Managing Agitation in Alzheimer's Dementia: A Comprehensive Person-Centered Approach
ManagingAgitation
IN ALZHEIMER’S DEMENTIA:
A Comprehensive Person-Centered Approach
Agitation in Alzheimer’s dementia (AAD) is one of the most common and disturbing behavioral symptoms of Alzheimer’s dementia, as shown in Box 1, that can manifest as excessive motor activity, verbal or physical aggression.¹ These behaviors affect the quality of life of individuals living with dementia and place a heavy burden on caregivers. The Agitation in Alzheimer’s Screener for Caregivers (AASC®) is an easy-to-use tool that can help health care providers recognize AAD behaviors that may not have been reported by the patient or caregiver.²
WhyManagingAADMatters
Not only does AAD impact the quality of life, it causes emotional strain for the person with AAD and their caregivers and is associated with negative health outcomes. AAD accelerates decline in both cognitive and physical functioning and increases the risk of injuries, infections, early institutionalization, and death.³ Individuals with AAD tend to have more comorbidities and increased use of concomitant therapies.⁴
ManagingAAD
AAD behaviors are signs that an individual is experiencing distress that they are unable to communicate by other means. Effective management of AAD should focus on preventing or mitigating episodes by identifying, understanding, and addressing the underlying triggers and contributing factors.³ Box 2 outlines effective nonpharmacological strategies to enhance function and independence for individuals with AAD.⁵⁶
When used appropriately, pharmacologic interventions can also play a valuable role in managing AAD.The Gerontological Society of America’s Agitation in Alzheimer’s Disease (see Box 3) Decision Tree guides health care providers through a range of nonpharmacologic strategies and highlights appropriate use of pharmacologic approaches to manage AAD.⁷
Box 1: Common Symptoms of AAD
Repeating motions or behaviors (e.g., rocking, raising fist, pointing finger)
Pacing or restlessness (i.e., cannot be still)
Using profanity or lashing out verbally
Raising voice or yelling or screaming
Resisting assistance or care
Throwing, hitting, or breaking things
Trying to hurt self or others (e.g., grabbing, kicking, hitting, biting)
Box 2: Nonpharmacological Strategies to Enhance Function and Independence for Individuals with AAD
•Establish predictable routines built on strengths and aligned with individual preferences.
•Ensure personal care needs are met, including comfort.
•Simplify tasks and routines and offer simple choices.
•Engage in meaningful activities such as music, art, or walking.
The Gerontological Society of America’s Agitation in Alzheimer’s Dementia Video Series
This series demonstrates that treating AAD involves not only reducing troubling behaviors; it also shows how these improvements can enhance functioning and quality of life for both the individual with AAD and their caregiver. Each pair of videos shows an individual with AAD and their caregivers. One video illustrates an individual with a poorly managed symptom of AAD while attempting an activity, and a second companion video illustrates the individual with wellmanaged AAD engaging in the same activity. Viewers will notice that in both videos, the caregivers attempt nonpharmacological strategies to address behavior, yet these are not as successful in the poorly managed AAD examples
Verbal Aggression
Sharon, who lives with AAD, arrives at the doctor’s office with her daughter, Emily, for a routine check-up Sharon expresses confusion, shows frustration, and insists she isn’t sick The situation tests the care team’s ability to respond with empathy and flexibility.
Poorly Managed: Sharon becomes increasingly agitated, lashes out verbally, and refuses to cooperate, which disrupts the visit.
Well-Managed:
Sharon voices frustration and seems annoyed but remains calm enough for the exam.
Asking Repeated Questions
Frank joins his daughters, Susie and Mary, for dinner at his favorite restaurant, which is a comforting routine. Although Frank is physically well, his AAD affects memory and recognition. He repeatedly asks when Mary will arrive, not realizing she’s sitting across from him.
Poorly Managed: Frank grows agitated, questions his daughters loudly, and causes emotional strain for his daughters, which disrupts the outing.
Well-Managed: Frank remains calm and engaged with gentle redirection, which allows the family to enjoy their time together
Pacing and Restlessness
Randy takes his mother, Janet, who has AAD, to the grocery store, which is a tradition rooted in their shared past. Janet’s AAD prevents her from managing the trip alone. Randy includes her to maintain connection.
Poorly Managed:
Janet becomes increasingly restless and acts disruptive, which leaves Randy emotionally drained and makes the outing stressful
Well-Managed:
Janet engages briefly and responds to Randy’s redirection, which allows the trip to end with small, encouraging successes
Resistance to Assistance or Care
Lucille begins her morning helping her husband, Gerald, start his day, which is a task made harder as his AAD progresses. Once independent, Gerald now often resists help with dressing, eating, and taking medication.
Poorly Managed:
Gerald refuses help and grows agitated, which leaves Lucille emotionally drained and disrupts the morning.
Well-Managed:
Gerald responds to Lucille’s calm approach and engages in self-care tasks, which allows for a more peaceful start to the day
A G I TAT I O N IN ALZHEIMER’S DISEASE: A
DECISION TREE FOR HEALTHCARE PROVIDERS
Professional Resources
The GSA KAER Toolkit for Brain Health: Kaerbrain.org
Insights & Implications in Gerontology: Agitation in Alzheimer's Disease and associated AAD resources: Geron.org/brainhealth PsychU—Agitation Resources for Professionals: https://psychu.org/resource-library/agitation
Touch Neurology Agitation in Alzheimer’s dementia videos: https://touchneurologyime.org/cme/curriculums/agitation-in-alzheimers-dementia/
Caregiver Resources
Alzheimer’s Association—Anxiety and Agitation: https://www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation National Institute on Aging— Coping with Agitation, Aggression, and Sundowning in Alzheimer’s Disease: https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/coping-agitation-aggression-and-sundowning
References
1. Agitation in Alzheimer’s Screener for Caregivers (AASC®). Agitation in Alzheimer’s Dementia (AAD): Why Early Detection Is Important. 2024. Accessed July 30, 2025. www.theaasc.com/agitation-in-alzheimers-dementia
2. AASC®. Helping Your Patients and Their Caregivers Identify the Symptoms of Agitation in Alzheimer’s Dementia (AAD). 2024. Accessed July 30, 2025. https://www.theaasc.com/hcp
3. Gerontological Society of America. Insights & Implications in Gerontology: Agitation in Alzheimer’s Disease. GSA Enrich: Learning Center August 2023. Accessed July 30, 2025. https://gsaenrich.geron.org/behavioral-and-psychological-symptoms-of-dementia
4. The Alzheimer’s Association. Alzheimer’s and Multiple Chronic Conditions Fact Sheet. March 2022. Accessed July 30, 2025. https://www.alz.org/getmedia/4102d0c5-51a8-4de0-8771-a044b715690e/alzimpact.org
5. The Alzheimer’s Association. Anxiety and Agitation. 2025. Accessed July 30, 2025. https://www.alz.org/help-support/caregiving/stages-behaviors/anxiety-agitation
6. Scales K, Zimmerman S, Miller SJ. Evidence-based nonpharmacological practices to address behavioral and psychological symptoms of dementia. Gerontologist. 2018;58(suppl_1):S88–S102. doi: 10.1093/geront/gnx167
7. Gerontological Society of America. Agitation in Alzheimer’s Disease: A Decision Tree for Healthcare Providers. GSA Strategic Alliances. March 2023. Accessed July 30, 2025. https://issuu.com/gsastrategicalliances/docs/aad_decision_tree?fr=xKAE9_zU1NQ
