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    Dementia Symptoms & Caregiver Strategies: Managing Agitation and Aggression in Cognitive Impaired Adults

    People with cognitive difficulties may occasionally become agitated or aggressive. Agitation means that a person is restless or worried. He or she doesn’t seem to be able to settle down and may pace and/or experience sleeplessness. A person may also exhibit aggression by lashing out verbally or by trying to hit or hurt someone.

    Causes of Agitation and Aggression
    Most of the time, agitation and aggression occur for a reason. If can you understand what the underlying causes are, the behavior may improve. For example, the person could be experiencing:

    • Pain, depression, or stress
    • Too little rest or sleep

    • Constipation
    • Soiled underwear or diaper
    • Sudden change in a well-known place, routine, or person
    • A feeling of loss—for example, the person may miss the freedom to drive
    • Too much noise or confusion or too many people in the room
    • Being pushed by others to do something—for example, to bathe or to remember events or people—when the person’s cognitive impairment has made the activity increasingly hard or impossible
    • Feeling lonely and not having enough contact with other people
    • Interaction of medicines
    If you can, try and be aware of the early signs of agitation or aggression. If the signs are noticed when the behavior starts, you can deal with the cause before problem behaviors get worse. Ignoring the underlying cause or doing nothing often allows the behaviors to accelerate.

    Tips for Coping
    Here are some ways you can cope with agitation or aggression:
    • Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if your loved one is angry or fearful.
    • Allow the person to keep as much control in his or her life as possible.
    • Coping with changes is hard for someone with cognitive impairment. Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
    • Build quiet times into the day, along with activities.
    • Keep well-loved objects and photographs around the house to help your loved one feel more secure.
    • Try using gentle touching, soothing music, reading, or walks to calm the person.
    • Reduce noise, clutter, or the number of people in the room.
    • Try to distract the person with a favorite snack, object, or activity.
    • Limit the amount of caffeine, sugar, and “junk food” the individual drinks and eats.
    • Slow down and try to relax if you think your own worries may be affecting the person’s agitated behavior.
    • Try to find a way to take even a short break from caregiving
    Safety Concerns
    When the person you care for is aggressive, protect yourself and others. If you have to, stay at a safe distance from the individual until the behavior stops. Also, it may be a good idea to remove or hide weapons and sharp objects to protect both you and the person you’re caring for from hurting himself or herself.

    A doctor may also be able to help. A physician can give the person a medical exam to find any problems that may cause agitation and aggression such as pain or an infection. Also, ask the doctor if medication might necessary to prevent or reduce the agitation or aggression.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: