Understanding Alzheimer’s and Agitation

Alzheimer’s is a truly heartbreaking condition, deeply affecting both those who suffer from it and their families.

About 72 million Americans are dealing with this distressing illness. They face various common symptoms, such as memory loss, difficulties in planning or completing tasks, confusion, trouble with speaking and writing, misplaced items, poor judgment, social withdrawal, and more.

However, it’s essential to note that there are symptoms that don’t always get the attention they deserve. One symptom that often puzzles caregivers is agitation, which they might mistakenly attribute to poor caregiving.

Dr. Richard Stefanacci, a medical director, emphasizes the importance of understanding that agitation stems from the brain changes brought on by Alzheimer’s, not from any shortcomings in care. He explains that the brain damage due to Alzheimer’s makes individuals more susceptible to agitation, irrespective of how compassionate their caregivers might be.

The Alliance of Aging Research highlights that agitation can manifest in numerous ways, including pacing, attempts to leave, angry outbursts, cursing, hitting, emotional swings, and throwing objects. Caregivers might wrongly blame themselves for these behaviors, thinking they are due to exhaustion, new routines, or a lack of patience.

Dr. Nikhil Palekar, who leads a center specializing in Alzheimer’s, notes the stigma surrounding agitation symptoms. Many caregivers might feel they’ve done something wrong, not realizing how common agitation is in Alzheimer’s patients, with rates ranging from 56% in earlier stages to 68% in more advanced stages of the disease.

How Alzheimer’s Can Cause Agitation Symptoms

As with many facets of Alzheimer’s, the brain’s condition is central. Dr. Stefanacci explains that Alzheimer’s damages areas responsible for emotions and decision-making, leading to heightened reactions to situations that would have been manageable before the illness progressed.

Specifically, this involves neurotransmitters, which are crucial for mood regulation and other functions. Alzheimer’s causes a decrease in serotonin, norepinephrine, and dopamine—contributing to agitation symptoms.

Environmental factors also play a role. For instance, chaotic events like the holidays can intensify agitation. Disruptions in routine, unfamiliar faces, new foods, and changes in surroundings can be particularly upsetting for those in advanced stages of Alzheimer’s. Therefore, modifying environments and maintaining routines can help reduce stress.

There Is Hope For Alzheimer’s Agitation

If you or someone you care about is facing agitation due to Alzheimer’s, it’s important to understand that there are ways to manage this challenge. Below are suggestions from experts:

Create and maintain routines.

Establishing consistent daily schedules—like for meals, activities, and bedtimes—is crucial. When changes must occur, preparing ahead of time helps, while trying to keep other routines constant.

Avoid arguing when possible.

When someone with Alzheimer’s holds a harmless belief, Dr. Stefanacci advises not to argue. Instead, focus on the feelings behind their words, as reasoning with someone affected by the illness can be unproductive.

Use calming approaches.

Staying calm, while sometimes difficult, is vital. Speaking in a soothing voice, playing familiar music, and minimizing confusing background noise can help create a more peaceful environment.

Know that there are helpful treatments available.

Feeling overwhelmed is common when caring for someone with Alzheimer’s, but it’s not hopeless. Treatments, both behavioral and medical, have proven effective for managing agitation.

Dr. Palekar recommends discussing any agitation symptoms with the medical provider overseeing the patient’s care. Additionally, he mentions several non-drug approaches to reduce agitation:

• Maintaining a daily routine and structure
• Reducing noise and clutter
• Gentle touch
• Soothing music
• Reading
• Walking, ideally outside in sunlight
• Engaging in distractions like snacks and activities
• Avoiding stimulants, like caffeine, later in the day

Take care of yourself as a caregiver.

Caring for someone with Alzheimer’s is undoubtedly challenging. Dr. Stefanacci encourages caregivers to seek support from fellow caregivers, groups, or counseling. He also urges them to feel free to simplify or omit holiday traditions that feel too burdensome.

Ultimately, it’s normal for someone with Alzheimer’s to exhibit agitation—this is linked to the disease itself, not to the caregiver’s actions. If you are navigating this journey, remember: you are not alone, and support is available.