Agitation and behavioral changes

The majority of dementia patients experience some form of behavioral symptoms, which may include restlessness, wandering, repetitive questions, loud vocalization, “sundowning”, being combative, hitting, sexual advances and being aggressive towards others including family members. This is usually addressed as agitation. This can be disruptive to others, as well as being a major concern for the comfort and safety of the patient. This is caused by physical changes in the brain and it is out of the control of the patient.

The four most common problems that cause agitation are physical/medical problems, environmental stresses, sleep problems and psychiatric syndromes.

Astrum Care - nutrition

  • May be occurring when an infection, bronchitis or pneumonia, dehydration or poor nutrition occurs.
  • Flare up of other pre-existing conditions like arthritis, heart disease, diabetes, that cause discomfort or symptoms undetected due to the limitation in the patient’s ability to verbalize.
  • Reaction to a new medication that may interact with existing medicines or cause side effects


  • If a hospitalization, dental procedure, or medical procedure occurs, it may cause confusion resulting in agitation.
  • A noisy, poorly lighted environment and or one that is too cold or hot.


  • May be caused by too much activity at bedtime or consuming beverages with caffeine.
  • “Sundowning” is a sleep pattern disturbance created by the internal clock of the brain that senses day and night and the right cycle to sleep is damaged. Generally, there is disorientation and confusion that grows worse as evening and night hours approach.


  • Psychosis
  • Psychosis means being out of touch with reality. There are two kinds of psychotic symptoms:
    – Delusions (incorrect beliefs).
    – Hallucinations (hearing, seeing, or smelling things that are not there).

  • Anger and Aggression
    Inability to control angry impulses exists that result in behaviors that are aggressive. Many times the patient misunderstands or misinterprets the actions of others and then the patient lashes because of fear or a sense of being mistreated.
  • Depression
    The changes in the brain may lead to depression, which is experienced by seeing the patient sad, withdrawn, tearful or fretful. The depression may lead to other concerns of poor appetite, excessive hand wringing and even trouble sleeping.
  • Anxiety
    May be observed as fidgeting, being nervous, or frightened. Patients with anxiety may become especially anxious when caregivers schedule change or when the routines change.

Managing agitation and associated behaviors may be difficult at times and is an area of specialty for the medical director and staff members of the facility or community where the patient resides.

Using non-pharmacological approaches first and adding medications only when necessary is the preferred pathway to treat agitation.

Each treatment for agitation should focus on the cause. The potential physical and medical causes may be related to symptoms from an infection, dehydration, poor nutrition, flare up of a chronic pre-existing condition, or reactions to medications.

Environmental stresses can cause agitation in a dementia patient – causes that include sitting or lying in one position for an excessive period of time, changes in routine, a noisy or poorly lit environment, or environmental temperature that is too hot or cold. Caregivers should make the appropriate adjustments in the environment in order to reduce the stresses that may be causing agitation. Closer and more frequent observation for environmental stresses may be required.

Problems with sleep or sleep cycle can cause agitation in a patient with dementia. These include trouble falling asleep as a result of too much stimulation before bedtime, depression or sundowning as a result of the brain’s internal clock being affected by dementia. After evaluating the situation and identifying causation, the items in the Astrum Sensory Care Kit can be helpful in alleviating the agitation.

Psychiatric syndromes that lead to agitation include delusions, hallucinations and psychosis. These need to be managed through by the patient’s physician to allow for early diagnosis and appropriate treatment.

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