Everyday, we come across things that irritate, annoy or worry us, but usually we don't overreact. This good behaviour of staying calm, of taking the longer view, of shrugging it off, or keeping it to ourselves is learned, not instinctive. Just think of how toddlers (or teenagers for that matter) learn to control themselves. Not each of us is equally good at it. Ironically, we are usually better behaved with strangers than with people that we know.

Learning to control ourselves is complex; the frontal lobes are crucial for this. As they become affected by the disease, it is harder for a person to exercise control. Keep in mind that not all aggression is a matter of their frontal lobes, but the idea that the person is having a lot of difficulty controlling their behavior is an important one in learning how to cope.

In our experience, the response of aggression to treatment with a cholinesterase Cholinesterase
An enzyme that breaks down acetyl choline into active parts that can be recycled. inhibitor varies, so that the extent to which it produces a reversible effect of the lack of the brain chemical acetyl choline Acetyl choline
A neurotransmitter released in synapse that is active in the transmission of nerve impulses. is not clear. Recently, an English study found that one cholinesterase inhibitor (rivastigmine) was no more effective than placebo in treating agitation in people with Alzheimer's disease Alzheimer's disease
A neurological disease that affects memory and behaviour. It is characterized by beta-amyloid plaques and neurofibrillary tangles in the brain. There is no known cause but genetics and lifestyle are thought to play a role., even if it did have modest cognitive Cognitive
See cognition effects. Interestingly, quetiapine, one of the newer neuroleptic Neuroleptic
A class of drugs used to treat psychosis. drugs, also had no effect, and appears to have made cognition Cognition
The mental processes associated with knowing and understanding thoughts and perceptions about one's environment. worse. (Ballard C et al., Quetiapine and rivastigmine and cognitive Cognitive
See cognition_decline in Alzheimer's disease: randomised double blind placebo controlled trial. BMJ. 2005;330:874). It has been described as being successfully treated in nursing home residents with the drug resperidone. (Rabinowitz J et al., Behavioral and psychological symptoms in patients with dementia as a target for pharmacotherapy with risperidone. J Clin Psychiatry. 2004;65:1329-34.)

The treatment of aggression in dementia remains complicated, and controversial, with much of the evidence for treatment effects being disputed. For example, there is a concern that some of the newer agents, while effective, also can increase the risk of stroke Stroke

Blood supply to the brain is interrupted, usually by a blood clot. As a result, a portion of the brain can die from not receiving enough blood and oxygen.