Aggression– A Difficult Behavioral Disturbance In Demented Persons

If you have a loved one who has dementia then you know how many everyday things become problems.

Tasks and abilities that we take for granted gradually and surely turn into difficult challenges.

Dementia is a vast topic and there are many points that can be made about it. There will be several other posts which will address other facets of dementia.

Aggression in Dementia

Today I want to talk about aggressive behavior that may be seen in patients with dementia. 

When I say aggressive behavior, I mean shouting, yelling, throwing things, being very agitated, maybe even punching someone.

Let’s first consider the following: a hot tempered person who has been easily agitated and borderline violent all his or her life will not all of a sudden turn into this calm persona when demented (at least not typically). When people have normal cognition they are usually inhibited to some degree and will not allow their aggressive impulses to reign freely. Demented persons on the other hand often lose their inhibitions. They speak their minds freely and they don’t necessarily “pull themselves together” in order to act “socially appropriate”. There are no medications that can treat how a person is.

This is not easy to accept. We often wish there were easy solutions but unfortunately, there are not.

When there are new behaviors of violence or aggression in a demented person we have to stop and analyze: What is going on? A demented person cannot clearly articulate and express what bothers or hurt them.

The first question to answer is this: What were the circumstances of the event? What has led to it? Who were the people involved? What was the environment like? Was there some kind of provocation?

Possible triggers may be: 

There are many reasons for aggressions

• Change in environment
• Change in care taker
• fear
• A loud noise
• Temperature too hot or too cold (in room or water when washing)
• Aggressive care giver with little patience
• Rough care taking without soothing explanations

The best way to figure this one out is to put yourself into the person’s position. If someone came to you and treated you that particular way would that agitate you?

When there is a change from someone’s regular behavior it is always something to worry about and should trigger evaluation by a nurse, or a physician.

Causes for these behaviors may be: 

• Pain
• Hunger, Thirst
• Infection
• Constipation
• Soiled diapers



Aggression can be ugly

• Side effects from medications

Aggressive behavior in people with dementia is one of the most common reason for institutionalization. It really poses a huge problem. You should not face it alone. Seek help from physicians, home care services, nurses and support groups.

Remember also that these behaviors are not really “against” you. They need to be interpreted in context and often are rudimentary expressions of a person who can no longer express accurately.

Here is a wonderful resource from the website of National Institute of Aging: click here.

Stay calm, don’t argue, de-escalate, and get help! You are not alone!

I really hope you find the support that you need. 

Don't lose hope!

Be well,

Dr. B