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Alzheimer’s Agitation and Restlessness: Causes and Management

Medically reviewed by Ifeanyi Nwaka, M.D.
Updated on February 5, 2024

“My husband is getting restless in the evenings — pacing about, looking for nothing in particular. He is restless in bed through the night — yawning, sniffing, and moving around. I’m a light sleeper, so every movement wakes me,” shared one myALZteam member.

If you’ve noticed symptoms of restlessness or agitation in your loved one with Alzheimer’s disease, you are not alone. Here, we explore why someone with Alzheimer’s may experience these symptoms and what you can do about it.

Alzheimer’s Symptoms of Agitation and Restlessness

Restlessness is a common symptom of Alzheimer’s disease that may look different for everyone. Following are some symptoms of agitation and restlessness.

Fidgeting and Repetition

Sometimes, older adults living with Alzheimer’s may fidget or tap their hands repetitively. One member asked, “Have any of you noticed repetitive movements and verbal sounds such as humming nonstop?”

Another said, “My mother is a smoker and will put out her cigarette just to light it back up. It’s like she is obsessed with the ‘hand to mouth’ and lighting up.”

When you’re concerned about your loved one’s symptoms, including restlessness and agitation, it’s important to speak to their health care provider.

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Walking and Pacing

People with Alzheimer’s may walk or pace for hours on end, some even trying to wander out of the house. “Is nonstop walking and talking a normal phase?” one myALZteam member asked.

Loss of Sleep

Some caregivers notice that their loved ones lose sleep due to their Alzheimer’s. “My husband has been up since yesterday. He has been very restless lately,” one member shared.

Another said, “Does anyone else notice a lot of twitching and jumping when their loved one with dementia is sleeping during the day?”

Sleep disturbances are extremely common in Alzheimer’s and dementia and in older people in general who need less sleep.

Behavioral Symptoms

Along with this restlessness often comes personality changes, mood changes, and aggressive behavior. One member said, “I think what hurts the most is the nasty things he accused me of doing. I know it’s the disease, not him, because he was never like that. I really hate this rotten Alzheimer’s disease.”


As many as 66 percent of people living with Alzheimer’s or other dementias experience sundowning.

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Sundowning

When symptoms of confusion, anxiety, agitation, or restlessness occur in the late afternoon or early evening, it is called “sundowning.” As many as 66 percent of people living with Alzheimer’s or other dementias develop this symptom, according to Alzheimer Society of Canada. Usually, it peaks in the middle stages and lessens as the disease progresses.

Causes of Agitation and Restlessness

For family members and caregivers, managing a loved one’s restlessness and agitation can be extremely difficult. Finding out what causes these symptoms in the first place can help with reducing how often they occur.

Several factors can trigger agitation in people living with Alzheimer’s disease:

  • Pain, hunger, thirst, constipation, or other physical conditions may cause discomfort.
  • Environmental factors like loud noises, excessive stimulation, unfamiliar environments, or changes in routine may cause agitation.
  • Overstimulation from too many activities, tasks, or people may be an issue for some individuals. The Alzheimer’s Association recommends scheduling doctor’s appointments, trips, and bathing in the morning and early afternoon while your loved one has more energy and is more alert.
  • Cognitive decline and changes in the brain associated with Alzheimer's can cause confusion, frustration, and anxiety.
  • Side effects from antipsychotic drugs may cause agitation. A doctor may prescribe antipsychotic medications to help manage aggression.
  • Restless leg syndrome is a medical condition that causes an irresistible urge to move one’s legs, especially in the middle of the night.

It may take some trial and error to figure out what is triggering your loved one’s restlessness. Once you figure out the cause, you can take steps to prevent and manage these episodes in the future.

8 Tips for Managing Agitation and Restlessness as a Caregiver

Your loved one’s bouts of agitation can be frustrating or upsetting, but practicing patience and understanding is important. Below are some interventions and strategies to prevent and treat restlessness and agitation, which can help improve quality of life for both you and your loved one.

1. Identify Triggers

Pay attention to the circumstances and events that seem to trigger agitation in the person you care for. This strategy can help you anticipate and prevent future episodes. You can write them down for future reference and share them with other family members or any other caregivers who may provide respite care.

2. Create a Calm, Familiar Environment

Ensure the person’s surroundings are quiet, well-lit, and free from clutter. Having too much stimulation or not being able to see can be confusing and agitating.

“Our routine is breakfast, his pills, and a shower. We do it every day the same. I feel it works for him, but it helps me too.”

— A myALZteam member

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3. Establish a Daily Routine

Maintain a consistent routine to provide a sense of familiarity and security. Set a schedule for daily activities, including mealtimes, bathing, and bedtime, to provide structure and reduce uncertainty. “Our routine is breakfast, his pills, and a shower. We do it every day the same. I feel it works for him, but it helps me too,” shared a member who cares for a parent.

4. Offer Reassurance and Comfort

Speak calmly and provide reassurance to the person you care for. Use a gentle touch or soothing gestures to help calm down your loved one.

One myALZteam member recommended the following to another member whose mother was upset: “Take a few deep breaths. Take her dominant hand between your hands. Speak calmly and lower your tone. Say something soothing. Repeat this over and over. I hope this sequence will keep you calm and soothe her. I also used a stress-relieving lotion or oil to massage my late mom’s hands, neck, and shoulders to calm her.”

5. Engage in Calming Activities

Encourage activities that promote relaxation, such as listening to calming music, engaging in gentle exercise, or doing hobbies the person enjoys. “My mom enjoys gospel and oldies to help her sleep and feel comfort,” one member commented.

6. Avoid Overstimulation

Limit noise, visitors, and activities that may overwhelm your loved one. Monitor their reactions and adjust the environment as needed. Oftentimes, a change of scenery can work wonders. “We went out to dinner yesterday for our 43rd anniversary,” a myALZteam member wrote. “The first place we went to, Hubby got real nervous due to the noise level while waiting to be seated. We left and went to one of his favorite places instead, much quieter. This is something new, not liking crowded noisy places.”

7. Ensure Physical Comfort

Regularly check for any physical discomfort, such as hunger, thirst, pain, or the need to use the bathroom. One member said, “Part of the problem is dehydration. Try to keep your loved one hydrated, it will help a bit.”

Addressing any biological needs promptly can help prevent agitation before it gets worse.

8. Speak to Your Loved One’s Doctor

When you’re concerned about your loved one’s symptoms, including restlessness and agitation, it’s important to speak to their health care provider. Clinicians can recommend potential treatment options or lifestyle changes to help reduce their symptoms of agitation and restlessness.

Talk With Others Who Understand

On myALZteam, the social network for people living with Alzheimer’s disease and their loved ones, more than 85,000 members come together to ask questions, give advice, and share their stories with others who understand life with Alzheimer’s.

Have you experienced a loved one with Alzheimer’s facing agitation? What tips do you have for others in the same position? Share your thoughts below in the comments or post to your Activities page.

    Updated on February 5, 2024
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    Ifeanyi Nwaka, M.D. earned his medical degree from the American University of Antigua College of Medicine. Learn more about him here.
    Scarlett Bergam, M.P.H. is a medical student at George Washington University and a former Fulbright research scholar in Durban, South Africa. Learn more about her here.

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