Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. It is caused by physical changes in the brain. Alzheimer’s disease is the most common type of dementia, accounting for 60-80% of cases. Other types include vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. As dementia progresses, it affects people in different ways at different stages. One common symptom that can occur is increased anger and aggression. Understanding when anger and aggression may arise can help caregivers be prepared to handle these challenging behaviors.
What are the stages of dementia?
There are generally considered to be 7 stages of dementia progression:
Stage 1: No impairment (pre-dementia)
In the earliest stage, no symptoms of dementia are evident. The person functions normally.
Stage 2: Very mild cognitive decline
The person may start to experience occasional memory lapses or struggle to find the right word. Thinking and concentration problems are minor enough that the doctor may not even notice signs of dementia. Daily functioning is not significantly affected.
Stage 3: Mild cognitive decline
Symptoms become more apparent to close family and friends. Memory and thinking problems worsen but usually do not interfere heavily with daily activities. The person may get lost in unfamiliar places, repeat questions, forget appointments or social engagements, and struggle with complex tasks.
Stage 4: Moderate cognitive decline
Dementia symptoms begin noticeably affecting daily life. Significant memory loss occurs, including forgetting details about personal history and inability to recall recent events. The person may have difficulty with math, planning, organization, and complex tasks. Assistance with some daily activities becomes necessary. Behavior changes, such as wandering or getting angry easily, often emerge.
Stage 5: Moderately severe cognitive decline
Major gaps in memory and significant confusion start to emerge. Help will be needed with day-to-day activities and personal care. New surroundings present major challenges. Significant personality changes may occur alongside increased anxiety, suspiciousness, agitation or anger. Sleep disturbances are common.
Stage 6: Severe cognitive decline
Memory problems worsen and everyday skills deteriorate dramatically. 24-hour caregiver support usually becomes necessary for safety and daily functioning. The person may experience delusions, struggle to recognize loved ones, and lose awareness of recent experiences. Changes in physical abilities also occur, including difficulty swallowing and incontinence.
Stage 7: Very severe cognitive decline
In the final stage, dementia has progressed enough that the person loses the ability to engage in meaningful communication and respond purposefully to the environment. They require extensive help with daily activities and personal care. Physical functions decline until the person is completely bedridden.
When does anger and aggression arise in dementia?
Anger and aggressive behaviors may arise at different points across the stages of dementia:
Early-stage dementia
– Frustration over memory and thinking problems
– Irritability when overwhelmed by too much sensory input or demands
– Anxiety or depression related to diagnosis
Mid-stage dementia
– Confusion and fear caused by worsening memory loss
– Embarrassment or frustration over growing difficulties
– Misinterpreting words/actions of others as hostile
– Reacting angrily to feeling dependent or like loss of control
Late-stage dementia
– Severe confusion causing lashing out
– Pain or physical discomfort
– Delusions making the person feel threatened
– Frustration over loss of verbal skills
Why does anger occur in dementia?
There are a few key reasons people with dementia may experience and express more anger:
Brain changes
Physical changes in the brain related to dementia can reduce inhibitions and impair judgment. This makes it more difficult for the person to control impulses and emotions.
Frustration
As cognitive abilities decline, everyday tasks become increasingly frustrating. The person may feel embarrassed, helpless, or inadequate, which can come across as anger or irritation.
Discomfort
Issues like pain, hunger, thirst, constipation, infection, or medication side effects are common causes of aggression in dementia. The person struggles to communicate their needs.
Overstimulation
Too much noise, clutter, or activity can overwhelm the person’s limited capabilities. This leads to anxiety, confusion, and angry outbursts.
Misunderstandings
Memory loss and confusion mean the person may misinterpret words or actions of others as hostile or threatening. They lash out in response.
Loss of control
As dementia progresses, the person becomes more dependent. Anger may arise when they feel they are losing autonomy and control.
Environment
A chaotic, overstimulating or uncomfortable environment can trigger reactions. Unfamiliar settings and situations are also challenging.
Health problems
Issues like infections, poor nutrition, dehydration, sleep disturbances and side effects of medications can all contribute to increased agitation and anger.
Tips for dealing with anger and aggression
If a loved one with dementia starts exhibiting anger and aggression, here are some management tips:
Address medical issues
Look for any underlying issues causing pain or discomfort. Ensure they are receiving appropriate medical care.
Reduce stressors in the environment
Minimize loud noises, clutter, disruptions, and too many people around. Maintain structure and familiar surroundings.
Communicate calmly and patiently
Use a gentle, reassuring tone of voice and simple language. Validate their feelings and give them space if needed. Avoid arguing.
Try relaxing activities
Physical exercise, music therapy, massage, and other pleasant activities can improve mood and reduce agitation.
Keep a routine
Sticking to regular schedules for meals, bathing, activities, and bedtime can help prevent restlessness.
Use distractions
If an outburst occurs, gently redirect attention to something else pleasant that can calm them down.
Consult a doctor
Medications may help in some cases if behavioral techniques don’t resolve serious aggression issues.
Dealing with anger and aggression in a loved one with dementia can be very difficult. Having patience, using preventive strategies, addressing underlying causes, and providing reassuring comfort can help defuse situations. Consider support from a doctor, counselor, or support group.
When to seek medical help
Consult a doctor right away if anger or aggression:
– Comes on suddenly or increases severely
– Puts the person or others at risk of harm
– Continues regularly despite behavioral management efforts
– Is accompanied by other new behaviors or symptoms
– Is disrupting quality of life for the person or caregivers
A medical evaluation may identify underlying health issues to treat or determine if prescription medication is appropriate in more severe cases.
Conclusion
Anger and aggressive behavior are common but challenging symptoms that can occur across different stages of dementia. Deteriorating brain function, growing confusion and frustration, discomfort, and loss of control are some factors that can cause increased agitation and lashing out. Understanding when and why anger arises allows caregivers to be better prepared and utilize preventive strategies. While anger can escalate with progression of dementia, addressing medical conditions, creating a soothing environment, avoiding triggers, and using distractions can often help diffuse situations. In severe cases where aggressive behavior is putting people at risk or remains uncontrolled with behavioral approaches, medical intervention may become necessary. With compassion and patience, caregivers can hopefully reduce instances of anger to support a better quality of life.