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Michael E. DeBakey VA Medical Center - Houston, Texas

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VA Study Identifies Causes of Aggression in Dementia Patients

April 14, 2010

Valuable Information Will Help Patients, Physicians, and Caregivers Improve Quality of Life

HOUSTON - In a study published March 9, 2010 in the Journal of Clinical Psychiatry, Mark Kunik, M.D., M.P.H., a psychiatrist at the Michael E. DeBakey VA Medical Center (MEDVAMC), and his colleagues found aggressive behavior in patients with recent-onset dementia is closely linked with pain, caregiver burden, and declining quality of the caregiver-patient relationship.

"Historically, behavioral problems in patients with dementia, such as aggression, have been treated with tranquilizing medications without regard to what might be causing the behavior," said Kunik, primary author of the paper. “The medications are not particularly effective and often result in unwanted side effects.”

The researchers hoped by understanding the possible causes of aggression that non-pharmacologic interventions can be developed to prevent its development or more effectively treat aggression once it develops.

The study included 215 community-dwelling, mostly male patients, at least 60 years old, who were diagnosed in the past year with dementia, and their caregivers. They excluded patients who had shown aggressive behavior since their diagnosis.

Every four months for two years, the researchers assessed patients for frequency and disruptiveness of aggression. The behavior was defined as spitting, cursing and other verbal aggression, physically trying to hurt themselves or others, destroying property, and making inappropriate verbal and/or physical sexual advances.

The research team also analyzed caregiver burden, along with the quality of the patient-caregiver relationship, including the frequency of communication, positive engaging interactions, attachment, and emotional support.

Of the study group, 89 patients or 41 percent developed aggression.

"Caregivers do play an important role in the onset of aggression, but it is important to not place blame on the caregiver," said Kunik. "This responsibility is extremely stressful and often caregivers feel isolated and have little access to help or resources to help them."

The study advises physicians to carefully screen for and appropriately treat pain in dementia patients. Sometimes, the best way to prevent aggression may be a prescription of an over-the-counter pain reliever. It is noted; however, that pain is difficult to recognize in persons with dementia because of the language problems associated with the disease. Physicians should also evaluate caregiver stress and offer guidance, advice, and information about community resources such as the Alzheimer's Association.

“The identification of causes of aggression and proactively attempting to prevent aggression is a fundamental shift in how aggression is currently managed,” said Kunik.

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