Agitation, which can include restlessness, worry, anxiety, pacing, and aggression, is common in people with Alzheimer’s. Everyday surroundings, such as loud noises, bright lights, or unfamiliar places, can sometimes trigger or worsen these symptoms.

As Alzheimer’s progresses, changes in the brain can make sights, sounds, and other sensations feel overwhelming. Identifying what upsets your loved one can help you create a calmer environment and reduce distress.

Read on to learn about common environmental and sensory triggers and ways to help manage agitation.

🗳️ What seems to trigger agitation most often in your loved one with Alzheimer’s?

Loud noises or crowded places

Changes in routine or surroundings

Physical discomfort, such as pain or hunger

Dim lighting or changes in time of day

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How Can You Manage Environmental Triggers?

Learning what might be upsetting your loved one can help you make changes to their surroundings and create a calmer, more comfortable environment.

Noise, Crowds, and Background Activity

People with dementia may struggle to filter out sensory information, such as background noise or visual distractions. Busy places can quickly feel overwhelming.

“My husband gets anxious with too many people around, even our kids and their families. Shopping at prime hours is hard, and he refuses to go to church.”

— A myALZteam member

Overstimulating environments can include:

• Noisy places
• Overlapping conversations
• Loud television or music
• Crowded places
• Bright lights

Creating a calm environment at home with minimal noise can help reduce overstimulation. Try turning off the television when no one is watching, limiting background conversations, and keeping shared spaces free of clutter.

If you’re having visitors over, consider inviting smaller groups rather than hosting large gatherings. You can also set aside a quiet, comfortable place where your loved one can take a break if they feel overwhelmed.

Playing quiet, soothing music may help them relax, too, especially if it’s music they enjoy.

In a busy setting, you could try noise-canceling headphones or familiar, soothing music to limit distracting sounds. Sunglasses may help if bright lights are also bothersome.

Lighting, Shadows, and Clutter

Being in a cluttered or visually overwhelming space that is too brightly lit can also cause someone with Alzheimer’s to become overwhelmed and agitated. On the other hand, a space that is dim and shadowy can cause confusion, which could contribute to agitation.

Agitation that happens late in the day is often called sundowning. Sundowning can cause confusion, anxiety, and aggression. It’s often made worse by low lighting, fatigue, and a departure from normal routine.

“My loved one gets restless and has agitated behavior that starts in the afternoon and can last into the evening. It seems to be worse on gray, dreary days, and in darker or low-lit areas of the house.”

— A myALZteam member

To reduce agitation in dimly lit areas, you can try:

• Increasing lighting in the evening
• Using enough light to reduce shadows
• Using night lights around the house
• Maintaining a predictable evening routine

Some sensory therapies, such as gentle hand massage or touching different textures or fabrics, may help ease agitation in people with Alzheimer’s. Researchers are still studying how well these approaches work and whether they improve quality of life.

“Before it gets dark, I close all the curtains and turn the lights on bright to avoid sundowning, and I think it helps,” shared one myALZteam member.

Changes in Routine or Surroundings

For people with Alzheimer’s and other types of dementia, changes to routine can be frightening or overwhelming. Even a small change in schedule, a new caregiver, or a visit to an unfamiliar place may be confusing and cause agitation.

As someone’s memory and awareness decline, their cognitive challenges can make life feel unfamiliar and unpredictable. These feelings can result in lashing out or becoming defensive.

Maintaining familiar routines and surroundings can help reduce agitation. If it’s necessary to change a routine, try redirecting the person’s attention to things that are familiar to them. This might help make the transition easier.

You can try:

• Playing a song they recognize from earlier in life
• Sharing a story that they may know
• Completing a familiar task together
• Moving them to a place they’re familiar with

“Routine is so important for us. I made a binder with pretty, colorful paper that has Mom’s daily routine and other helpful notes that I add to and update. Sometimes I put loving notes that are disguised directives on her bathroom mirror.”

— A myALZteam member

How Can You Manage Sensory Triggers?

People can often ask for help when they feel hungry, lonely, bored, or in pain. Someone with dementia, however, may have trouble identifying what they are feeling or explaining what they need.

As Alzheimer’s progresses, it can become harder for people to express their needs. Agitation may be one way they show that something is wrong.

Hearing and Vision Loss and Other Sensory Changes

Brain changes linked to Alzheimer’s can make it harder to process sights, sounds, and other sensations. Changes in vision, hearing, smell, taste, and touch can also occur with aging and Alzheimer’s.

Trouble seeing or hearing can contribute to confusion, agitation, or feelings of isolation in people with Alzheimer’s.

You can help make sure your loved one can see and hear as well as possible. Here are some tips:

• Make sure your loved one uses prescription glasses or hearing aids, if needed. Help them put in hearing aids with working batteries or wear clean glasses with the correct prescription.
• Make sure rooms have enough light.
• Speak calmly and clearly, at a volume your loved one can hear.
• Talk in places where it’s easy to hear each other.

Temperature, Clothing, Touch, and Other Unmet Needs

Some researchers suggest that the type of agitation your loved one shows may offer clues about what they need.

Boredom, loneliness, or a lack of stimulation may be linked to fidgeting, pacing, wandering, repetitive movements, anxiety, or restlessness. Pain or discomfort may also be expressed through verbal outbursts or physical aggression.

“When my loved one changes behavior for no apparent reason, the first step is to check if they are thirsty, hungry, in discomfort, or in pain.”

— A myALZteam member

Possible unmet needs to consider when your loved one becomes agitated include:

• Hunger
• Thirst or dehydration
• Feeling hot or cold
• Constipation
• Having a full bladder
• Exhaustion, fatigue, or inability to sleep
• Loneliness or lack of social interaction
• Boredom or sensory deprivation

Here are some questions you can ask your loved one if you’re concerned about unmet needs:

• Would you like a blanket or a change of clothes?
• Are you hungry or thirsty?
• Do you need to use the bathroom?
• Does anything hurt or feel uncomfortable?
• Are you feeling tired? Would you like to rest?
• Would you like to sit somewhere quieter?
• Would you like some company?
• Do you want to listen to music or do something together?
• Would you like to have some space?

That said, agitation that begins suddenly over hours or days may be a medical emergency. In those cases, contacting a healthcare professional right away is extremely important. Sudden or severe agitation may signal pain, illness, side effects from medication, or another medical problem.

For example, pain from urinary tract infections, ear infections, or sinus infections can cause restlessness or agitation.

How Caregivers Can Identify Patterns

Caregivers may be able to ease agitation by meeting their loved one’s needs and reducing triggers.

Some myALZteam members have found that tracking their loved one’s behavior and surroundings helps them spot patterns and avoid possible triggers.

“Keeping a log was especially helpful for the staff that helped out in our home. I encouraged them to write down anything that they found helpful in certain situations, as well as logging my loved one’s sleep, eating, and mood,” shared one member.

“I find journaling helpful. I can see that when midday naps are skipped, the next day he is more confused. Increased stimulation of being around strangers spawns incorrect memories, but after interacting with our kids or close family, he can actually read an analog clock,” shared another member.

Dealing with these behaviors is challenging, but you are not alone. There are ways to help. Medication is an option for some people, but health experts usually recommend trying approaches that don’t involve medication first.