How Do You Treat Alzheimer's Agitation? A Guide for Caregivers

According to the Alzheimer's Association, nearly half of all people with Alzheimer's will experience agitation as the disease progresses. Knowing how to address this challenging symptom is a critical skill for caregivers. This guide will explain how do you treat Alzheimer's agitation, covering both non-drug approaches and pharmacological options.

Quick Summary

Managing agitation in Alzheimer's involves identifying underlying triggers, implementing behavioral techniques like routine and distraction, and using calming communication. Non-drug interventions are the first line of defense, but medication can be considered for severe cases. Seeking support is essential for caregivers.

Key Points

• Identify Triggers: Agitation is often a response to an unmet need, pain, or confusion, not intentional behavior. Look for specific environmental or physical triggers to address the root cause.

• Prioritize Non-Drug Approaches: Start with behavioral and environmental changes, such as maintaining a consistent routine, reducing noise, and using calm communication before resorting to medication.

• Use Effective Distraction: Redirect the person's attention with meaningful and enjoyable activities like listening to personalized music, looking at photos, or performing simple, familiar chores.

• Consider FDA-Approved Medication When Necessary: Brexpiprazole (Rexulti) is the only FDA-approved medication for Alzheimer's agitation, used for severe cases. Be aware of side effects and use under strict medical supervision.

• Seek Caregiver Support: Managing agitation is challenging; utilize resources like support groups and helplines from organizations such as the Alzheimer's Association to prevent burnout.

• Maintain Calm and Patience: Your demeanor significantly impacts the person with Alzheimer's. Remain calm, speak softly, and avoid arguing or correcting them when they are agitated.

• Ensure Physical Comfort and Safety: Check for signs of pain, hunger, or discomfort, and remove any potentially harmful objects from the immediate environment during an episode.

The Importance of Identifying Triggers

Before implementing any treatment, caregivers must first understand why the agitation is occurring. Unlike intentional misbehavior, agitation in Alzheimer's is a symptom of brain changes and is often triggered by an unmet need, confusion, or environmental factors. Identifying the cause is the most important step toward finding a compassionate solution. The DICE approach—Describe, Investigate, Create, Evaluate—is a framework to help caregivers systematically address these triggers.

Potential Triggers for Agitation

• Physical discomfort: Pain, hunger, thirst, constipation, or a full bladder can all lead to agitation, especially if the person can no longer express these needs verbally.
• Changes in routine or environment: A new residence, a different caregiver, or a hospital admission can be disorienting and terrifying.
• Overstimulation: Loud noises, clutter, excessive background noise like a TV, or too many visitors can be overwhelming and trigger a stress response.
• Fatigue and sleep problems: Being overly tired or experiencing poor sleep can increase restlessness and confusion, especially in the late afternoon and evening, a phenomenon known as “sundowning”.
• Medication issues: Side effects or interactions between different medications can worsen confusion and contribute to agitated behavior.

Non-Pharmacological Strategies for Management

For most cases of mild to moderate agitation, non-drug approaches are recommended as the first-line treatment. These strategies focus on promoting physical and emotional comfort and are generally effective when implemented consistently.

• Create a calm, predictable environment: Stick to a consistent daily routine for meals, bathing, and activities to provide a sense of security. Reduce noise and visual clutter to minimize overstimulation.
• Use effective communication: Speak in a calm, reassuring tone and make eye contact. Listen to the feelings behind the words rather than arguing or correcting facts. A gentle touch, if well-received, can also be calming.
• Employ redirection and distraction: Offer a favorite snack, listen to soothing music, or engage the person in a simple, meaningful activity. For example, if they enjoyed cooking, folding laundry or stirring cookie dough can provide a sense of purpose.
• Incorporate sensory therapies: Music therapy, particularly interactive and personalized playlists, has shown positive short-term effects in reducing agitation by tapping into parts of the brain still active despite dementia. Pet therapy and gentle massage can also be beneficial.
• Encourage physical activity: Regular, moderate exercise like a walk can help release restless energy and improve sleep patterns.

Pharmacological Treatment Options

If non-drug methods fail or if the agitation poses a significant risk of harm to the person or others, medication may be necessary. A doctor will perform an evaluation to rule out other medical causes first before considering drug options.

• Brexpiprazole (Rexulti): As of May 2023, this is the only drug specifically FDA-approved for the treatment of agitation associated with dementia due to Alzheimer's disease. It is an atypical antipsychotic but carries a boxed warning about an increased risk of death in older patients with dementia-related psychosis.
• Antidepressants: Selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa) and sertraline (Zoloft) may be used off-label to help with low mood, irritability, and restlessness.
• Anti-anxiety medications: Anxiolytics, such as lorazepam (Ativan), can be used for short-term, severe episodes but are generally not recommended for long-term use due to risks of confusion and falls.
• Other options: Other medications sometimes used off-label include antiseizure medications (like carbamazepine) and the synthetic cannabis drug dronabinol, which has shown promise in recent clinical trials.

Comparison of Treatment Approaches for Alzheimer's Agitation

Aspect	Non-Pharmacological Strategies	Pharmacological Treatments
Application	First-line intervention for most cases; proactive and reactive management.	Considered when non-drug methods are insufficient or for severe cases.
Effectiveness	Often highly effective, especially for mild to moderate agitation, and dependent on consistent caregiver implementation.	Can provide rapid relief for severe symptoms; effectiveness varies by drug and individual.
Side Effects	Minimal to none; focuses on creating a positive, safe environment.	Potential for significant side effects, including increased risk of death, falls, sedation, and cognitive worsening.
Focus	Identifying and addressing the root causes of distress (e.g., pain, confusion, noise) rather than just the behavior.	Modifying brain chemistry to reduce severe behavioral symptoms when necessary.
Caregiver Involvement	Requires high caregiver engagement, patience, and creative problem-solving.	Involves careful monitoring and close communication with a prescribing physician.
Long-Term View	A sustainable approach that improves overall quality of life for the patient.	Should be used at the lowest possible dose for the shortest duration, with regular reviews.

The Role of Caregiver Support and Self-Care

Managing agitation can be emotionally and physically draining for caregivers. Preventing burnout is crucial for both the caregiver and the person with Alzheimer's. Caregiver support resources can provide a vital outlet for sharing experiences and learning new coping skills.

• Support groups: Connect with other caregivers through organizations like the Alzheimer's Association to share strategies and receive emotional support.
• Respite care: Allow yourself regular breaks to rest and recharge. Adult day programs or short-term residential care can provide temporary relief.
• Helplines: The Alzheimer's Association offers a 24/7 Helpline staffed by master's-level dementia experts who can provide crisis assistance and support.
• Education and training: Learning more about the disease helps to set realistic expectations and depersonalize the agitated behavior, which is a symptom of the illness.

Conclusion

Understanding how do you treat Alzheimer's agitation is a process that begins with compassionate observation and prioritizing non-drug interventions. By identifying and addressing underlying triggers, creating a calm environment, and using gentle communication and distraction techniques, caregivers can often successfully manage agitated behavior. When symptoms become severe, safe and effective pharmacological options are available under a doctor's guidance. The most successful long-term approach involves a combination of strategies tailored to the individual's needs, always remembering that the person is not being deliberately difficult, but is struggling with the disease itself. Caregivers are not alone in this journey and should seek out the robust support networks available to them.

Frequently Asked Questions

What is the very first step to take when an Alzheimer's patient becomes agitated?

The very first step is to stay calm and identify the potential cause of the agitation. Check for immediate needs like pain, hunger, thirst, or a full bladder. A calm demeanor can help de-escalate the situation, as the person with Alzheimer's often mirrors your emotions.

How does music therapy help with Alzheimer's agitation?

Music therapy is a powerful non-drug intervention because the part of the brain that processes music is often spared by dementia. Individualized, interactive music listening can induce relaxation, improve mood, and decrease agitated behaviors by distracting and engaging the person in a pleasant, familiar activity.

Is medication for Alzheimer's agitation safe for older adults?

Medication should be used with caution and under a doctor's supervision. Antipsychotics, for example, carry a boxed warning from the FDA regarding an increased risk of death in older dementia patients. The benefits must be carefully weighed against significant risks like sedation, falls, and cardiovascular issues.

What is 'sundowning' and how can it be managed?

Sundowning is a state of increased confusion, agitation, and restlessness that typically begins in the late afternoon and evening. Management strategies include maintaining a consistent daily schedule, ensuring adequate sunlight exposure during the day, limiting daytime naps, and creating a calming evening routine.

How should a caregiver communicate with a person experiencing agitation?

Communicate using a simple, clear, and reassuring tone. Avoid arguing or correcting them, as their reality is altered by the disease. Instead, respond to the emotion you perceive, validate their feelings, and use distraction to redirect their attention.

What if non-drug interventions are not effective?

If consistent application of non-drug approaches fails to manage agitation, it may be time to consult a physician. The doctor can rule out other medical issues and determine if medication is an appropriate next step, based on the severity of the symptoms and risk of harm.

Where can caregivers find resources for managing Alzheimer's agitation?

Caregivers can find extensive support through organizations like the Alzheimer's Association (alz.org), which offers a 24/7 helpline, support groups, and educational resources. Local Agencies on Aging and online caregiver communities are also valuable resources.