The fight or flight response in people with dementia: Angry reactions might not be what they seem

A common trait of people living with dementia as their condition progresses can be that they often appear angry and are even known to lash out at their carers.

They can appear agitated and upset and even frightened.

While at first this anger might seem as though it is being directed at the carer for something they have done wrong, in reality, what you are seeing is a ‘fight or flight’ response.

The dementia patient’s brain is no longer hard-wired to accurately perceive how threatening a situation is.

Perfectly innocent actions can be perceived as highly threatening in a person with dementia.

In a healthy person, the amygdala part of the brain receives information from two sources – a direct route through the thalamus, and a longer route through the the thalamus and then through the cortex.

The information delivered through the thalamus triggers a fast response – the fight or flight response.

The information that flows through both the thalamus and then the cortex allows for an evaluation of the situation, and determines whether or not the situation is truly threatening.

In a person with dementia, the parts of the brain that control the perception of threat have deteriorated, and therefore perfectly innocent actions, such as being fed, can be perceived as highly threatening situations.

How to avoid triggering a fight or flight response in a person with dementia:

• Approach them with a smile and a friendly face.
• Remind them of who you are if necessary, using your name and telling them who you are.
• Speak respectfully and reassuringly, in a non-threatening, low voice.
• Limit noise and distraction, turn off the TV and radio.
• Use simple words and short sentences.
• Speak to them at their eye level, even if they are sitting down.
• Be gentle and affectionate, show you care.
• Make sure you have their attention before doing anything.

What to do if a person with dementia does become agitated and angry:

• Change the subject.
• Change the environment, for example, by taking them for a walk. If you are moving the person to a different environment, make sure you let them know first, for example say, “I can see you’re upset. Let’s walk out into the garden.”
• Touch them gently.
• Speak in a soothing voice.
• Remind them of happy times.
• Don’t physically restrain them.
• Make sure dangerous items aren’t accessible.
• Sympathise with their loss of control over their life.