Many people with dementia can experience periods of restlessness or agitation. This page explores the causes and treatment options for dementia associated restlessness and agitation, to give you the tools to support someone with dementia who is experiencing the symptoms.
Restlessness – including fidgeting, pacing and trying to leave the house – is common in people with dementia. It can be upsetting for the person, especially if they are prevented from moving around, and for those who care for the person, who worry about the person’s safety.
Sometimes, the person with dementia may get up and start pacing, which can be frustrating and upsetting for the person and their carer.
There are things that can be done to support someone with dementia who is pacing, this includes:
A particular worry can be the person with dementia wants to leave their home. This may happen if:
Terminal restlessness – which is sometimes called terminal agitation or terminal delirium – is a state of increased agitation, confusion, and distress that can occur in the final days or hours of a person’s life. In the context of dementia, terminal restlessness can be caused by a combination of factors, including the progression of the illness, infections, metabolic changes, responses to medications, and increased pain or discomfort.
In the context of dementia, agitation describes significant and often distressing behaviours that indicate restlessness, emotional upset, or a heightened arousal. It’s a common symptom in dementia and can show in various ways, depending on the person.
Shouting, screaming, or using aggressive language are all signs of agitation. In the later stages of dementia, people may sometimes vocalise discomfort, frustration, or an inability to communicate needs through moaning and groaning.
Someone experiencing restlessness or agitation may find themselves repeating actions such as hand-wringing, tapping, rocking, or rubbing surfaces. These actions can be soothing to the person but may seem distressing to those around them.
Aggression refers to hostile behaviour directed either inward at oneself or outward at others or objects. Hitting, kicking, scratching, or biting the people around them is one example of aggressive behaviour in a person with dementia, and is often a response to feeling threatened, confused, or overwhelmed.
Some people who have dementia experience a growing sense of restlessness, agitation or anxiety in the evening, around dusk and the term sundowning is used to describe these changes in behaviour.
Sundowning often makes the person with dementia feel very strongly that they are in the wrong place. They might say they need to go home, even if they are at home, or that they need to pick the children up from school, even if they’re now adults. Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on around them.
Some people who have dementia experience a growing sense of restlessness, agitation or anxiety in the evening, around dusk and the term sundowning is used to describe these changes in behaviour.
Sundowning often makes the person with dementia feel very strongly that they are in the wrong place. They might say they need to go home, even if they are at home, or that they need to pick the children up from school, even if they’re now adults. Other symptoms might include shouting or arguing, pacing, or becoming confused about who people are or what’s going on around them.
Several things may contribute to restlessness and agitation in people living with dementia. These include:
Restlessness and agitation can occur at any stage, but they tend to become more pronounced as dementia progresses. The prevalence of these symptoms can vary depending on factors such as the type of dementia and the stage that they are at.
Restless legs syndrome (RLS) is a condition that causes an irresistible urge to move the legs, often accompanied by uncomfortable sensations. It typically worsens in the evening or at night, and can disrupt sleep.
Some studies suggest a potential link between the condition and an increased risk of developing dementia but this may be because both conditions share risk factors, such as sleep deprivation. Another theory is that RLS may be a sign of underlying vascular disease, which can also increase the risk of dementia.
Agitation and restlessness can manifest differently in different types of dementia.
In Alzheimer’s disease, people may show repetitive behaviors like pacing or fidgeting. They might also experience sundowning, where agitation worsens in the late afternoon or evening.
In vascular dementia, restlessness can stem from frustration because of struggles with cognitive abilities or physical limitations caused by the disease. Agitation may arise from sudden changes in the environment or routine.
People with Lewy body dementia are more likely to experience hallucinations, where they experience something that isn’t really happening, like hearing voices (auditory hallucinations) or seeing things that aren’t there (visual hallucinations).
As cognitive abilities become more difficult, people with dementia often struggle to process emotions, communicate their needs, or understand their surroundings. This can lead to feelings of fear, frustration, or confusion, which can manifest as restlessness or agitation.
Some of the most common emotional triggers for restlessness and agitation are:
Causes of restlessness in a person with dementia linked to their environment may include:
Simple changes to the environment around a person with dementia can be effective, such as removing any hazards to reduce anxiety, and encouraging free movement to help manage restlessness.
Reducing clutter and noise, which can be overwhelming, and making sure the area around the person is well lit but not overly bright can contribute to a calmer space. Playing soothing music or using aromatherapy with scents that aren’t overwhelming, such as lavender, can help, too.
Research suggests that listening to music or singing songs can provide emotional and behavioural benefits for people living with dementia, this is why music therapy is recommended. Musical memories are often preserved in dementia, when other types of memories are lost, because of the areas in the brain that are affected. In people living with dementia it can also have the effect of reducing agitation.
Art can be a powerful way for people with dementia to not only express themselves but also stimulate their mind which can improve thinking ability.
Creative activities like painting can stimulate the brain and be particularly valuable in helping people living with dementia communicate in a nonverbal way when verbal communication is more difficult or lost. Similarly, painting and drawing can allow us to use our power of imagination, which can make people living with dementia feel more connected to the world and people around them.
Exercise helps our brains not only by keeping the blood flowing but also by increasing certain chemicals that protect the brain. It tends to counter some of the natural reduction in brain connections that occurs with ageing. It also reduces the risk of heart disease and diabetes, strengthens bones and muscles, and reduces stress. While excercise for someone with dementia may need to be tailored to their needs and abilities, it’s important to keep them moving where possible.
Medication can be used to treat restlessness and agitation in dementia, but this approach is only typically considered only after non-pharmacological strategies have been tried first.
Antidepressants such as sertraline, citalopram, mirtazapine and trazodone are often prescribed to help combat changes in mood and behaviour, while anti-psychotics can be used in extreme cases to help with severe agitation, aggression, or psychosis.
As a carer, managing restlessness and agitation for someone with dementia can be challenging, but there are many techniques and strategies you can use to help improve the person’s comfort and well-being.
It’s important to make a plan in case the person with dementia succeeds in leaving their home alone. For example:
People with dementia may forget to eat or drink, or not recognise the signs of hunger or thirst. These tips might help:
To speak to a dementia specialist Admiral Nurse about restlessness or any other aspect of dementia, please call our free Dementia Helpline on 0800 888 6678 (Monday-Friday 9am-9pm, Saturday and Sunday 9am-5pm, every day except 25th December), email helpline@dementiauk.org or you can also pre-book a phone or video appointment with an Admiral Nurse at a time to suit you.
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Aggression refers to hostile behaviour directed either inward at oneself or outward at others or objects. Agitation is a more general state of restlessness, emotional distress, or heightened arousal, often without a specific target. While aggression and agitation are common in dementia, and both can be responses to an inability to cope with the environment, emotions, or physical discomfort, they manifest differently and may require different approaches.
Restless leg syndrome (RLS) and dementia may share a link, possibly due to common risk factors like sleep deprivation.
It’s not always possible to completely prevent dementia-related restlessness or agitation, but by using some of the strategies on this page, the frequency and severity of these symptoms can be reduced. Addressing potential triggers and creating a supportive environment means caregivers can often minimise agitation and improve the quality of life for people with dementia.
Restlessness and agitation can be signs of dementia progressing, but they aren’t definitive signs that the illness is getting worse and can often be caused by other factors such as pain, discomfort, or environmental triggers.
Restlessness and agitation are very common in people living with dementia and are among the most frequently reported symptoms.
