The behavior changes are often the hardest part of dementia caregiving: the agitation, the aggression, the late-day restlessness.

Here is the single most important thing to hold onto: it is the disease, not the person, causing these behaviors. They are not deliberate, and they almost always happen for a reason. Once you start looking for the reason instead of fighting the behavior, dementia caregiving gets a little less overwhelming. This guide explains why these behaviors happen and gives you practical, NIA-backed strategies for the moments that feel impossible.

Why Dementia Behaviors Happen

As Alzheimer's and related dementias progress, people may become agitated or aggressive, have trouble sleeping, experience hallucinations, and wander or pace. It is natural to take these moments personally, but the National Institute on Aging is emphatic: the disease, not your loved one, is causing them.

And these behaviors are rarely random. Most of the time they happen for a reason, and the reason usually falls into two buckets:

  • Emotions: sadness, fear, stress, confusion, or anxiety. A person who cannot understand where they are or why can become frightened, and fear can look like anger.
  • Health problems: pain, lack of sleep, or trouble seeing or hearing. Someone who cannot tell you their hip hurts or that they cannot hear you may show it through agitation instead.

This reframe is the whole game. The question shifts from "how do I stop this behavior" to "what is this behavior telling me."

Coping With Agitation and Aggression

Agitation means your loved one is restless and worried and cannot settle down. They may pace, be unable to sleep, or act aggressively toward others. When it happens, the NIA's approach is to find the cause and address it, rather than argue or restrain:

  • Check for physical causes first: pain, hunger, thirst, needing the bathroom, being too hot or cold, or a noisy, over-stimulating environment.
  • Lower the stress in the room: reduce noise and clutter, move to a calmer space, and keep your own voice and body language calm and reassuring.
  • Do not argue or correct. Trying to convince someone with dementia that they are wrong usually escalates things. Redirect gently to a different activity or topic instead.
  • Talk with a health care provider about behaviors, especially new or sudden ones. Agitation can be the only sign of a treatable problem like an infection or pain, and a provider can discuss possible solutions.

Easing Sundowning

Many people with dementia grow more confused, anxious, or agitated in the late afternoon and evening, a pattern called sundowning. You cannot always prevent it, but the NIA recommends habits that often help:

  • Stick to a daily schedule. Predictability is calming; chaos is not.
  • Get daytime light. Arrange time outside or by a sunny window each day.
  • Stay active, but not over-scheduled. Aim for physical activity daily, without packing the day so full it becomes exhausting.
  • Watch late-day intake. Avoid alcohol and caffeine later in the day.
  • Discourage long or late naps. Dozing late in the afternoon can worsen evening restlessness and disrupt night sleep.

You Are Not Failing

When behaviors are at their worst, caregivers often feel they are doing something wrong. You are not. These are symptoms of a brain disease, and even perfect caregiving cannot prevent all of them. What you can do is stay safe, look for triggers, and get support, including a real break. See caregiver self-care, respite care, and caregiver burnout. For the programs and help available where you live, find your state's dementia-care guide through the caregiver programs directory. For round-the-clock guidance, the NIA's ADEAR Center (1-800-438-4380) and the Alzheimer's Association 24/7 Helpline (1-800-272-3900) are there.

Struggling with dementia behaviors? Chat with Brevy's care navigator for strategies and to find dementia caregiver support and respite in your state.

Frequently Asked Questions

Because the disease, not the person, causes these behaviors, and they usually have a trigger, an emotion like fear or confusion, or a health problem like pain, poor sleep, or trouble seeing or hearing. Finding and addressing the cause is the most effective response.

Sundowning is increased confusion and agitation in the late afternoon and evening. To ease it, stick to a daily schedule, get sunlight and activity during the day, avoid caffeine and alcohol late, and discourage long or late naps.

Check for physical needs like pain, hunger, or the bathroom; reduce noise and stimulation; keep your voice and manner calm; and redirect rather than argue or correct. Do not try to convince them they are wrong.

Talk with a health care provider about behaviors, especially new or sudden ones, since agitation can be the only sign of a treatable problem like pain or an infection.

Learn More

Find personalized dementia caregiving support at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.