A number of behavioral problems may be associated with Alzheimer’s disease. The word agitation is often used as an umbrella term to describe these behaviors. As Alzheimer’s progresses, most people with the disease experience agitation in addition to memory loss and other thinking problems.

In the early stages of the disease, people with Alzheimer’s may experience personality changes such as irritability, anxiety, or depression. As the disease progresses, other symptoms may occur, including sleep disturbances, delusions (firmly held belief in things that are not real), hallucinations (seeing, hearing, or feeling things that are not there), pacing, constant movement or restlessness, checking and rechecking door locks or appliances, tearing tissues, general emotional distress, and uncharacteristic cursing or threatening language.

Agitation may be caused by a number of different medical conditions and drug interactions or by any circumstances that worsen the person’s ability to think. Situations that may lead to agitated behavior include moving to a new residence or nursing home, other changes in the environment or caregiver arrangements, misperceived threats, or fear and fatigue resulting from trying to make sense out of a confusing world.

Agitated behavior can be disruptive and painful to both the person with the disease and the caregiver. Agitation may interfere with the ability of the person with the disease to carry out the activities of daily living, and it may increase the risk of harm to the affected individual and others. Caregivers may be frightened, upset, or simply exhausted by the demands of caring for a person who is agitated.

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A person exhibiting agitated behavior should receive a thorough medical evaluation, especially when agitation comes on suddenly. The treatment of agitation depends on a careful diagnosis, determination of the possible causes, and the types of agitated behavior the person is experiencing. With proper treatment and intervention, significant reduction or stabilization of the symptoms can often be achieved.

The symptoms of agitation often reflect an underlying infection or medical illness. For example, the pain or discomfort caused by pneumonia or a urinary tract infection can result in agitation. An untreated ear or sinus infection can cause dizziness and pain that affects behaviors. In some cases, prescription medication can cause agitation. This is most likely to occur when multiple medications are used, and the medications interact. Uncorrected visual or hearing loss may also lead to agitated behaviors. Treating the underlying medical condition may lessen the agitation.

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There are two distinct types of treatments for agitation: behavioral interventions and prescription medications. Behavioral interventions should be tried first. In general, steps to managing agitation include (1) identifying the behavior, (2) understanding its cause, and (3) adapting the caregiving environment to remedy the situation.

Correctly identifying what has triggered agitated behavior can often help in selecting the best behavioral intervention. Often the trigger is some sort of change in the person’s environment:

• Change in caregiver
• Change in living arrangements
• Travel
• Hospitalization
• Presence of house guests
• Bathing
• Being asked to change clothing
• Frustration in trying to communicate
• Being asked to do a task that is too difficult, or unfamiliar
• Environment is too large
• Environment is over-stimulating
• No contact with the outside, natural world

A key principle of intervention is redirecting the affected individual’s attention, rather than arguing, disagreeing, or being confrontational with the person. Additional intervention strategies include the following:

• Simplifying the environment
• Simplifying tasks and routines
• Allowing adequate rest between stimulating events
• Using labels to cue or remind the person
• Equipping doors and gates with safety locks
• Removing guns
• Using lighting to reduce confusion and restlessness at night
• Provide safe, supervised access to the out of doors.
  

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Medications can be effective in the management of some symptoms of agitation, but they must be used carefully and are most effective when combined with behavioral or environmental changes. Medications should target specific symptoms so that improvement can be monitored. People with Alzheimer’s disease are susceptible to side effects that require close observation. In general, it is best to begin treatment with a single medication and with low doses.

For more information, see Symptom Management (National Resource Center).

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