The most distressing dementia symptom? And clinical tips for helping families manage it
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Somewhere around 80% of people with dementia, at some point in the course of their disease, will have changes in their behavior. So it could be agitation and aggression, it could be paranoid thinking, it could be hallucinations.
Freddi Segal-Gidan, PA-C, memory and cognitive disorders neurology specialist
A 79-year-old woman with dementia was arrested earlier this year in Florida after attacking her husband with a hammer. [] Reports say the woman failed to recognize her husband in their home and believed he was an intruder.
Experts say that while not everyone living with dementia experiences aggressive behaviors, it is also not a rare occurrence.
“Many of the core symptoms of dementia—these are complications obviously—are characterized by agitation, aggression, and sometimes violence. So it's not rare that there would be agitation,” David Reuben, MD, chief of the Division of Geriatrics at the UCLA Center for Health Sciences, tells MDLinx.
The symptom's scope
Research suggests that between 40% and 60% of people living with dementia experience agitation or aggression.[]
This can be due to the changes taking place in the brain of a person with dementia, according to Freddi Segal-Gidan, PA-C, memory and cognitive disorders neurology specialist with Keck Medicine of USC.
“There is degeneration going on in the brain. The nerve cells are degenerating or dying off. The connections between nerve cells are dying away, and the chemistry in the brain is disrupted...the aggression and the agitation is the symptom of the neurochemical imbalance and the degeneration and dysfunction of the brain,” she tells MDLinx.
She continues: “When people have dementing illness…unusual behaviors are part of the disease. Somewhere around 80% of people with dementia, at some point in the course of their disease, will have changes in their behavior. So it could be agitation and aggression, it could be paranoid thinking, it could be hallucinations. It's a range of behaviors [that] can occur.”
What can physicians do to support families?
Dr. Reuben says there are a number of ways physicians can help support families in managing aggressive behaviors from loved ones with dementia.
One of the strategies he suggests is to encourage families to avoid activities that could trigger an emotional or aggressive response.
“The best way is treating behavioral complications with behaviors—in other words, behaviors trying to avoid precipitants. Particularly, there is a precipitant that will trigger these kind of bad reactions. Sometimes you'll see it when you're trying to bathe somebody, for example, and they get violent with that. So you do a different kind of bathing,” he says.
There are medicines that can help with symptoms like these, Dr. Reuben notes. "Occasionally, there are less advantageous drugs that are used for behaviors, but there are also now medicines that are aimed at trying to prevent aggression of the disease."
Dementia can be more than memory loss
Aggressive behaviors are just one of many challenges patients with dementia and their family members may face—something many non-MDs may not realize.
Segal-Gidan says it’s crucial that physicians providing a diagnosis of dementia explain to the patient's family that they can anticipate other symptoms in addition to loss of memory. "In speaking with people, and working with people about this diagnosis, they will need to anticipate that it's not just memory problems," she says. "The disease is more than just memory and thinking problems but can also affect people's behavior. That's number one."
She continues: “The other thing is to try to set up things that are preventative. So we work with families to help them set up a regular schedule [and] to have a regular routine of what they're doing, so that the world is less confusing for the person with dementia.”
Related: Researchers may have found a new cause of dementia