementia changes how the brain reads situations and controls feelings. The person may truly believe they are in danger. The disease, not the person, causes these changes.²

Will calling 911 get the person in trouble?

The goal of calling is safety for everyone. Tell the dispatcher about the dementia so responders know the behavior comes from an illness.¹ Afterward, ask the doctor to look for causes and make a plan.

Will the aggression last forever?

Not always. Behaviors often change as the disease moves through its stages. Finding and treating a cause, such as pain or an infection, can bring real relief.⁵ See Middle-stage dementia, when many behavior changes are most common.

Sources

Alzheimer's Association. Aggression and anger. Alzheimer's Association, accessed 2026. alz.org
National Institute on Aging. Alzheimer's caregiving: managing personality and behavior changes. NIH, accessed 2026. NIA
Alzheimer's Association. Treatments for behavior. Alzheimer's Association, accessed 2026. alz.org
Alzheimer's Association. Dementia-related behaviors (tip sheet). Alzheimer's Association, 2021. alz.org
Husebo BS, Ballard C, Sandvik R, Nilsen OB, Aarsland D. Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia: cluster randomised clinical trial. BMJ, 2011. BMJ
Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ, 2015. BMJ
U.S. Food and Drug Administration. FDA approves first drug to treat agitation symptoms associated with dementia due to Alzheimer's disease. FDA, 2023. FDA
MedlinePlus. Delirium. U.S. National Library of Medicine, accessed 2026. MedlinePlus
988 Suicide and Crisis Lifeline. 988 Lifeline. Substance Abuse and Mental Health Services Administration, accessed 2026. 988lifeline.org

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.

Agitation and aggression