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Aggression | Doctor's Diary

Aggression, particularly when accompanied by physical threats or actual violence, is an extremely disturbing symptom of dementia. Families need to be aware that the person with dementia literally has no control of themselves at this stage; it is not as if they can be 'talked out of it'. On the other hand, a calming approach will be helpful. That is very hard to do if you are on your own and scared, and the person with dementia will often pick up on your anxiety, making their own worse. This is one reason that aggression often is the breaking point for a person being able to stay in their own home.

The skill to deal with an agitated person is not shared by everyone, not even all health care professionals. I recall one time being urgently paged around breakfast time to see an agitated patient in hospital. I arrived to find the nurses outside the man's door; inside he was yelling and very violent. They were quite upset, and had sent for security, and for a burly hospital orderly. I began by talking to them, to find out who the patient was, and what had been going on. While we were strategizing, a woman came by, glanced at us, and went in the man's room. He immediately calmed down, so much so that the need for urgent treatment with antipsychotic drugs clearly passed. Later, as I was writing up my consultation note, I overheard the nurses talking about the woman - who was a nursing aide at the home from which the patient had been transferred - talking about the remarkable event we had just seen. They concluded that it was 'because he knew her". For my part, I am not at all sure that the man, in his agitation delirium, and severe dementia, actually did recognize the nurse's aide. Rather, I suspect that he reacted to her calm approach, and her obvious care.

Health care has an obvious hierarchy, in which a nurse's aide at a long term care facility ranks much further down than nurses at a tertiary care teaching hospital. But the skill to care for an agitated person does not always recognize such boundaries. For me, it is also an example of how health care systems often undervalue the skills of people who care for others with dementia.

One very important fact to remember about agitation when it comes on suddenly, especially in a person with mild Alzheimer's disease , is that it might be caused by an acute medical illness. Sudden changes in behaviour, especially when accompanied by a change in the level of arousal (with too much arousal in agitation), can represent delirium. Delirium is very often a treatable problem.



See Also:
About Dementia > Alzheimer's Disease > Memory
About Dementia > Types of Dementia > Delirium
About Dementia > Treatments for Dementia > Counselling
Symptom Library > Behaviour > Irritability/ Frustration
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Last updated August 11, 2017
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