Managing Dementia Behaviors: Agitation, Sundowning, Wandering & More

Caring for someone with dementia means facing behaviors that can be confusing, exhausting, and heartbreaking. Your calm, gentle parent may become angry and suspicious. Simple tasks like bathing become battles. Nights blur into days as they wander the house.

These behaviors aren't deliberate. They're symptoms of the disease—the brain's struggle to make sense of a world that no longer makes sense. Understanding why these behaviors happen is the first step to managing them.

This guide covers the most challenging dementia behaviors and gives you evidence-based strategies to handle them while maintaining your own wellbeing.

Understanding Dementia Behaviors

Before diving into specific behaviors, it helps to understand what's driving them.

The Brain Behind the Behavior

Dementia damages the brain's ability to:

• Process and make sense of information
• Control impulses and emotions
• Communicate needs clearly
• Remember recent events (while older memories may remain)
• Recognize familiar people and places

When someone with dementia acts out, they're often expressing something they can't put into words: "I'm scared," "I'm in pain," "I need to use the bathroom," "I don't know where I am."

Common Triggers

Most challenging behaviors have triggers. Common ones include:

Physical needs:

• Pain or discomfort (they may not be able to tell you it hurts)
• Hunger or thirst
• Need to use the bathroom
• Fatigue
• Medication side effects
• Infections (especially urinary tract infections)
• Constipation

Environmental factors:

• Overstimulation (too much noise, activity, or people)
• Understimulation (boredom)
• Unfamiliar surroundings
• Changes in routine
• Lighting (shadows can be frightening)
• Temperature (too hot or cold)

Emotional factors:

• Fear or anxiety
• Frustration at lost abilities
• Feeling rushed or pressured
• Loss of control
• Grief over what's happening to them

Agitation and Aggression

Perhaps the most distressing behavior for caregivers is when their loved one becomes agitated, angry, or even physically aggressive.

What It Looks Like

• Pacing, restlessness, inability to settle
• Verbal outbursts, yelling, cursing
• Hitting, pushing, grabbing
• Refusing care
• Throwing objects
• General irritability

Common Triggers

• Pain or physical discomfort
• Overstimulation or overwhelming environments
• Feeling threatened or afraid
• Being asked to do something they can't do
• Loss of control or independence
• Caregiver frustration (they pick up on your stress)
• Changes in routine or environment

How to Respond

In the moment:

• Stay calm. Your anxiety will increase theirs
• Speak in a low, soothing voice
• Don't argue, correct, or reason—logic doesn't work
• Give them space if safe to do so
• Remove yourself if you're in danger
• Try to redirect attention to something pleasant
• Use their name and gentle touch (if they respond well to touch)

What NOT to do:

• Don't take it personally—this is the disease, not them
• Don't argue or try to explain why they're wrong
• Don't restrain unless there's immediate danger
• Don't punish or scold
• Don't crowd them or invade their space

Prevention strategies:

• Look for patterns: What time of day? What happened before?
• Rule out medical causes (pain, infection, medication)
• Simplify the environment
• Break tasks into small steps
• Allow extra time—never rush
• Give choices to maintain sense of control
• Maintain consistent routines

Sundowning

Sundowning refers to increased confusion, agitation, and anxiety that occurs in the late afternoon and evening.

What It Looks Like

• Increased confusion as the day progresses
• Anxiety, restlessness, or irritability in evening
• Pacing or wanting to leave the house
• Crying or calling out
• Difficulty settling for bed
• Paranoia or suspiciousness

Why It Happens

Researchers aren't entirely sure, but likely factors include:

• Disrupted internal body clock (circadian rhythm)
• Fatigue from the day's activities
• Low lighting creating confusion and shadows
• Changes in the brain affecting sleep-wake cycles
• Unmet needs accumulated throughout the day

Management Strategies

During the day:

• Expose them to bright light, especially in the morning
• Encourage physical activity (appropriate to ability)
• Limit daytime napping to short periods
• Avoid caffeine after morning
• Keep a consistent daily routine

In the afternoon and evening:

• Reduce stimulation as evening approaches
• Turn on lights before it gets dark—avoid shadows
• Close curtains to minimize external stimuli
• Play soft, calming music
• Offer a light, early dinner (heavy meals can increase agitation)
• Plan calm activities: folding towels, looking at photos

At bedtime:

• Create a calming bedtime routine
• Keep the bedroom comfortable temperature
• Use nightlights to prevent disorientation
• Limit fluids before bed to reduce nighttime bathroom trips
• Consider white noise machines

Wandering

Wandering is one of the most dangerous dementia behaviors. People with dementia who wander can become lost, injured, or exposed to weather extremes.

Types of Wandering

• Goal-directed: Looking for something or someone (often from the past)
• Exit-seeking: Trying to leave to "go home" or "go to work"
• Modeling: Following others around
• Self-stimulating: Pacing for physical release
• Night wandering: Getting up and walking at night

Warning Signs Someone Might Wander

• Returns from regular walks or drives later than usual or gets lost
• Talks about wanting to "go home" (even when home)
• Tries to fulfill former obligations (going to work, picking up children)
• Asks where past homes, jobs, or people are
• Acts restless or paces
• Has difficulty finding familiar places in the home

Prevention Strategies

Home modifications:

• Install door alarms or motion sensors
• Use childproof covers on doorknobs
• Place deadbolts high or low where they're not easily seen
• Camouflage doors with curtains or paint them same color as walls
• Put a "STOP" sign on exit doors
• Place dark mats in front of doors (may appear as holes)
• Secure outdoor areas with fencing

Identification and tracking:

• Ensure they wear ID at all times (bracelet, necklace, shoe tag)
• Register with MedicAlert + Alzheimer's Association Safe Return
• Consider GPS tracking devices (watches, shoe inserts, clip-ons)
• Keep a recent photo and description available
• Notify neighbors and local police about the risk

Address underlying needs:

• Provide regular exercise and activity
• Maintain consistent routines
• Look for patterns: time of day, triggers, destinations
• Reassure them when they express wanting to "go home"

If Your Parent Wanders

1. Search the immediate area first (most people don't go far)
2. Check dangerous areas: pools, stairwells, dense bushes
3. Call 911 immediately—don't wait
4. Alert neighbors
5. Contact MedicAlert + Safe Return if enrolled
6. Have the recent photo ready for searchers

Repetitive Questions and Actions

Hearing the same question 50 times a day can be maddening. Understanding why it happens helps you respond with patience.

Why It Happens

• Short-term memory loss—they genuinely don't remember asking
• Anxiety about something (the question may reflect underlying worry)
• Need for reassurance or connection
• Boredom or lack of stimulation
• Habit or routine behavior

How to Respond

Answer as if it's the first time:

• They're not trying to annoy you—they don't remember asking
• Keep your voice calm and patient
• Avoid saying "I just told you" or "You already asked that"

Try alternative approaches:

• Write the answer on a whiteboard or card they can check
• Post schedules, calendars, or notes with key information
• Redirect to an activity after answering
• Look for the emotion behind the question and address that

Example redirection:

"What time is dinner?" (asked repeatedly)

• Answer: "Dinner is at 5:00. Let's look at this photo album while we wait."
• Or: "You seem hungry. Would you like a snack?"

Repetitive Actions

If they repeatedly perform an action (packing and unpacking, folding and refolding), this is often self-soothing behavior. It's usually harmless and may actually provide comfort.

• Redirect only if the behavior is problematic
• Provide safe items to manipulate (sorting buttons, folding towels)
• Consider activity boards with zippers, latches, and buttons

Sleep Problems

Dementia often disrupts sleep patterns, leading to exhaustion for both the person with dementia and their caregiver.

Common Sleep Issues

• Difficulty falling asleep
• Waking frequently during the night
• Wandering at night
• Sleeping excessively during the day
• Day-night reversal (awake at night, sleeping during day)

Management Strategies

Establish good sleep habits:

• Keep a consistent schedule for waking, meals, and bedtime
• Get exposure to bright light during the day
• Limit daytime naps to 30 minutes in early afternoon
• Avoid caffeine and alcohol
• Encourage physical activity during the day (not near bedtime)

Create a sleep-friendly environment:

• Keep the bedroom cool, quiet, and dark
• Use nightlights to prevent falls and reduce disorientation
• Remove items that could cause confusion or injury
• Consider a motion-sensor that alerts you if they get up

Bedtime routine:

• Same sequence of activities each night
• Calming activities: warm bath, soft music, gentle massage
• Limit fluids to reduce nighttime bathroom visits
• Ensure they use the toilet right before bed

Suspicion and Paranoia

"You're stealing from me." "Someone's been in my room." "You're not my daughter." Accusations and paranoia are painful to hear but common in dementia.

Why It Happens

• Memory loss (they forget where they put something, so assume it's stolen)
• Confusion about surroundings and people
• Fear and anxiety
• Visual or hearing impairment causing misinterpretation
• Difficulty distinguishing between past and present

How to Respond

Don't:

• Argue or try to convince them they're wrong
• Take it personally
• React with anger or frustration
• Dismiss their feelings

Do:

• Validate their feelings: "I can see you're upset. I'm sorry this is bothering you."
• Offer to help: "Let's look for your wallet together."
• Redirect: "I understand. Let's have some tea and talk about it."
• Keep duplicates of frequently "lost" items
• Create a designated spot for important items

Misidentification

When they don't recognize you or think you're someone else:

• Don't argue or insist they should know you
• Introduce yourself gently: "It's me, Sarah, your daughter."
• If they accept the misidentification, go along with it if safe
• Focus on being a supportive, caring presence regardless of who they think you are

Resistance to Care

Bathing, dressing, and other personal care can become battles. Understanding why helps you find solutions.

Why They Resist

• Loss of control and independence
• Embarrassment about needing help
• Fear of water or the process
• Not understanding what's happening
• Physical discomfort (cold bathroom, sensitive skin)
• Feeling rushed

General Strategies

• Maintain their dignity—use towels for privacy
• Give choices: "Do you want to wear the blue shirt or the green one?"
• Break tasks into small steps with one instruction at a time
• Allow them to do as much as they can themselves
• Use a calm, reassuring voice
• Try different times of day
• Make the environment comfortable (warm room, soft music)

Bathing Tips

• Keep the bathroom warm
• Test water temperature carefully
• Use a handheld showerhead for control
• Consider sponge baths if showers cause fear
• Maintain modesty with a towel or bathrobe during the process
• Have everything ready before starting
• Use no-rinse cleansers if full baths are too difficult

Coping Strategies for Caregivers

Managing these behaviors day after day takes an enormous toll. Taking care of yourself isn't optional—it's essential.

Remember: It's Not Personal

The anger, accusations, and resistance are symptoms of the disease. The parent who loved you is still there, even if they can't always show it. Separating the person from the disease helps you respond with compassion.

Take Breaks

• Use respite care services
• Accept help from family and friends
• Take time for activities you enjoy
• Consider adult day programs for your parent

Get Support

• Join a caregiver support group
• Talk to a therapist who understands caregiver stress
• Call the Alzheimer's Association 24/7 Helpline: 1-800-272-3900
• Connect with online caregiver communities

Know When to Ask for More Help

Consider whether you need additional help if:

• Behaviors are escalating or becoming dangerous
• You're experiencing caregiver burnout
• Your own health is suffering
• You're feeling hopeless or having thoughts of harm
• Your parent's needs exceed what you can safely provide

When to See the Doctor

Contact the doctor if you notice:

• Sudden changes in behavior (could indicate infection or medical problem)
• Signs of pain or discomfort
• Aggression that puts anyone at risk
• Severe sleep disturbances
• Hallucinations or delusions that cause significant distress
• Depression or withdrawal
• Behaviors that don't respond to non-medication approaches

Medications are sometimes necessary for severe behavioral symptoms, but they're typically a last resort after other approaches have been tried. Discuss risks and benefits carefully with the doctor.

Helpful Resources

• Alzheimer's Association 24/7 Helpline: 1-800-272-3900
• Alzheimer's Foundation of America: 1-866-232-8484
• Eldercare Locator: 1-800-677-1116 (helps find local services)
• MedicAlert + Safe Return: 1-888-572-8566