Distressed behaviours can be thought of as an overarching term for a range of behaviours, including, but not limited to, restlessness, pacing, repetitive questioning, agitation, aggression, resisting or not engaging with interventions, apathy, and sleep disturbance. A person with dementia’s experience of distress is unique and individualised to them. When distress is present it may indicate that the person with dementia has an underlying biological, psychological, social or environmental need, such as untreated pain, anxiety or unfamiliar surroundings.126 Distress can also be present in people with delirium. Distress within the context of delirium is covered in the SIGN guideline on risk reduction and management of delirium.65

As distressed behaviours are usually a manifestation of an underlying unmet need in the person with dementia, most guidance recommends non-pharmacological interventions in the first instance.22 Guidance on use of pharmacological approaches is available in the NICE guideline on dementia: assessment, management and support for people living with dementia and their carers.22