Understanding Dementia And Anger: A Guide For Families And Caregivers

Caring for an individual with dementia can be uniquely challenging, particularly when anger and aggression are present. Emotional outbursts can be common in dementia patients, and they can be deeply distressing for families and caregivers. In this guide, we’ll explore the causes of dementia-related anger and aggressive behavior, plus offer some helpful tips for caregivers seeking to manage it. Caregivers may benefit from working with a mental health professional who can help them cope with the more challenging aspects of their responsibilities.

Understanding the connection between dementia and anger

Anger and aggressive behavior can be common symptoms in individuals with dementia, with research suggesting that these behaviors occur in approximately 30% to 50% of individuals over the course of the illness, although updated evidence may be needed. This may not only place a significant emotional and physical responsibility on caregivers, but it can also present a major challenge in caring for the individual’s safety and well-being.

To understand why anger can be common in dementia patients, it may help to understand how the disease affects the brain. The frontal lobe, which is primarily responsible for regulating emotions and behavior, is often compromised by Alzheimer’s disease and other types of dementia. As the disease progresses, frontal lobe dysfunction may impair a person’s ability to manage their emotional responses, often leading to outbursts of anger, although more recent research may be necessary.

Additionally, the serotonergic system, which typically regulates mood and aggression, is thought to play a role in the aggression seen in patients with dementia. Serotonin is a neurotransmitter primarily responsible for regulating mood and emotional arousal, and several studies have linked dementia-related changes in serotonergic function to aggressive behavior. 

Causes of anger and aggression in people with dementia

Individuals with dementia tend to become angry for the same reasons as those without dementia. However, the neurological effects of the disease can make it more challenging for them to regulate their emotions and communicate their needs, potentially leading to agitation or anger. Thus, it may be important for caregivers to remain attuned to the patient’s feelings and needs and identify any potential sources of irritability. 

Common causes of dementia-related anger can include the following: 

• Unmet needs: Hunger, thirst, sleep deprivation, needing to use the bathroom, etc.
• Physical discomfort: Pain, illness, being too warm or cold, uncomfortable clothing, constipation, etc. 
• Psychosis: Dementia-related hallucinations and paranoia can lead to anger or agitation
• Change in routine: Schedule disruptions, unfamiliar environments, and other sudden changes may be frustrating
• Overstimulation: Loud noises, crowded spaces, too much activity, strong lighting, etc.
• Issues with the caregiver: Communication issues, a lack of trust, or a strained relationship could trigger unpleasant emotions
• Medication side effects: Some medications may cause mood swings, irritability, or confusion, contributing to aggressive behavior
• Sense of loss of control: Individuals may find it frustrating or overwhelming when they cannot manage tasks they once could
• Depression: Depression commonly occurs with dementia and can lead to irritability, anger, or aggressive behavior

Sundowning and dementia-related anger

Sundowning, also known as sundown syndrome, generally refers to a state of increased confusion and irritability that many people with dementia experience in the late afternoon or evening. 

It is thought to be linked to the body’s circadian rhythms, which regulate the sleep-wake cycle, as well as increased levels of stress hormones, fatigue, reduced light exposure, and other medical and situational factors.

Anger and aggression may be more frequent or pronounced in the evenings, which can make it important for caregivers to ensure that the patient’s basic needs are met and to create a soothing evening routine later in the day. It may also help to discuss sundowning symptoms with a doctor, as certain medications can help manage symptoms at later hours.

How to manage anger in a person with dementia

For families and caregivers, learning to manage anger in someone with dementia often takes time and patience. Each individual is different, and there may be an adjustment period as you learn what works best. Try to remain empathetic, remembering that the person with dementia is not acting out of malice, but rather due to the effects of the disease. Consider the following tips for preventing and managing anger.

1. Identify causes

Anger in dementia patients often stems from unmet needs or environmental stressors. Look for patterns that could reveal specific causes, such as hunger, physical pain, or frustration from an inability to communicate. It can help to consider the circumstances that lead you to feel frustrated and to remain alert to potential issues that may cause distress.

2. Listen, understand, and communicate clearly

A helpful rule of thumb when caring for a person with dementia may be to remember that feelings and emotions may be more important than facts. Listen to what they may be trying to express or look for clues to help you understand. Due to the cognitive impairments caused by dementia, it may be necessary to use calm, simple language, avoiding arguing with or correcting them. 

3. Create a calm environment

Noisy, chaotic, or otherwise overstimulating environments can be upsetting for those with dementia. Try to create a relaxing environment by ensuring their living quarters are clean, pleasant, and softly lit. If the individual becomes agitated, it may help to guide them outside or to a different space to calm down, or to leave the room for a few minutes and give them space to relax. 

4. Maintain a routine

A consistent daily schedule can provide a sense of security and predictability, helping to reduce confusion and the frustration that often accompanies it. This can also help you ensure the individual’s basic needs are met throughout the day. A relaxing sundown routine may be particularly important, as individuals with dementia are often more prone to anger and aggressive behavior in the evenings.

5. Use redirection techniques

When a person with dementia becomes angry, you may be able to de-escalate by gently guiding their attention elsewhere. For example, you could offer them a comforting activity, such as looking at a photo album, engaging in a favorite hobby, or inviting them to go on a short walk with you. Redirecting their focus may remove them from the upsetting situation and redirect their mental energy.

6. Encourage physical activity and relaxation

Physical activity, like a short walk or gentle exercises, can release pent-up tension and reduce irritability, as well as improve sleep. Try to incorporate movement, and, if possible, exercise, into the individual’s daily routine to help maintain a positive mood. It can also help to designate some quiet time throughout the day for rest and relaxation. 

7. Consult a healthcare professional

If anger becomes difficult to manage, consult the individual’s doctor. They may recommend behavioral interventions or medications to help manage mood swings. You might also consider connecting with a nurse specializing in dementia care for guidance on identifying causes, managing behavioral challenges, and building effective care routines.

When anger becomes dangerous: Knowing when to seek help

While occasional anger may be a common symptom of dementia, there are times when it can escalate to dangerous levels. If a person’s anger causes them to become a threat to themselves or others, it may be necessary to contact emergency services. They can help subdue the individual and ensure their safety, and they can also put you in touch with social workers specializing in connecting families with home health care. 

While physical violence may be the most significant risk, verbal outbursts can take a toll on caregivers. If anger and aggression cause significant distress, it may be necessary to consult a healthcare professional for advice on managing these behaviors. It might also be worth considering seeking mental health support for managing stress and emotional challenges related to caregiving duties.

Mental health support for caregivers

Current scientific research overwhelmingly supports the use of cognitive behavioral therapy (CBT) for helping caregivers of people with dementia manage stress, anxiety, depression, and dysfunctional thinking patterns. 

With therapy platforms like BetterHelp, caregivers can access effective, low-cost, evidence-based therapy with a licensed therapist through a convenient online portal.

Online therapy can be just as effective as in-person therapy, and it may be preferable for caregivers who might otherwise have to arrange care for their loved one while they attend appointments. With tools and features like guided journaling, group sessions, and digital therapy worksheets, you can engage with therapy more deeply, potentially helping you work through the complex feelings associated with caring for your loved one.