October 7, 2016

Managing Challenging Behaviors: Aggression

Since Alzheimer's disease and other dementias affect various parts of the brain, these diseases can cause people to act in different and unpredictable ways. Some individuals become anxious or aggressive. Others repeat certain questions or gestures. Many misinterpret what they hear. The main cause of behavioral symptoms associated with dementia is the progressive deterioration of brain cells, but other factors — such as confusion, fear, anger or pain — can make the situation worse. These types of reactions can lead to misunderstanding, frustration and tension, particularly between the person with dementia and their caregiver.


Often times, aggression is the first challenging behavior that care providers encounter when caring for a client or loved one with dementia. In the case of Phyllis Edelstein, who spent years caring for her husband with dementia, aggression would appear to come out of nowhere, seemingly unprovoked. It's important to understand that the person is not trying to be difficult and that all behavior is an attempt at communication.

It is critical that we assess what’s causing the aggression: physical discomfort (pain, sleep deprivation, medication side effects), environmental factors (overstimulation, under-stimulation, feeling lost) and poor caregiver communication (complicated instructions, projecting frustration or anxiety) can all be triggers for agitation.  In the short term, try and identify the immediate cause of the aggression, rule out pain as a source of stress, focus on feelings (not facts), and shift the focus to another activity, ideally one that is calming and relaxing.

Anyone experiencing behavioral symptoms should receive a thorough medical checkup, especially when symptoms appear suddenly (UTIs, or urinary tract infections, can cause changes in someone with Alzheimer's disease that you might never expect). Treatment depends on a careful diagnosis, determining possible causes and the types of behavior the person is experiencing.

This blog post is Part 1 of a 5-part series on managing challenging behaviors.