​Behavioural changes in persons living with dementia can occur as a result of changes in their brain.

The Department of Psychological Medicine from Changi General Hospital (CGH), a member of the SingHealth group, explains the common symptoms displayed by persons with dementia and offers caregivers tips on how to better manage these behaviour changes when caring for their loved ones with the condition.

Anger, agitation and aggression in persons with dementia 

Agitation is a state of heightened emotional response to provocation. 

In the context of dementia, a person with dementia may become agitated without provocation. Agitation is often associated with anxiety, anger and restlessness which may show as pacing, worry, etc.

Aggression is a further level of agitation in which the behaviours can be expressed through verbal abuse, threats, damaging property, physical violence towards another person or overreacting to a minor setback or criticism.

What to do when a dementia patient gets angry, agitated or aggressive

Dealing with aggressive behaviour is not easy. It is always useful to identify what triggers the aggression and find effective ways to manage it. 

It is also important to realise that the behavioural symptoms can be a form of miscommunication depending on how the person with dementia behaves. 

If you can establish what they are trying to communicate, it may prevent the person with dementia from feeling frustrated and acting aggressively.

6 Tips to manage agitation and aggressive behaviours in persons with dementia

1. Watch for signs of anger

Identify signs or behaviour indicating agitation or aggression. Distract them early with appropriate activities before an outburst.

2. Ensure a safe environment around you

Keep away any dangerous objects that can possibly cause harm (e.g., scissors, knife) to you and your loved one with dementia.

3. Show tenderness, love and care to the loved one you're caring for

Approach your loved one with dementia slowly and calmly; reassure him/her and acknowledge his/her feelings. Ensure that his/her needs are met (e.g., hunger, thirst, sufficient sleep). Try to adhere to their daily routines, environment and caregivers.

4. Avoid arguing further when the person with dementia gets angry

Stay calm and avoid an argument. A heated response from you may worsen the situation. If the person with dementia gets agitated or aggressive when you are caring for them, you can try to:

• Explain your actions in short, simple sentences – “I am going to help you remove your shirt” or if another person is present with you, “We are here to help you”.

• Ask yourself if what you are doing for the person really needs to be done at that moment. Give them some time and space and return in a while to gently try again.

If the person with dementia gets physically abusive: 

• Distance yourself from the person (at least one arm’s length) to prevent yourself from getting physically injured.

• Do not try to physically restrain or restrict the outburst of anger unless the person is causing harm to himself/herself or to others. Call for help if needed.

Causes of agitation and aggression in persons with dementia

1. Disease progression of dementia leading to loss of emotional control or control over behaviour.

2. Physical discomfort such as pain, fever, illness or constipation.

3. Fatigue due to sleep deprivation.

4. Defensive behaviour when independence and freedom are threatened.

5. Frustration due to inability to cope with daily tasks.

6. Fear of surroundings/people as the person with dementia can no longer recognise them.

7. Adverse reaction to medications.

8. Frustration as they are unable to communicate their needs (e.g., pain) clearly to the caregivers, and hence their needs are not fully attended to.

About BPSD (Behavioural and psychological symptoms of dementia)

Behavioural and psychological symptoms of dementia (BPSD) are neuropsychiatric symptoms and behaviours displayed by persons with dementia.

These symptoms constitute a huge aspect of dementia irrespective of its subtype, and they demonstrate a strong correlation with the degree of functional and cognitive impairment.

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Learn how to manage paranoia and delusion, click here.