Understanding Dementia Agitation : Causes, Treatment and Management

Dementia agitation is a set of behavior that is characterized by restlessness, irritability, trouble sleeping, and emotional distress in people with dementia. The person may show wandering, pacing, verbal, and physical aggression, or resistance to care.

It is a common problem in people with various forms of dementia including Alzheimer’s disease, vascular disease, and Lewy body dementia. According to a study, 90% of people with dementia eventually develop agitation and other behavioral symptoms.⁽¹⁾

Dementia agitation can be managed by knowing about the underlying cause and treating it.⁽²⁾ It can also be managed with a calm environment, emotional support and reassurance, and using medications and interventions as appropriate. The treatment can also be tailored according to individual needs under the guidance of a healthcare professional.

Dementia agitation affects both the individual as well as their caregivers.

It can increase the level of stress, anxiety, and confusion in the individual. They might start harming themselves or others physically. Their ability to participate in daily activities would gradually get affected, they may interact less with others and this in turn may affect their quality of life.

The caregivers can have a hard time managing the agitation in the individuals, which may increase their stress and burden. The caregivers may experience emotional distress when they see their loved one suffering. They may have feelings of guilt and helplessness. Also, dementia agitation may impact the ability of caregivers to provide effective care.

The causes of dementia agitation may include physical, psychological, and emotional factors.

• Physical and Emotional Stress: Any type of physical and emotional stress caused due to illness, fatigue or changes in mood can trigger agitation in a person suffering from dementia.
• Environmental Factors: Loud noises, unfamiliar surroundings, and changes in routine can stress out a person with dementia and lead to agitation.
• Pain and Discomfort: People with dementia when experiencing pain and discomfort due to physical conditions such as arthritis, infections, or injuries may experience agitation and restlessness.
• Neurological Changes: Dementia can lead to changes in the brain that can affect the behavior and emotion of a person.
• Medical Conditions: There are a few medical conditions such as vitamin deficiencies and thyroid disorders that may lead to agitation and other changes in behavior.

Dementia agitation can be challenging for an individual as well as their caregivers. It may also contribute to cognitive decline. Persistent agitation in dementia can be a reason for cognitive decline as well as a decline in the quality of life.⁽³⁾

It is important to seek help and support from a healthcare professional to help manage the symptoms of dementia and improve the overall quality of life.

The conventional treatments involved in dementia agitation include both pharmacological and non-pharmacological interventions.

The non-pharmacological interventions include:

• Creating a calm environment by adjusting the stressors including noise, clutter, and bright lights.
• Engaging in calming activities including music art and gentle exercises.
• Reducing over-stimulation by limiting exposure to external stimuli such as noise and chaotic environment.
• Providing sensory stimulation such as blankets and textured objects to help reduce agitation.

The pharmacological intervention includes medications to manage dementia. These include:

• Antipsychotic medications, which are used in the treatment of severe agitation in patients with dementia.⁽⁵⁾ But, these medications have side effects linked with them and hence should be used with caution.⁽⁶⁾ A person taking antipsychotics should be closely monitored by a healthcare professional and the caregiver.
• Antidepressants may be used for anxiety and depression that may contribute to agitation.⁽⁴⁾ These medications can increase the risk of heart issues in older people. Therefore, it is important to take them under a doctor’s guidance.
• Anxiolytic medications are also used for the treatment of anxiety to reduce agitation in some people.
• Always the treatment should start with non-pharmacological options. If they are ineffective, pharmacological options should be considered. The medications have benefits as well as side effects.

Benefits of medications used for dementia agitation include:

• Medication can effectively reduce agitation and bring down its frequency.
• It can sometimes reduce the risk of agitation and keep the patient from having aggressive and dangerous behavior.
• Agitation can sometimes disrupt sleep patterns. Medications can be helpful in improving sleep.

Drawbacks of using medications for treating dementia agitation include:

• The medication may have its own side effects such as sedation, confusion, and movement issues, especially in older adults.
• There is an increased risk of mortality in people using antipsychotic medications.
• The medication may provide short-term relief but may be lacking in long-term effectiveness. People may also develop tolerance to the medication gradually and the dosage may be needed to be increased or a change in medication would be required.
• The medication’s cost may also be an issue for some people as they may find them to be too expensive.

Other than conventional treatment there are alternative treatment options that can be effective in managing dementia agitation. These include:

• Music Therapy: This involves listening to music to calm and engage people with dementia. Music therapy can be effective in reducing agitation and improving mood in people with dementia.
• Massage Therapy: Gentle massage can be given to provide relaxation and reduce stress. Research shows it to be effective in reducing stress and improving overall well-being.⁽⁷⁾
• Acupuncture Therapy: In acupuncture therapy, thin needles are used to stimulate specific points in the body. Research shows that acupuncture can reduce anxiety and agitation in people with dementia.⁽⁸⁾
• Aroma Therapy: In aroma therapy, essential oils are used to promote relaxation and reduce stress. Certain essential oils including lavender and bergamot are mostly used to reduce agitation and improve sleep in the dementia patient.

Alternative treatments can be used in conjunction with conventional treatments. These treatments may have beneficial effects as well as a side effects. Therefore, a doctor should be consulted if planning to try any of the treatments along with the other.

Benefits of alternative treatments include:

• Alternative treatment may have fewer side effects than the conventional treatments
• They can be helpful in improving the quality of life
• Some of these therapies including music therapy or art therapy can be quite engaging and give people more control over their life.
• They can be helpful in reducing the reliability of the medications.

Drawbacks of alternative treatments include the following:

• Due to limited research, determining the safety and effectiveness of these treatments is difficult.
• Due to a lack of standardization, there may be significant variability in the quality and effectiveness of these treatments.
• Some of these treatments can be expensive and may also not be covered by insurance.
• The effect of these treatments is slow. This can delay the treatment.

Managing dementia agitation can be very challenging. There should be a proper plan to deal with it. Some of the best practices for managing dementia agitation include:

• Identifying Triggers: Identifying the trigger and avoiding them can be the best way to manage dementia agitation.
• Validation of Feelings: Acknowledging feelings and responding in a calm and reassuring manner can help de-escalate the situation.
• Create a Calm Environment: Creating a calm environment which includes reducing noise, ensuring a comfortable temperature, and creating a familiar and safe environment. This can help in managing agitation in people with dementia.
• Redirecting Attention: Redirecting attention to something else by engaging in calming activities, listening to music, watching a favorite movie or TV show or simple daily tasks can be helpful in reducing agitation.
• Take Medications Seriously: Taking the medications as prescribed by the healthcare professional is important to reduce dementia occurrence.
• Seek Support: Seeking support from family or friends can be helpful and can help cope with situations effectively.

Research is being done to look for more innovative treatments for dementia agitation. These include:

• Virtual Reality: This involves using headsets or a digital environment to reduce agitation in people with dementia. This therapy can be effective in improving mood, reducing anxiety, and increasing social attention.
• Sensory Therapy: This involves using aromatherapy, music therapy, or touch therapy to calm people. Studies show that it can calm agitation and improve mood.⁽¹⁰⁾
• Transcranial Magnetic Stimulation: This involves a magnetic pulse to stimulate nerve cells in the brain. This therapy is shown to improve cognitive function and reduce agitation in people with dementia.⁽¹¹⁾
• Cognitive Stimulation Therapy: This therapy involves engaging people with dementia in activities that stimulate the brain such as memory games, music therapy, and art therapy. This can be helpful in diverting attention from triggers and reducing the risk of agitation.
• Exercise Therapy: It involves physical activities such as walking, stretching, and resistance training. It can help improve mood, reduce anxiety, and increase physical functioning.

These innovative treatments prove to be promising but need more research.

Supporting a person with dementia agitation can be difficult. There are various conventional and non-conventional techniques that can help a person with agitation cope.

Caregivers and loved ones should work with the people in developing a care plan. A doctor can be helpful in identifying support options. Dementia agitation can be manageable if help is taken at the earliest.