Dealing with Dementia Anger

Your sweet parent has become someone you barely recognize. They scream at you, accuse you of stealing, even try to hit you when you're just trying to help. The anger and aggression can feel like a personal attack, leaving you hurt, confused, and sometimes afraid.

Here's what you need to know: This is not your parent. This is the disease. Anger and aggression are common symptoms of dementia, affecting up to 50% of people at some point in their illness. Understanding why it happens—and how to respond—can help keep both of you safer and reduce the frequency of these painful episodes.

Why Dementia Causes Anger

Brain Changes

• Damage to emotional regulation: The parts of the brain that control impulses and emotions are affected
• Lost ability to process: Can't understand what's happening around them
• Communication breakdown: Can't express needs, leading to frustration
• Loss of inhibition: Filters that kept inappropriate responses in check are gone

Triggers for Anger

• Fear and confusion: Not recognizing where they are or who you are
• Feeling rushed: Being hurried through tasks
• Loss of control: Others making decisions for them
• Overstimulation: Too much noise, activity, people
• Understimulation: Boredom, lack of engagement
• Physical discomfort: Pain, hunger, need for bathroom, fatigue
• Feeling criticized: Being corrected or told they're wrong
• Invasion of personal space: Especially during intimate care
• Change in routine: Unfamiliar situations
• Time of day: Sundowning increases agitation in late afternoon/evening

In the Moment: How to Respond

What TO Do

• Stay calm: Your agitation will escalate theirs. Take a breath.
• Speak slowly and simply: Short sentences, calm voice
• Give space: Step back, don't crowd them
• Acknowledge their feelings: "You seem upset. I'm sorry."
• Look for the underlying need: Pain? Fear? Bathroom? Hunger?
• Distract and redirect: "Let's go get a snack" or "Look at this photo"
• Remove yourself if needed: It's okay to leave the room briefly if safe to do so
• Try again later: Whatever triggered it can often be addressed after they calm down

What NOT to Do

• Don't argue or try to reason: Their brain can't process logic
• Don't confront or demand explanations: "Why did you do that?" makes it worse
• Don't take it personally: This is the disease, not them
• Don't restrain physically unless absolutely necessary for safety: This often escalates
• Don't punish or show anger: They won't understand and it increases fear
• Don't crowd or corner them: Feeling trapped increases panic

Preventing Angry Episodes

Track Patterns

• Keep a log of when episodes occur
• Note what happened before the episode
• Look for patterns: time of day, specific activities, certain people
• Identify triggers you can avoid or modify

Modify the Environment

• Reduce noise and chaos: Keep background TV/radio low or off
• Good lighting: Shadows can cause confusion and fear
• Familiar surroundings: Avoid unnecessary changes
• Calm colors and minimal clutter: Reduce visual overwhelm
• Avoid mirrors: Can frighten them if they don't recognize themselves

Modify Your Approach

• Slow down: Rushing is a major trigger
• Approach from front: Don't startle them from behind
• Give choices: "Red shirt or blue shirt?" gives sense of control
• Break tasks into steps: One instruction at a time
• Maintain routine: Predictability reduces anxiety
• Give warnings: "In a few minutes, we're going to..."
• Offer privacy during personal care: As much as safely possible

Address Physical Comfort

• Ensure regular meals and snacks
• Maintain good hydration
• Schedule regular bathroom breaks
• Check for pain (they may not be able to tell you)
• Ensure adequate sleep
• Check hearing aids and glasses

Specific Challenging Situations

Bathing Aggression

Bathing is one of the most common triggers for aggression.

• Keep the room warm
• Cover with towels for privacy during the process
• Consider sponge baths if showers are too upsetting
• Try bathing at different times
• Use distraction—play favorite music
• Keep same routine each time
• Accept that daily bathing may not be necessary

Accusations and Paranoia

"You stole my money!" "You're trying to poison me!"

• Don't argue or defend yourself—it doesn't work
• Acknowledge the feeling: "That sounds scary"
• Redirect: "Let's go look for your money together"
• Keep duplicates of frequently "lost" items
• Check for actual problems: Is anyone actually taking things?

Sundowning

Late afternoon/evening agitation is common.

• Keep lighting bright as natural light fades
• Maintain calm, quiet activities in evening
• Avoid caffeine in afternoon
• Ensure adequate daytime activity
• Address hunger—low blood sugar contributes
• Limit naps or keep them early

When to Seek Medical Help

• Sudden change: New or significantly worsening aggression
• Physical aggression: Hitting, biting, kicking
• Danger to self or others: Safety is compromised
• Unable to provide necessary care: Aggression prevents bathing, medications, etc.
• Caregiver burnout: You're at your breaking point

Medical Options

• Treat underlying causes: Pain, UTI, constipation, etc.
• Medication review: Some medications worsen behavior
• Behavioral medications: As last resort, carefully chosen medications may help
• Geriatric psychiatry: Specialists in behavioral issues in dementia

Caring for Yourself

Being on the receiving end of anger and aggression is traumatic, even when you know it's the disease.

• It's okay to feel hurt: Your feelings are valid
• It's okay to walk away: Taking a break is necessary
• Get support: Caregiver support groups understand this pain
• Consider respite care: You need breaks to sustain caregiving
• Talk to a therapist: Processing these experiences helps
• Recognize your limits: Some situations require more help than one person can provide