Dementia and Aggression

Alzheimer’s aggression is one of the dominant reasons most people put their parents in nursing homes. Fortunately, new medications and caring methods can help, though agitation and aggression are still a fairly misunderstood aspect of Alzheimer’s.

“The public thinks Alzheimer’s is a memory disease,” says Dr. Ramzi Hajjar, a geriatrician at St. Louis University in Missouri, United States. “But, in fact, there are lots of neuropsychiatric symptoms. Alzheimer’s patients often develop delusions. They think their family is stealing things from them, for example. And they get very aggressive and irritable towards their spouse.”

He stresses that families need to always remember that Alzheimer’s aggression really has nothing to do with them. “The child always wants to take it personally, which causes unnecessary anxiety,” Hajjar says.

What’s Behind Their Behavior

No one knows for sure why some Alzheimer’s patients have aggressive outbreaks and others don’t, but one University of Kansas study showed that recognition was the strongest predictor. Forgetting what something was, or what was inside something, was the most common cause of aggressive behavior.

Other studies have shown that Alzheimer’s patients sometimes act out because of side effects like headaches, constipation, and nausea from some anti-anxiety medications such as Xanax® (alprazolam), Ativan® (lorazepam), and BuSpar® (buspirone). Patients who can’t communicate often express their discomfort from those symptoms by becoming even more agitated and combative.

The first step in managing difficult behavior in the care for Alzheimer’s patients is to find out where it’s coming from, the triggers, and what it means. Does the agitation or combativeness mean the patient is hungry or thirsty or scared? Is it a reaction to something threatening or uncomfortable in their environment?

“I’ve seen people strike out because of their distress,” says Dr. Ruth Tappen, director of the Louis and Anne Green Memory and Wellness Center at Florida Atlantic University in Boca Raton, Florida. “Once, a Holocaust victim would have his memories return at night, and he’d get aggressive, yelling and carrying on at his wife; twice he even brandished a knife. He was defending himself from long-gone dangers.”

Other times, agitation starts when patients get frustrated with themselves, as simple memories start slipping away. They might forget where they put the keys, or what time their dinner appointment is that night. After asking a few times, everyone around them becomes irritated, and they get agitated.

But it’s sometimes hard to know exactly why some get aggressive. That’s what author Jacqueline Marcell learned, the hard way.

Marcell, who wrote the book “Elder Rage” after an entire year of experiencing her father’s Alzheimer’s aggression, says she grew to learn what situations would trigger her dad’s outbursts. But first, it took a year of doctor visits to even diagnose him correctly with Alzheimer’s.

Find Out More About How To Manage Aggression