Handle agitation by staying calm, reducing demands and stimulation, checking for a medical or environmental trigger, and redirecting the person toward something comforting. If anyone could be harmed, step back, secure dangerous items when safe, and call 911 for an emergency while explaining that the person has dementia. In Alzheimer's disease, agitation may appear as restlessness, pacing, sleep difficulty, verbal outbursts, or physical aggression. A pattern that worsens in the late afternoon or evening is called sundowning, according to the National Institute on Aging.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- What to do during an episode
- What might be triggering the agitation?
- How can repeat episodes be reduced?
- When does agitation require medical or emergency help?
- When should medication be considered?
What to do during an episode
Lower your voice and listen without arguing. Reassure the person that they are safe and that you will stay with them. Try not to show frustration, even if the behavior feels unreasonable or personally directed.
Do not confront the behavior or press for an explanation. Offer a simple alternative that matches the person's abilities and interests: If the first option is refused, pause before offering another. Too many questions or choices can add pressure when the person is already distressed.
- A snack or drink
- Favorite music or a familiar program
- A walk
- Reading together
- A shared household activity
What might be triggering the agitation?
Look at what happened immediately before the episode. A task may have become difficult, the room may have grown noisy, or an established routine may have changed. The National Institute on Aging lists pain, constipation, inadequate sleep, medication interactions, loneliness, noise, routine changes, and pressure to complete difficult tasks as possible contributors.
Keep a brief record of the time, setting, activity, and possible trigger. Patterns may reveal that agitation follows poor sleep, a particular task, a crowded room, or a certain time of day. Contact the person's clinician when pain, constipation, medication problems, or another medical cause may be involved.
How can repeat episodes be reduced?
Build the day around a predictable routine. Keep familiar objects nearby, reduce noise and clutter, and allow adequate rest. Daylight and a comforting setting may help with late-day restlessness.
Match activities to what the person can comfortably manage. If bathing, dressing, or another task repeatedly causes distress, reduce the pressure and reconsider the timing or approach. Prepare easy redirection options before they are needed. Keep familiar music, a preferred program, reading material, snacks, and safe activities readily available.
When does agitation require medical or emergency help?
Seek medical advice when agitation worsens. NICE recommends a structured assessment for clinical and environmental causes, including pain, delirium, and care that may not suit the person's needs.
It also recommends psychosocial and environmental measures as initial and ongoing management. If aggression creates immediate danger:.
- Keep a safe distance.
- Secure knives, weapons, and other potentially harmful items when doing so will not put you at risk.
- Move away rather than arguing or trying to overpower the person.
- Call 911 in an emergency and tell responders that the person has dementia.
When should medication be considered?
Medication is not the default response to agitation. NICE advises generally reserving antipsychotics for severe distress or a risk of harm, using the lowest effective dose for the shortest time, and reviewing treatment at least every six weeks. These drugs can be especially problematic in Lewy body dementia and Parkinson's disease dementia.
In the United States, FDA-approved options specifically for agitation associated with dementia due to Alzheimer's disease include brexpiprazole and, since April 30, 2026, non-antipsychotic dextromethorphan-bupropion. As the FDA approval notice makes clear, these approvals do not cover agitation associated with every type of dementia. Before starting medication, ask which behavior it is intended to treat, how benefit will be judged, and when treatment will be reassessed. Confirm that the person's specific dementia diagnosis falls within the drug's approved use.
