Why a Person with Dementia Becomes Aggressive — and How to Respond Correctly

Experts emphasize: in most cases, such behavior is not related to a change in character, but to the progression of the disease.

Why Aggression Occurs

In dementia, various areas of the brain are gradually damaged, including the frontal lobes, which are responsible for controlling emotions, self-control, and the ability to adequately assess what is happening.

A person begins to understand the surrounding world worse, loses the ability to explain their feelings, and reacts to stressful situations much more sharply. Any irritant — a loud noise, an unfamiliar face, a sudden change of environment, or an unclear request — can be perceived as a threat.

"Aggression in dementia is rarely conscious. Most often, it is a reaction to fear, confusion, or a sense of danger that the patient cannot explain in words," notes neurologist Elena Voronova.

What Can Trigger Outbursts of Anger

The causes of aggressive behavior can be both physiological and emotional.

Physical factors include:

• pain that the person cannot describe;

• hunger or thirst;

• fatigue;

• sleep disturbances;

• overheating or cold;

• side effects of medications.

Emotional triggers can include:

• a sense of loss of independence;

• misunderstanding of what is happening;

• fear of unfamiliar people;

• changes in the usual daily routine;

• feelings of helplessness and loss of control over one’s life.

Sometimes a person may feel that they are being deceived, robbed, or harmed. Due to memory and perception disturbances, they may sincerely believe in what is happening.

"For a patient with dementia, the surrounding world gradually becomes unpredictable. When a person does not understand where they are and what is happening around them, anxiety can quickly turn into aggression," explains psychiatrist Andrey Sokolov.

How to Respond Correctly

The main mistake of relatives is trying to convince the person or prove to them that they are wrong.

During an episode of fear or aggression, logical arguments rarely work. It is much more important to create a sense of safety.

Experts recommend:

• speak in a calm and even voice;

• do not argue or raise your voice;

• maintain physical distance;

• remove sources of noise and other irritants;

• redirect attention to familiar objects, photographs, or favorite music;

• avoid sudden movements and do not try to forcibly calm the person.

In many cases, simply redirecting attention to a familiar activity or pleasant memory can help.

When to See a Doctor

If episodes of aggression become frequent or intensify, it is necessary to discuss the situation with a specialist.

Sometimes the cause may be chronic pain, infection, side effects of medications, or improperly adjusted therapy. Adjusting treatment often helps significantly reduce anxiety and irritability.

"A sudden change in behavior always requires a doctor's attention. Behind outbursts of aggression may lie problems that can be corrected and significantly improve the patient's quality of life," emphasizes geriatrician Natalia Belova.

Don’t Forget About Yourself

Caring for a person with dementia requires enormous emotional resources. Constant tension, sleepless nights, and a sense of responsibility can lead to burnout even among the most caring relatives.

Therefore, specialists advise not to refuse help from loved ones, to use social services, to seek consultation from psychologists, and to find time for personal rest.

Aggression in dementia is not a manifestation of a bad character or a conscious desire to hurt others. More often than not, behind the shouting, irritation, and accusations lie fear, confusion, and a sense of loss of control over one’s life. Understanding the reasons for such behavior helps relatives remain calm and build more trusting relationships with their loved one even in the face of a severe illness.