Agitation, aggression and wandering in dementia: understanding the causes and staying calm

As dementia progresses, a person may show restlessness, outbursts of anger, suspicion, repeated questions, walking about at night or wanting to leave the house. These behaviours are often the expression of a need, fear or discomfort they cannot put into words. Looking for the reason behind the behaviour eases the burden on both the person and the carer.

Look for the cause first

• Physical: pain, hunger, thirst, needing the toilet, constipation, tiredness, feeling too cold or too hot.
• Health: a urinary or chest infection, a change in medicines, not wearing their hearing aid or glasses.
• Environment: noise, crowds, poor lighting, an unfamiliar place, a disrupted routine.
• Emotional: fear, boredom, loneliness, feeling useless, embarrassment.

If the behaviour started suddenly over a few hours or days, or has clearly got worse, it may be delirium (sudden confusion); see a doctor the same day.

A behaviour diary

For a week, note when and where the behaviour happens, who is with them and what happened just before. Patterns often emerge: a particular time of day, bath time, a busy visit, hunger. Knowing the trigger is the first step towards preventing it.

How to respond in the moment

• Stay calm and lower your voice; keep your body language calm too.
• Do not argue or tell them they are wrong; respond to the feeling behind what they say (“You look frightened, I’m here.”).
• Offer simple choices and ask for one thing at a time.
• Gently redirect their attention: a cup of tea, a favourite song, a photo album, a short walk.
• If it is safe, give them space and approach again a little later.
• If you feel that you or the person are in danger, step away and call for help.

Repeated questions and suspicion

Repeated questions such as “When is my mother coming?” come from not knowing they have forgotten. Giving a short, calm answer each time and backing it up with a note or calendar can help. Accusations that their belongings have been stolen usually come from things being mislaid; rather than arguing, offer to look together and keep spares of items that often go missing.

Wandering and the risk of getting lost

• Regular movement and activity during the day can reduce walking about at night.
• Have them carry a bracelet or card with their name and a relative’s phone number.
• Keep a recent photo to hand.
• Let neighbours and local shopkeepers know.
• A simple door chime or sensor on the door; safety measures for the cooker and dangerous items.
• If they go missing, call your local emergency number (112 in Türkiye and across the EU) without delay.

About medicines

Some medicines used for behavioural symptoms can have serious side effects in older people with dementia, which is why non-drug approaches are recommended first. Medicines should only be started after a doctor’s assessment and reviewed regularly. Do not give sedatives or sleeping tablets on your own initiative.

The carer’s resilience

These behaviours are not personal; they are part of the illness. Even so, they are exhausting, and feeling anger, sadness or guilt is natural. Take regular breaks, share tasks and ask for professional support if you need it.