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Caring for Agitation in Alzheimer's Disease

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Agitation in Alzheimer’s Disease: A Guide

Medically Reviewed By Avi Varma, MD, MPH, AAHIVS, FAAFP

Agitation commonly appears in later stages of Alzheimer’s disease. Both nondrug alternatives and medications may help treat this symptom.

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Alzheimer’s is a progressive brain disease and is the most common form of dementia. Many people associate Alzheimer’s with its primary symptoms of memory loss and confusion. However, Alzheimer’s disease can also lead to behavioral changes, including agitation.

About 30–50% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of people with Alzheimer’s disease experience agitation. It can appear as restlessness, pacing, difficulty sleeping, or aggression.

When agitated, people with Alzheimer’s may find it even more difficult to think and perform certain functions. Agitation also links with more extended hospitalizations and greater use of medications.

Understanding how agitation may develop in people with Alzheimer’s disease can help you recognize this symptom and manage interactions.

Causes of agitation in Alzheimer’s disease

People living with Alzheimer’s disease may become agitated due to a combination of changes in the brain and stimuli happening around them or to them. These stimuli may include:

  • pain
  • illness
  • less sleep
  • changes in the routine or living environment
  • excessive noise or activity
  • being too hot or cold
  • difficulty using the bathroom
  • loneliness
  • sundowning, changes in behavior as the sun sets
  • medication interactions or side effects

Alzheimer’s disease can affect their ability to adapt to these stimuli. Agitation can be a possible outcome or result.

How to cope with agitation

When a person with Alzheimer’s disease is agitated, approach them calmly and reassuringly. Listen to their concerns and offer to help if possible. Sometimes, you can address the direct cause, such as adjusting the temperature in the room. Other times, engaging them in another activity as a distraction may be useful.

You can also try to prevent agitation in other ways. Ideas to consider include:

  • maintaining consistent daily routines, like mealtimes and bathing
  • keeping the environment quiet and soothing, being aware of lights, sounds, and clutter
  • avoiding boredom by providing opportunities for activity, such as reading, gentle exercise, and socialization
  • ensuring comfort by helping them go to the bathroom or relieve hunger, thirst, or pain
  • incorporating music therapy, which may be effective, according to a 2021 research review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source

Enlisting a doctor’s help with handling agitation

If new behavioral changes develop or become serious, experts recommend getting a doctor’s care. A complete medical examination can reveal whether there’s an underlying cause like infection, unmanaged pain, or drug interaction that may be treatable.

It’s important to use nonpharmacological alternatives when addressing agitation. However, medications may be helpful when symptoms are severe or when a risk of harm to self or others is present.

Brexpiprazole (Rixulti) is an atypical antipsychotic medication. It’s the first drug approved Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source by the Food and Drug Administration (FDA) for treating agitation associated with Alzheimer’s disease.

People can take this medication by mouth daily, and it acts on chemical pathways in the brain. Some clinical trials show there may be improvements in agitation by 12 weeks Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source .

Other medications doctors may use to treat Alzheimer’s disease symptoms include:

  • antidepressants, such as sertraline (Zoloft)
  • antipsychotics, such as olanzapine (Zyprexa)
  • sleep medications, such as suvorexant (Belsomra)
  • mood stabilizers, such as carbamazepine (Tegretol)

Takeaway

Potential risks and benefits link with all medications. For people with Alzheimer’s disease, experts recommend that caregivers start them with the lowest dose and closely monitor the response for any side effects or reactions.

Unpredictable behavior can develop as Alzheimer’s disease progresses. Understanding why these changes occur and where you can turn to if you need help is helpful. Reach out for professional support as necessary.

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  1. Alzheimer's disease and healthy aging. (2023). https://www.cdc.gov/aging/index.html
  2. Carrarini C, et al. (2021). Agitation and dementia: Prevention and treatment strategies in acute and chronic conditions. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085397/
  3. Coping with agitation and aggression in Alzheimer’s disease. (2017). https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-and-aggression-alzheimers
  4. Food and Drug Administration. (2023). FDA approves first drug to treat agitation symptoms associated with dementia due to Alzheimer’s disease [Press release]. https://www.fda.gov/news-events/press-announcements/fda-approves-first-drug-treat-agitation-symptoms-associated-dementia-due-alzheimers-disease

Medical Reviewer: Avi Varma, MD, MPH, AAHIVS, FAAFP
Last Review Date: 2023 Nov 17
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