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Understanding what might contribute to changes in behavior can help a person cope and respond appropriately. Changes in personality and behavior are common in people with dementia. These changes may involve angry outbursts and aggressive behaviors such as shouting verbal threats, physical violence, and damaging property. Understanding the reasons for their behavior can help prevent the behaviors from happening again and help caregivers respond and cope better. This article explores anger in people with dementia and explores its causes. It also offers several tips to help caregivers cope with this behavior. Anger in people with dementia Share on PinterestThe Good Brigade/Getty ImagesThere may sometimes be warning signs, such as changes in voice and facial expressions, when a person with dementia becomes angry. However, this anger may also occur spontaneously without apparent cause or due to seemingly small things. Anger in people with dementia may present in physical or verbal forms:yelling, screaming, and calling outattempting to attack physicallyverbal abuse such as making threats and insultsphysical abuse such as pinching, biting, scratching, pinching, and pulling hairthrowing things Learn about the early signs of dementia here. According to the Alzheimer’s Society, aggression may have links to a person’s personality before dementia. However, people not known to be aggressive before having this condition can also change. These behavior changes may begin in the middle to later stages of most types of dementia. They may become more noticeable as a person needs more hands-on help to perform daily activities such as dressing and eating. It increases with time and is observable more in older adults within institutions. Learn more about the different stages of dementia and its progression. Causes Dementia occurs when once-healthy neurons and nerve cells in the brain stop working and die. This results in the loss of cognitive functions such as reasoning, memory, problem-solving, and judgment. These symptoms may make a person with dementia feel embarrassed, frustrated, and patronized, causing them to react with meanness and anger. Below are some potential causes of anger relating to symptoms of dementia. Lack of recognition People with dementia may no longer remember people, even those close to them. This may cause fear and anxiety and may make them feel threatened. Learn more about short- and long-term memory loss. Misunderstanding Communicating with people with dementia may become more difficult as they lose their ability to understand what others say. People with this condition may think their caregivers are wrong and misunderstand or misinterpret them. They may get frustrated, misinterpret, or feel frightened, leading to angry outbursts. Confusion As the disease progresses, a person may no longer be able to identify people and places. This can make someone feel confused and lead to anger or aggression. Learn more about what causes confusion. Paranoia and delusions A person with dementia may hold irrational thoughts that can make them feel fearful and anxious. They may become paranoid and become suspicious of the people around them. Without resolution of these thoughts, they may progress into delusions. When others challenge these delusions or paranoid behaviors, a person may react aggressively. Hallucinations Hallucinations are false perceptions affecting the senses that appear real but originate from the mind. Tactile hallucinations, such as the feeling of insects crawling on their skin, or visual hallucinations, such as seeing dead loved ones, may cause fear and confusion that can lead to angry outbursts. Environmental factors According to the Alzheimer’s Association, many people with dementia function better in the mornings and are more alert at certain times. They may feel overwhelmed with unfamiliar surroundings and people or when there are loud noises, physical clutter, or an overactive environment. Many factors can also trigger it, such as:physical discomfort, including pain, hunger, and a lack of sleepfrustration from the inability to do simple tasksside effects from medicationsemotional triggers such as feeling overwhelmed, lonely, or boredmental triggers, such as the loss of train of thought and mixed-up memories Individuals may also lose their ability to control their impulses and regulate their emotions. This makes them express their anger in outbursts instead of showing it in other ways, such as withdrawal or silence. Caregiver burnout Sometimes, a person with dementia may pick up on their caregiver’s frustration, impatience, and anger despite not verbalizing them. They may reflect their feelings to their caregiver. A 2020 study on the association between caregivers’ burden and neuropsychiatric symptoms in people with Alzheimer’s disease found that crying spells and agitation have specific associations with moderate to severe caregiver burden. Tips for responding and coping Although anger and aggression can be distressing and frustrating for caregivers, there are steps people can take to cope with these behaviors. Below are several tips from the Alzheimer’s Association to help caregivers respond to angry outbursts and changing behaviors. Try to identify the origin or cause Caregivers should try to recall what happened before the reaction that may have triggered someone’s behavior. There may also be patterns when they become angry, such as during a certain time. It is also essential to rule out pain, hunger, boredom, and lack of sleep. Discover the link between sleep and dementia here. Distract them Distraction can help take a person’s mind off a trigger, such as confusion or a fixation on an irrational thought. Changing the scenery, doing an activity, playing music, or telling a story can help divert the person’s attention. Respond appropriately A caregiver should not try to talk the person with dementia out of their beliefs or argue with them. It may be best to ask questions to allow them to express their feelings. If they try to attack physically, a person should avoid physical contact and never react to the violence with force. If they threaten the safety of themselves, their caregiver, or someone else, then seek the help of others, such as calling 911. If a person calls 911, they should tell them that the individual has dementia. Give them space and time Caregivers may take a step back or remove themselves from the situation or the room to give the person time to calm down. This may help dispel their anger. Respond calmly People with dementia can detect distress and anger in others and may mirror these emotions or worsen their anger. Caregivers should always respond with a calm tone of voice and be aware of their reactions. Do not take attacks personally The things a person with dementia says in anger are often due to triggers or confusion. They are not trying to intentionally hurt others. Caregivers can be understanding and patient with what they are trying to express. Read more on how to care for a person with dementia. Talk with a healthcare professional Their behavior may be secondary to an infection or a painful condition, sleep problems, side effects of medications, and constipation. A medical examination can help identify any underlying issues. Treatment Several nonmedical treatments may help caregivers manage anger in people with dementia. They include:improving communication strategiesplacing them in a familiar and calm environmentusing signs and labelsdoing activities such as crafts and looking through their memory bookestablishing a consistent routinescheduling visits during their “good days”doing regular physical activity and exercise Antipsychotics and other drugs may help alleviate their aggression but do not address their underlying cause. They may also come with side effects and increased mortality. Other behavioral symptoms Anger and aggressive behavior belong to a group of symptoms that doctors call behavioral and psychological symptoms of dementia. According to the National Institute on Aging, other behavior changes that may accompany anger include:pacing, wandering, and fidgetinghoardinghiding things or believing other people are hiding thingsrestlessness, such as continuous pacingdelusions and hallucinationsdepression or apathy, which refers to disinterest in their usual activitiesmisunderstanding what they see or hear When to speak with a doctor When outbursts become out of control, a person may become unsafe to themselves and those around them. When this happens, it is best to speak with a healthcare professional. Medications may not be the first choice in managing challenging behaviors. However, when caregivers cannot identify the cause of the anger and it remains persistent, a doctor may evaluate if medications can help. Frequently asked questions Here are some answers to common questions about dementia and anger. How long does the angry stage of dementia last There is no specific “angry stage” in dementia. However, pronounced mood, personality, and cognitive function changes often appear during the middle or moderate stage of dementia. This middle stage of dementia is the longest and can last many years. How can I explain something to someone with dementia without them getting angry Caregivers may need to manage their expectations and know what kinds of conversations a person with dementia can hold. Holding complex and lengthy discussions with a person with the condition may only trigger frustration or anger. It is essential to use a calm tone of voice and be aware of a person’s body language and facial expressions. Speak slowly and clearly, using short and simple sentences. Talk with them with respect, not as children. Because a person with dementia has short-term memory loss, it is important not to include information about the recent past when explaining it to them. Do not bombard them with information. Instead, ask questions one at a time and give them time to process and respond. Additionally, explain with “I” statements, such as “I think we could take a break and sit down,” versus “You should stop doing that because you might hurt yourself.” What are signs that dementia is getting worse The progression of dementia and its symptoms vary from person to person. However, these signs generally indicate that the condition is progressing and getting worse:significant personality and behavior changesincreasing need for assistance to total dependence on daily tasksmore substantial loss of memory, including memories in the distant past such as names of people, birthdays, weddingsloss of physical capabilities, such as walking, head control, swallowing, and bladder and bowel functionincreased vulnerability to infections Summary As the disease progresses, people with dementia may behave differently and act aggressively or become angry. It is helpful for caregivers to be understanding and compassionate. Dementia symptoms, such as hallucinations, paranoia, confusion, and a lack of awareness, can contribute to aggressive behavior. Other factors, such as physical illness, caregiver burnout, and sudden environmental changes, can also play a role. Learning about possible triggers and adopting strategies, including not arguing, giving them space, and responding calmly, may help caregivers prevent angry outbursts and better manage them. Last medically reviewed on August 22, 2022Alzheimer's / DementiaCaregivers / HomecareSeniors / Aging 9 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Aggression and anger. (n.d.).https://www.alz.org/help-support/caregiving/stages-behaviors/agression-angerAggressive behavior and dementia. (2021).https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/aggressive-behaviour-and-dementiaChen, Y.-A, et al. (2021). Association between caregivers' burden and neuropsychiatric symptoms in female patients with Alzheimer's disease with varying dementia severity.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8090980/Coping with dementia behavior changes. (2021).https://www.nhs.uk/conditions/dementia/behaviour/Cloak, N., et al. (2022). Behavioral and psychological symptoms in dementia.https://www.ncbi.nlm.nih.gov/books/NBK551552/Devanand, D., et al. (2017). Low dose lithium treatment for agitation and psychosis in Alzheimer's disease and frontotemporal dementia: A case series.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322244/Managing personality and behavior changes in Alzheimer's. (2017).https://www.nia.nih.gov/health/managing-personality-and-behavior-changes-alzheimersMiddle-stage Alzheimer's & dementia caregiving. (n.d.).https://www.alz.org/help-support/caregiving/stages-behaviors/middle-stageWhat is dementia? Symptoms, types, and diagnosis. (2021).https://www.nia.nih.gov/health/what-is-dementiaFEEDBACK:Medically reviewed by Nicole Washington, DO, MPH — By Rachel Ann Tee-Melegrito on August 22, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? 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