What causes agitation crises in people with Alzheimer's disease?

Agitation crises in Alzheimer's patients are not acts of malice but symptoms of the disease itself. The damaged brain can no longer properly manage emotions, frustration, and confusion. These behaviors occur because the person's cognitive abilities are impaired, making it difficult for them to process their environment and communicate their needs effectively.

How should I react when my loved one with Alzheimer's becomes aggressive or agitated?

When your loved one becomes agitated, follow a step-by-step soothing protocol: remain calm yourself, speak in a soft and reassuring voice, avoid arguing or reasoning, remove potential triggers from the environment, offer comfort through gentle touch if they accept it, and redirect their attention to something pleasant. The key is to approach them with patience and kindness.

What are common triggers that can cause agitation in Alzheimer's patients?

Common triggers include environmental factors like loud noises, crowded spaces, or sudden changes in routine. Physical discomfort such as pain, hunger, or fatigue can also trigger agitation. Additionally, feeling confused about time or place, being rushed during activities, or having difficulty communicating needs can lead to behavioral outbursts.

How can I prevent agitation crises in my loved one with Alzheimer's?

Prevention involves maintaining a calm, structured environment with consistent daily routines. Ensure their basic needs are met (comfortable temperature, adequate lighting, regular meals). Identify and avoid known triggers, provide engaging but not overstimulating activities, and watch for early warning signs of agitation to intervene before a crisis develops.

When should I seek medical help for agitation in Alzheimer's patients?

Seek medical help if agitation becomes frequent or severe, if the person poses a danger to themselves or others, if behavioral changes are sudden or dramatic, or if your current management strategies are no longer effective. A healthcare professional can assess for underlying medical issues, adjust medications, or recommend additional support resources.

Is it normal to feel afraid or overwhelmed when dealing with Alzheimer's agitation?

Yes, it's completely normal to feel afraid, overwhelmed, or frustrated when dealing with agitation crises. Many caregivers experience these emotions, especially when their loved one becomes unrecognizable during episodes. Remember that these behaviors are symptoms of the disease, not personal attacks. Seeking support from healthcare professionals, support groups, or respite care services is important for your own well-being.

Managing Agitation Crises in a Person with Alzheimer’s: Step-by-Step Practical Guide

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title: Managing Agitation Crises in a Person with Alzheimer’s: Step-by-Step Practical Guide

description: Comprehensive guide to understanding, preventing, and managing agitation crises in people with Alzheimer’s: triggers, calming techniques, prevention strategies, and step-by-step protocol to regain calm.

keywords: agitation crisis Alzheimer, calm Alzheimer person, Alzheimer aggression, Alzheimer behavior management, soothe Alzheimer, behavioral disorders

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Alzheimer, agitation, crisis, aggression, soothing, behavioral disorders, management

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Reading time: 24 minutes

"My father starts shouting for no reason, he becomes aggressive." "My mother gets agitated in the evening, she wants to leave, go out, she can't calm down." "He hit me today, I no longer recognize him." "I don't know what to do anymore, I'm afraid of him."

Agitation crises are one of the most challenging aspects of Alzheimer’s disease. Your usually calm loved one may suddenly shout, become aggressive (verbally or physically), fidget, refuse any help. These behaviors are not malice, but symptoms of the disease: the damaged brain can no longer manage emotions, frustration, confusion.

This guide explains why these crises occur, how to prevent them, and most importantly, how to react step by step to soothe your loved one and regain calm.

1. Understanding Agitation Crises

2. Common Triggers

3. Soothing Protocol: Step by Step

4. Prevention Techniques

5. When to Seek Medical Help

Understanding Agitation Crises {#comprendre}

What is an Agitation Crisis?

Manifestations:

Shouting, screaming
Motor agitation (aimless walking, gesticulating)
Verbal aggression (insults, threats)
Physical aggression (hits, bites, scratches)
Refusal of care (violently pushing away the caregiver)
Attempt to flee (wants to leave, go out)

Duration: From a few minutes to several hours (if not managed).

Why Does This Happen?

1. Brain Degeneration

Brain areas regulating emotions (frontal lobe, amygdala) are damaged.

Consequence: Loss of emotional control, disproportionate reactions.

2. Inability to Express Verbally

The person can no longer say:

"I am in pain"
"I am hungry"
"I am scared"
"I am lost"

Agitation = only way to express discomfort.

3. Confusion, Disorientation

No longer recognizes places, people.

Fear, anxiety → Defensive agitation.

4. Frustration

No longer understands what is being asked, can no longer do simple things.

Frustration → Anger.

This is NOT Malice

Your loved one does not want to hurt you.

He/she is suffering, confused, scared, and cannot express it otherwise.

Fundamental principle: Never take agitation personally.

◆ ◆ ◆

Common Triggers {#declencheurs}

Physical Triggers

1. Pain

Constipation (common, very painful)

Urinary infection (major cause of sudden agitation)

Joint, dental pain

Fever

2. Fatigue

Lack of sleep

Overexertion (too many activities)

3. Hunger, Thirst

Forgetting to eat/drink

4. Need to Go to the Bathroom

Urgent need, cannot express it

5. Uncomfortable Environment

Too hot, too cold

Excessive noise

Too bright or too dim light

Emotional/Cognitive Triggers

1. Confusion, Disorientation

No longer recognizes the place

Thinks they are elsewhere (their childhood home)

2. Fear

Hallucinations (seeing people who do not exist)

Paranoia ("Someone is stealing my things")

3. Frustration

Task too difficult (dressing, eating)

Misunderstanding of instructions

4. Change of Routine

New place, new person

Change in usual schedules

5. "Sundowning" Syndrome

Systematic agitation in the late afternoon/early evening

Cause: Fatigue, increased disorientation, decrease in light

Caregiver-Related Triggers

1. Caregiver's Tone of Voice

Speaking loudly, harshly

Impatient, irritated tone

2. Sudden Movements

Pulling, shoving

3. Forcing

Forcing to do something against their will

4. Contradicting, Correcting

"No, you are wrong!" → Generates frustration

5. Too Many Stimuli

Multiple people talking at the same time

TV on, background noise

Soothing Protocol: Step by Step {#protocole}

Step 1: Ensure Your Safety and That of the Person

ABSOLUTE PRIORITY: Safety.

If physical violence (hits, bites):

1. Step back, create distance (leave the room if necessary)

2. Never retaliate physically (worsens the situation)

3. Protect the person from themselves

Remove dangerous objects (knives, scissors)

Block access to stairs, windows

4. Call for help if necessary

Family, neighbor, firefighters (15) if imminent danger

Principle: Your safety first. You cannot help if you are injured.

Step 2: Stay Calm (Even If It's Difficult)

Your calm = key to soothing.

The person with Alzheimer’s senses your emotions (even if they no longer understand the words).

If you are stressed, agitated → They become more agitated.

Techniques to Calm YOURSELF:

1. Deep Breathing

Inhale for 4 seconds, exhale for 6 seconds (x3)

2. Self-Talk

"It's not against me, it's the disease."

"I can handle this, I will stay calm."

3. Smile (even if forced)

The brain interprets the smile as a signal of calm

Step 3: Identify the Trigger

Ask yourself the questions:

Physical?

Does he/she have pain somewhere?

Has he/she eaten/drunk recently?

Does he/she need to go to the bathroom?

Is he/she cold/hot?

Environmental?

Too much noise, light?

Unknown place?

Emotional?

Is he/she afraid of something?

Is he/she frustrated (difficult task)?

Time?

Sundowning (end of the day)?

If pain/infection suspected → Consult a doctor quickly (urinary infection, constipation).

Step 4: Adapt Your Communication

Golden Rules:

1. Tone of Voice

Calm, gentle, reassuring

Speak slowly

No shouting (even if she shouts)

2. Short, Simple Sentences

"I am here. Everything is fine."

"We will sit together."

3. Do Not Contradict, Do Not Reason

If she says "I want my mother" (deceased):

- ❌ "Your mother is dead, stop"

- ✅ "Are you thinking of your mother? She loved you very much." (validation)

4. Non-Verbal Language

Eye contact (at her level, crouched if she is sitting)

Slow, open gestures (no sudden movements)

Smile (soothing)

5. Avoid Touching (at the beginning of the crisis)

Some perceive it as aggression

Wait for the person to calm down a bit before touching

Step 5: Soothing Techniques

1. Distraction

Redirect attention to something pleasant.

Examples:

"Look at this photo, who is it?"

"Do you want a glass of water?"

"Shall we listen to some music?"

2. Familiar Music

Very powerful effect (musical memory preserved for a long time).

Play music from their youth (50s-60s if elderly today).

Soothing songs that they liked.

3. Soothing Activity

Petting an animal (if present, or a stuffed toy)

Looking at family photos

Folding laundry, sorting objects (repetitive, soothing activity)

Playing with EDITH (calm games, puzzles)

4. Walking

If she gets agitated while walking aimlessly:

Accompany the walk (in the garden, in the room).

Speak softly while walking ("We are walking together, it's nice").

Physical fatigue → Gradual calming.

5. Change of Environment

If agitation in one room: Suggest going to another room (quieter, more familiar).

"Let's go to the living room, it's quieter."

6. Reassuring Presence

Sit next to her (without talking, just being there).

Hand on shoulder (gently, if she accepts).

Synchronized breathing (breathe calmly, she will unconsciously align).

Step 6: Respond to Physical Needs

If trigger identified:

Pain:

Analgesics (paracetamol) if prescribed

Consult a doctor if pain persists

Hunger/Thirst:

Offer a snack, drink

Bathroom:

Accompany to the bathroom

Temperature:

Add/remove blanket, clothing

Fatigue:

Offer to lie down, rest

Step 7: Patience and Perseverance

Soothing takes time (15 min to 1h).

Do not expect an immediate return to calm.

Stay present, patient, kind.

If one technique does not work, try another.

◆ ◆ ◆

Prevention Techniques {#prevention}

1. Structured Routine

Fixed schedules (waking, meals, bedtime) = Secure, limits confusion.

2. Calm Environment

Soft light (no harsh fluorescent lights)

Little noise (TV off if not listening)

Pleasant temperature (20-22°C)

3. Avoid Fatigue

Short naps (30 min max) after lunch

Not too many activities during the day

Early bedtime (before sundowning)

4. Suitable Activities

Cognitive stimulation with EDITH (15-20 min/day)

Manual activities (coloring, knitting)

Walks (if possible)

5. Nutrition, Hydration

3 meals + 2 snacks (avoid hypoglycemia)

Drink regularly (1.5L/day)

6. Address Physical Causes

Regular medical follow-up (screening for infections, constipation)

Analgesics if chronic pain (osteoarthritis)

7. Kind Communication

Calm, gentle tone

No contradiction, no conflict

Emotional validation

8. Light at the End of the Day

Sundowning: Turn on lights before sunset (avoid abrupt day/night transition).

When to Seek Medical Help {#aide-medicale}

Consult Quickly If:

1. Sudden and Unusual Agitation

May indicate urinary infection, acute pain

Consult your primary care physician (or emergency room if weekend)

2. Frequent Physical Violence

Repeated hits, bites

Danger to the caregiver or the person

Consultation: Neurologist, geriatrician (possible adjustment of medication).

3. Constant, Uncontrollable Agitation

Despite all techniques, no calming

Total exhaustion of the caregiver

Solutions:

Temporary hospitalization (assessment, adjustment of treatment)

Temporary or permanent accommodation (nursing home, long-term care facility)

Medication Treatments

Last option (after trying everything).

Possible medications:

Antianxiety medications (benzodiazepines): Short duration, risk of falls

Antipsychotics (risperidone, olanzapine): If hallucinations, severe aggression

Antidepressants: If underlying depression

Risks: Side effects, excessive sedation.

Always under strict medical supervision.

◆ ◆ ◆

Testimonials

Marie, caregiver for her father

"My father had agitation crises every evening. I didn't understand. Then I read about sundowning. I changed: lights on earlier, meals advanced, soft music. It changed everything! The crises decreased by 80%."

Jean, son of a mother with Alzheimer’s

"My mother screamed when I dressed her. I realized I was going too fast, I was abrupt (due to fatigue). I slowed down, I speak to her softly, I explain each gesture. Now, it goes well. It's long, but it's calm."

Conclusion: Soothing with Patience and Kindness

Agitation crises are exhausting, frightening, but manageable with the right techniques. Understanding triggers, adapting communication, using soothing strategies, and above all staying calm: these are the keys to regaining serenity.

Key Steps:

1. ✅ Ensure safety

2. ✅ Stay calm

3. ✅ Identify trigger

4. ✅ Adapted communication

5. ✅ Soothing techniques (distraction, music, activity)

6. ✅ Respond to physical needs

7. ✅ Patience

You are not alone. Our Alzheimer training teaches you these techniques in detail. EDITH helps prevent agitation through cognitive stimulation. And our free guide supports you daily.

DYNSEO Resources for Managing Agitation:

Alzheimer Training: Practical Solutions

EDITH: Preventing Agitation through Stimulation

Free Guide