Agitated Behaviors in Alzheimer Disease Strongly Linked to Caregiver Burden in US Survey

Key Clinical Summary

• High prevalence: Nearly all individuals with Alzheimer disease (99.6%) exhibited at least 1 agitated behavior in the prior 2 weeks, most commonly restlessness, repetitive speech, and verbal aggression.
• Caregiver impact: Agitation severity correlated with significantly higher caregiver burden, anxiety, depression, and impaired work productivity.
• Key takeaway: Effective management of agitation in Alzheimer disease could meaningfully reduce caregiver stress and improve daily functioning.

A national online survey published in 2024 examined the relationship between agitation in individuals with Alzheimer disease and the burden experienced by their caregivers. Conducted across the United States between August and September 2021, the study used the Cohen-Mansfield Agitation Inventory (CMAI) to measure agitated behaviors and assessed caregiver well-being using validated mental health and productivity scales.

Study Findings / Main News

The cross-sectional survey included 250 adult caregivers (mean age 44.5 years; 55.2% male), each providing unpaid, cohabitating care for an individual with Alzheimer disease (mean age 68.6 years). Participants reported an average of 39.1 hours per week devoted to caregiving, often supplemented by additional unpaid (58.8%) or paid (38.4%) care.

Agitation was nearly universal: 99.6% of care recipients displayed one or more agitated behaviors, including aggressive (83.6%), physically non-aggressive (85.6%), and verbal agitation (86.0%). The most frequent behaviors were repetitive questioning (94.8%), complaining (90.8%), negativism (88.4%), and pacing (86.8%). The behaviors caregivers found most distressing included verbal aggression (28.5%), spitting (22.5%), and hitting (18.1%)—symptoms often linked to decisions about long-term care placement.

Regression analyses revealed that each 5-point increase in CMAI total score was associated with a 19% higher likelihood of high caregiver burden, 7% higher odds of generalized anxiety, and 11% higher odds of depression (P < .001). Work productivity and daily activity impairment also rose by approximately 1.7 percentage points per 5-point CMAI increase. Over 60% of caregivers reported high burden, 35% had moderate-to-severe distress, and roughly two-thirds reported significant work or daily life impairment.

Clinical Implications

These findings underscore the substantial toll of agitation on both caregivers and individuals with Alzheimer disease. Agitated behaviors—whether repetitive questioning, aggression, or restlessness—can erode caregiver well-being, increase financial strain, and contribute to burnout.

Given that agitation often precedes institutionalization, its management is not only central to patient quality of life but also to sustaining home-based care. Interventions that reduce agitation frequency or severity could improve caregiver mental health and reduce indirect costs such as absenteeism and reduced productivity.

The results support broader adoption of evidence-based pharmacologic and behavioral strategies for agitation management, as well as systemic investment in caregiver support programs, respite care, and counseling.

Conclusion

Agitation in Alzheimer disease is nearly universal among US community-dwelling individuals and is closely tied to caregiver stress, depression, and functional impairment. Targeted treatment of agitated behaviors—and expanded caregiver support resources—could alleviate burden and enhance well-being for millions of American families affected by Alzheimer disease.

Reference

Grossberg G, Willey C, Houle C, et al. Agitation in individuals with Alzheimer’s disease: An assessment of behaviors using the cohen-mansfield agitation inventory in community-dwellers and impact on caregiver experience. Dementia. 2025. doi:10.1177/14713012251340463