6 Effective Strategies for Managing Mean or Aggressive Dementia Behaviors

Neurodegenerative conditions or diseases that occur after damage to cells and central nervous connections, like Alzheimer’s disease and dementia, cause continuous memory loss. They can also trigger changes in behavior, including agitation, aggression, and anxiety. These are normal side effects of cognitive decline, but they can also make your caregiving responsibilities more challenging.

Thankfully, there are several strategies you can use when dealing with a loved one whose dementia leads to rude, angry, or mean behavior. Approaching the situation in a delicate and precise way can reduce conflicts, improve communication, and make life much easier.

What causes people with Alzheimer’s disease and other dementias to become rude, angry, or mean?

“Rude, angry, and other confrontational behaviors by patients with Alzheimer’s and other dementias fall into several categories,” Laurence Miller, Ph.D., a forensic psychologist,  neuropsychologist, and author based in Boca Raton, Florida, said. 

Specifically, Miller cites seven factors, including:

1) “Loss of higher cortical control of limbic emotional activity;” (i.e. problems identifying and reacting to feelings or emotions.)

2) “Impaired reality testing and interpersonal perception, resulting in heightened fear and paranoia;” 

3) “Deficits in language and communication, resulting in an inability to express oneself or understand others;”

4) “Impaired memory, leading to confusion and misrecognition of others;”

5) “Psychotic or delusional disorders that may accompany some dementias;”

6) “Effects of medications to treat dementia or other illnesses;”

7) Neurodegenerative illnesses may even accentuate previous personality traits. 

“Life-long crabby and obnoxious people get dementia, too,” Dr. Miller said.

What should I do if my loved one becomes rude, mean, or angry?

Since up to 90% of people with dementia develop significant behavioral problems, your care recipient may experience behavioral changes. While you can’t predict when an outburst will occur, there are several things you can do to prevent confusion and reduce the frequency of arguments.

Dr. Miller says that an effective caregiver response includes the following strategies:

1) Proper diagnosis and medical management

Sometimes aggression and anger are symptoms of physical pain. If you’ve noticed an increase in disruptive behavior, schedule a visit with your loved one’s primary care physician. A physical exam can identify underlying health problems, like a urinary tract infection (UTI) or a nutritional deficiency.

2) Maintain a balance between engagement and overstimulation

Alzheimer’s disease and other dementias cause progressive brain damage, making it difficult to focus, express thoughts, or multitask. You don’t want your loved one to feel bored, but you always don’t want to overstimulate them. Keep sounds, lights, and clutter to a minimum. Tidy up regularly, make sure all pathways are clear, and turn off TVs and radios (unless you’re watching or listening to something).

3) Create a stable and familiar environment

Creating a comfortable environment and a daily routine can help reduce the risk of angry or aggressive outbursts. When someone with dementia knows what to expect, it’s easier for them to feel comfortable and relaxed. 

Instead of creating a new schedule out of the blue, watch your loved one from afar. Pay attention to when they eat, brush their teeth, get dressed, and bathe. Then, incorporate those activities into a schedule that makes sense for them. Doing the same things at the same times each day provides a sense of control and helps encourage independence.

4) Specialized de-escalation strategies

Alzheimer’s disease and other types of dementia affect everyone differently. There’s no one-size-fits-all approach when it comes to de-escalating rude or mean behavior, but above all else stay calm and speak in a soft, non-aggressive tone. 

If that doesn’t work, distract your care recipient with some relaxing music or turn on their favorite TV show. You can also present them with their favorite drink or snack. 

No luck there? Give them space. Never physically restrain or hold your loved one back. Doing so could hurt them or make them angrier and worsen the situation.

5) Know when the situation requires professional help

“At some point, caring for your loved one at home may not be possible,” Dr. Miller said. “It’s crucial to know when the situation’s out of your hands, so you can transition to a safer environment in a competent institutional setting. The key is often educating the family in the neuropsychology of dementia so that they understand what the family member is going through and can therefore respond more effectively.”

6) Lean on others for support

Providing round-the-clock care for someone with a neurodegenerative illness is hard work. It’s normal to feel isolated, overwhelmed, and alone, but remember you’re not. There are dozens of online support groups and forums where family caretakers can interact, share tips, and commiserate. 

Some of our favorites include ALZConnected, The Well Spouse Association, and Dementia Mentors.

Dementia-related Behavioral Changes Happen, But It Isn’t Personal

It can be difficult hearing your loved one say rude, insulting, or hurtful things, but they aren’t doing it purposely. Alzheimer’s disease and other dementias cause neurons to stop functioning correctly which leads to significant cognitive impairment. 

Sometimes, an angry outburst or a false accusation is their way of trying to communicate with you. If you can remember that, it’s much easier to keep your cool. 

Recommended reading:

Dementia Care 101: The Diagnosis

Dementia Care 101: Understanding the Stages

5 Tips for Communicating with Someone with Dementia

Living with Dementia: 7 Ways to Make Mealtimes Easier