Connection Between Alzheimer’s and Agitation
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Living with Alzheimer's Disease

Understanding the Connection Between Agitation and Alzheimer’s Disease

More than three-quarters of people with Alzheimer’s experience agitation as a symptom of the disease1, presenting a wide range of challenges for both patients and their caregivers.
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Information is provided below to help you better understand agitation associated with Alzheimer’s, how to spot it, and options for how to manage it.

What Agitation Looks Like.

Some identifiable symptoms of agitation due to Alzheimer’s include:
  • Increased physical aggression such as hitting, grabbing, shoving, kicking, biting, scratching, throwing objects, destroying property, and/or resisting2
  • Increased verbal aggression such as shouting, yelling, screaming and/or using profanity3
  • Excessive motor activity such as pacing, rocking, gesturing, pointing fingers4 , restlessness, and/or performing repeating mannerisms5
  • Increased emotional distress such as rapid changes in mood, irritability, and outbursts6 including crying7
  • Wandering8
  • Sleeplessness9

The Challenges for Individuals Living with Agitation.

Agitation and other behavioral symptoms due to Alzheimer’s are extremely common, affecting up to 90% of patients11. The emotional impact of agitation can be difficult to manage for patients and negatively affect both quality of life and disease progression. 12

Behavioral symptoms due to agitation can contribute to the financial burden of care and maintaining employment. Studies have shown these financial losses can amount to more than $7,000 annually, compared to $2,600 for patients not experiencing agitation13.

As agitation worsens and care becomes more difficult, many families may choose to move the patient to a long-term care facility14. This disruption to routine and loss of daily contact with loved ones can be particularly hard on patients, causing them added stress and anxiety.

The Challenges for Caregivers.

Patients with agitation require more care than non-agitated patients15 16, creating an increased burden on caregivers, family members, and the healthcare system.

The estimated annual healthcare cost for agitated patients is over $20,000 – more than double the cost of non-agitated patients 17.

Due to high costs of professional care, responsibilities often fall on the patient’s loved ones. As a result, caregivers for patients with agitation often sacrifice time otherwise spent working, potentially indirectly costing up to $5,000 annually in lost wages, nearly double the cost of care for patients without agitation 18. This increased need for care often results in a future loss of income for caregivers who are forced to sacrifice potential employment opportunities and career advancement19.

The challenges add up to financial and psychological difficulties that make it more difficult for caregivers to provide the necessary support for their loved ones. Studies show 30%-40% of family caregivers report experiencing symptoms of depression, compared to 5%-17% of non-caregivers of similar ages 20.

What Causes It.

Identifying the causes of agitation is vital to providing the best care possible. Symptoms can be triggered by a variety of causes including:
  • Insomnia
  • Sudden changes in routines or locations
  • Loud noises
  • Pressure from others to complete traditionally simple tasks that have become more difficult due to Alzheimer’s
  • Feeling lonely or detached from loved ones
  • Physical symptoms including diminished vision, hearing loss, and hunger or thirst10

How To Handle Agitation.

There are many ways to intervene, manage, and treat a patient exhibiting signs of agitation. When responding to agitation, it’s important to continuously document behavior and the frequency of disruptions to better help healthcare providers make informed decisions.

Two evidence-based areas for response are pharmacological interventions (medication administered by a healthcare professional) and non-pharmacological interventions (medication-free tactics)21 22.

Non-pharmacological treatments include:

  • Be Proactive: A good strategy is to stop symptoms stemming from agitation before they start. This can be accomplished by creating a calm, familiar environment for the patient and reducing the risk of potential triggers, such as loud noises 23.
  • Listen: If verbal symptoms of agitation occur, it is important to remain calm and listen to the patient’s concerns. Do your best to reassure them they are safe and provide as much comfort and support as you can 24. If the patient is agitated but non-verbal, more work should be done to understand the possible cause.
  • Collaborate with a Healthcare Team: Contact their healthcare provider to determine next steps and possible options. Share information about the patient’s behavioral symptoms and the frequency of these behaviors.
  • Take Care of Yourself: Caregivers often sacrifice their own wellbeing for that of the patient, which has costs. To provide the best care possible, it is important for caregivers to take breaks, get good sleep, and make sure physical needs are met.

Pharmacological interventions may include:
  • There are currently no medications to cure Alzheimer’s disease, however there are several medications that have been FDA-approved to address Alzheimer’s underlying biology and other drugs that treat the symptoms of the disease 25. These pharmacological interventions are administered in conversation with a healthcare provider.

For more information about Alzheimer’s-related dementia, visit BrainGuide’s resource page Living with Alzheimer’s Disease.
  1. https://content.iospress.com/download/journal-of-alzheimers-disease/jad210105?id=journal-of-alzheimers-disease%2Fjad210105
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  4. https://www.alzoc.org/agitation-and-aggression-associated-with-alzheimers-dementia-coping-strategies-for-caregivers/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  7. https://www.alzoc.org/agitation-and-aggression-associated-with-alzheimers-dementia-coping-strategies-for-caregivers/
  8. https://www.alzoc.org/agitation-and-aggression-associated-with-alzheimers-dementia-coping-strategies-for-caregivers/
  9. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease
  10. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483820/
  12. https://www.hopkinsmedicine.org/health/conditions-and-diseases/alzheimers-disease/beyond-memory-loss-how-to-handle-the-other-symptoms-of-alzheimers
  13. Herrmann, N., Lanctot, K., Sambrook, R., et al., “The Contribution of Neuropsychiatric Symptoms to the Cost of Dementia Care.” International Journal of Geriatric Psychiatry. 2006.
  14. Fillit, H., Aigbogun, M., Gagnon-Sanschagrin, P. et al, “Impact of Agitation in Long-Term Care Residents with Dementia in the United States”, International Journal of Geriatric Psychiatry. 2021; 36(12).
  15. Aigbogun S M, Stellhorn R, Hartry A, et al., “Treatment patterns and burden of behavioral disturbances in patients with dementia in the United States: a claims database analysis.” BMC Neurol. 2019;19(33). Doi:10.1186/s12883- 019-1260-3.
  16. Okura T, Langa KM. “Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: The Aging, Demographics and Memory Study” (ADAMS). Alzheimer Dis Assoc Disord. 2011;25(2):116-121. Doi:10.1097/WAD.0b013e318203f208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100441/
  17. Jones E, Aigbogun MS, Pike J, Berry M, Houle CR, Husbands J. “Agitation in Dementia: Real-World Impact and Burden on Patients and the Healthcare System.” J Alzheimer’s Dis. 2021;83(1):89-101. doi: 10.3233/JAD-210105. PMID: 34250934; PMCID: PMC8461728.
  18. Herrmann, N., Lanctot, K., Sambrook, R., et al., “The Contribution of Neuropsychiatric Symptoms to the Cost of Dementia Care.” International Journal of Geriatric Psychiatry. 2006. Studies have shown these financial losses to amount to over $7000 annually.
  19. Jones et al., 2021
  20. https://www.caregiver.org/resource/caregiver-statistics-health-technology-and-caregiving-resources/
  21. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
  22. https://link.springer.com/chapter/10.1007/978-3-030-60971-9_1
  23. https://www.healthline.com/health/alzheimers/alzheimers-agitation-aggression#treatment
  24. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease
  25. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory

What Agitation Looks Like.

Some identifiable symptoms of agitation due to Alzheimer’s include:
  • Increased physical aggression such as hitting, grabbing, shoving, kicking, biting, scratching, throwing objects, destroying property, and/or resisting2
  • Increased verbal aggression such as shouting, yelling, screaming and/or using profanity3
  • Excessive motor activity such as pacing, rocking, gesturing, pointing fingers4 , restlessness, and/or performing repeating mannerisms5
  • Increased emotional distress such as rapid changes in mood, irritability, and outbursts6 including crying7
  • Wandering8
  • Sleeplessness9

The Challenges for Individuals Living with Agitation.

Agitation and other behavioral symptoms due to Alzheimer’s are extremely common, affecting up to 90% of patients11. The emotional impact of agitation can be difficult to manage for patients and negatively affect both quality of life and disease progression. 12

Behavioral symptoms due to agitation can contribute to the financial burden of care and maintaining employment. Studies have shown these financial losses can amount to more than $7,000 annually, compared to $2,600 for patients not experiencing agitation13.

As agitation worsens and care becomes more difficult, many families may choose to move the patient to a long-term care facility14. This disruption to routine and loss of daily contact with loved ones can be particularly hard on patients, causing them added stress and anxiety.

The Challenges for Caregivers.

Patients with agitation require more care than non-agitated patients15 16, creating an increased burden on caregivers, family members, and the healthcare system.

The estimated annual healthcare cost for agitated patients is over $20,000 – more than double the cost of non-agitated patients 17.

Due to high costs of professional care, responsibilities often fall on the patient’s loved ones. As a result, caregivers for patients with agitation often sacrifice time otherwise spent working, potentially indirectly costing up to $5,000 annually in lost wages, nearly double the cost of care for patients without agitation 18. This increased need for care often results in a future loss of income for caregivers who are forced to sacrifice potential employment opportunities and career advancement19.

The challenges add up to financial and psychological difficulties that make it more difficult for caregivers to provide the necessary support for their loved ones. Studies show 30%-40% of family caregivers report experiencing symptoms of depression, compared to 5%-17% of non-caregivers of similar ages 20.

What Causes It.

Identifying the causes of agitation is vital to providing the best care possible. Symptoms can be triggered by a variety of causes including:
  • Insomnia
  • Sudden changes in routines or locations
  • Loud noises
  • Pressure from others to complete traditionally simple tasks that have become more difficult due to Alzheimer’s
  • Feeling lonely or detached from loved ones
  • Physical symptoms including diminished vision, hearing loss, and hunger or thirst10

How To Handle Agitation.

There are many ways to intervene, manage, and treat a patient exhibiting signs of agitation. When responding to agitation, it’s important to continuously document behavior and the frequency of disruptions to better help healthcare providers make informed decisions.

Two evidence-based areas for response are pharmacological interventions (medication administered by a healthcare professional) and non-pharmacological interventions (medication-free tactics)21 22.

Non-pharmacological treatments include:

  • Be Proactive: A good strategy is to stop symptoms stemming from agitation before they start. This can be accomplished by creating a calm, familiar environment for the patient and reducing the risk of potential triggers, such as loud noises 23.
  • Listen: If verbal symptoms of agitation occur, it is important to remain calm and listen to the patient’s concerns. Do your best to reassure them they are safe and provide as much comfort and support as you can 24. If the patient is agitated but non-verbal, more work should be done to understand the possible cause.
  • Collaborate with a Healthcare Team: Contact their healthcare provider to determine next steps and possible options. Share information about the patient’s behavioral symptoms and the frequency of these behaviors.
  • Take Care of Yourself: Caregivers often sacrifice their own wellbeing for that of the patient, which has costs. To provide the best care possible, it is important for caregivers to take breaks, get good sleep, and make sure physical needs are met.

Pharmacological interventions may include:
  • There are currently no medications to cure Alzheimer’s disease, however there are several medications that have been FDA-approved to address Alzheimer’s underlying biology and other drugs that treat the symptoms of the disease 25. These pharmacological interventions are administered in conversation with a healthcare provider.

For more information about Alzheimer’s-related dementia, visit BrainGuide’s resource page Living with Alzheimer’s Disease.
  1. https://content.iospress.com/download/journal-of-alzheimers-disease/jad210105?id=journal-of-alzheimers-disease%2Fjad210105
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  4. https://www.alzoc.org/agitation-and-aggression-associated-with-alzheimers-dementia-coping-strategies-for-caregivers/
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301197/
  7. https://www.alzoc.org/agitation-and-aggression-associated-with-alzheimers-dementia-coping-strategies-for-caregivers/
  8. https://www.alzoc.org/agitation-and-aggression-associated-with-alzheimers-dementia-coping-strategies-for-caregivers/
  9. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease
  10. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483820/
  12. https://www.hopkinsmedicine.org/health/conditions-and-diseases/alzheimers-disease/beyond-memory-loss-how-to-handle-the-other-symptoms-of-alzheimers
  13. Herrmann, N., Lanctot, K., Sambrook, R., et al., “The Contribution of Neuropsychiatric Symptoms to the Cost of Dementia Care.” International Journal of Geriatric Psychiatry. 2006.
  14. Fillit, H., Aigbogun, M., Gagnon-Sanschagrin, P. et al, “Impact of Agitation in Long-Term Care Residents with Dementia in the United States”, International Journal of Geriatric Psychiatry. 2021; 36(12).
  15. Aigbogun S M, Stellhorn R, Hartry A, et al., “Treatment patterns and burden of behavioral disturbances in patients with dementia in the United States: a claims database analysis.” BMC Neurol. 2019;19(33). Doi:10.1186/s12883- 019-1260-3.
  16. Okura T, Langa KM. “Caregiver burden and neuropsychiatric symptoms in older adults with cognitive impairment: The Aging, Demographics and Memory Study” (ADAMS). Alzheimer Dis Assoc Disord. 2011;25(2):116-121. Doi:10.1097/WAD.0b013e318203f208. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100441/
  17. Jones E, Aigbogun MS, Pike J, Berry M, Houle CR, Husbands J. “Agitation in Dementia: Real-World Impact and Burden on Patients and the Healthcare System.” J Alzheimer’s Dis. 2021;83(1):89-101. doi: 10.3233/JAD-210105. PMID: 34250934; PMCID: PMC8461728.
  18. Herrmann, N., Lanctot, K., Sambrook, R., et al., “The Contribution of Neuropsychiatric Symptoms to the Cost of Dementia Care.” International Journal of Geriatric Psychiatry. 2006. Studies have shown these financial losses to amount to over $7000 annually.
  19. Jones et al., 2021
  20. https://www.caregiver.org/resource/caregiver-statistics-health-technology-and-caregiving-resources/
  21. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory
  22. https://link.springer.com/chapter/10.1007/978-3-030-60971-9_1
  23. https://www.healthline.com/health/alzheimers/alzheimers-agitation-aggression#treatment
  24. https://www.nia.nih.gov/health/coping-agitation-and-aggression-alzheimers-disease
  25. https://www.alz.org/alzheimers-dementia/treatments/medications-for-memory