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Aggression | What's Happening in the Brain

Every day, we come across things that irritate, annoy or worry us, but usually we don't over-react. 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, but the frontal lobes are crucial for this. As they become affected by the disease, it is harder for a person to exercise control. Not all aggression is a matter of their frontal lobes, but the idea that the person is having a lot of difficulty controlling their behaviour is an important one in learning how to cope.

In our experience, the response of aggression to treatment with a cholinesterase inhibitor varies, so that the extent to which it reflects a reversible effect of the lack of the brain chemical acetylcholine 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 , even if it did have modest cognitive effects. Interestingly, quetiapine, one of the newer neuroleptic drugs, also had no effect, and appears to have made cognition worse. (Ballard C et al., Quetiapine and rivastigmine and cognitive _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 and related illnesses. On the other hand, the alternative is often to use older drugs that have been less thoroughly evaluated than the newer ones. Issues about treatment are discussed in the chapter on 'Psychotropic agents in Alzheimer disease' by David M. Blass, and Peter V. Rabins in the book Trial Designs and Outcomes in Dementia Therapeutic Research, published in London by Taylor & Francis, 2005, and edited Kenneth Rockwood and Serge Gauthier.

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 January 15, 2019
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