Miller, Bruce L

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Causes of aggressive behavior in patients with dementia.

Mark E Kunik; A Lynn Snow; Jessica A Davila; Avila B Steele; Valli Balasubramanyam; Rachelle S Doody; Paul E Schulz; Jagadeesh S Kalavar; Robert O Morgan (Profiled Author: Doody, Rachelle S)

Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Services, Houston, TX 77030, USA. mkunik@bcm.tmc.edu
The Journal of clinical psychiatry 2010;71(9):1145-52.

OBJECTIVE: To examine factors predicting development of aggression. METHOD: Community-dwelling patients over 60 years of age in a Veterans Affairs Medical Center who had a documented ICD-9-CM code for dementia within 12 months of screening and no other dementia codes recorded for 2 preceding years but no aggressive behavior during the 12 months preceding study initiation were assessed every 4 months for 24 months for aggression, depression, pain, patient/caregiver relationship quality (mutuality), involvement in pleasant events, and caregiver burden. The study was conducted from September 5, 2003, to June 10, 2005. RESULTS: Of 215 patients, 89 (41%) developed aggression. In individual models, high baseline mutuality decreased risk of aggression; high burden and pain increased risk. Increases in depression and pain and declines in total mutuality also increased risk. In a full model and step-wise model, high levels of baseline caregiver burden, worst pain, and decline in mutuality over time increased risk of aggression. CONCLUSIONS: Many dementia patients become aggressive. Higher levels of worst pain, caregiver burden, and declining mutuality over time increase risk of aggression.

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