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2008 HSR&D National Meeting Abstract

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National Meeting 2008

3024 — Incidence and Causes of Aggression in Dementia

Kunik ME (COE-Houston), Snow AL (Tusacaloosa VAMC, University of Alabama), Davila JA (COE-Houston), Steele AB (COE-Houston), Balasubramanyam V (COE-Houston), Doody R (Baylor College of Medicine), Schulz PE (Houston VAMC (MEDVAMC)), Kalavar JS (Houston VAMC (MEDVAMC)), Morgan RO (COE-Houston)

Objectives:
Aggression is among the most distressing and dangerous symptoms of dementia, yet uncertainty remains about its incidence and causes. The objective of this VA HSR&D-funded, two-year longitudinal examination of patients newly diagnosed with dementia who had been previously nonaggressive was to identify the incidence of aggression and factors that predict the development of aggression.

Methods:
Newly diagnosed, nonaggressive dementia patients were identified primarily through VA Administrative Databases and VA primary care physicians. Exclusion criteria were 1) current residence in a nursing home; or 2) having a caregiver less than 8 hours per week. Participants and their caregivers were assessed monthly for 24 months. The dependent variable was aggression (Cohen-Mansfield Agitation Inventory Aggression subscale). The independent predictor variables included: Depression (Hamilton Rating Scale for Depression), Psychosis (Neuropsychiatric Inventory), Pain (Philadelphia Geriatric Center Pain Intensity Scale), Caregiver Burden (Burden Index), Caregiver Relationship (Mutuality Scale) and Environmental Quality (Pleasant Events Scale). Cognitive status (Dementia Rating Scale) was a controlling variable.

Results:
The incidence of aggression in this cohort of 215 patients was 0.37 per year at risk. Using bivariate analyses, significant baseline differences existed between those who developed aggression and those who did not were observed in terms of dementia severity (p = .004), depression (p = .02), mutuality (p = .002), burden (p = .0001), delusion (p = .007) and hallucination (p = .004). Using cox proportional hazard analyses, higher total mutuality (p = .006) scores at baseline were associated with decreased risk of onset of aggression, while higher levels of caregiver burden (p = .0001) and pain (p = .03) were associated with increased risk of aggression. Analyses examining change of predictor variables will also be presented.

Implications:
Aggression occurs at rates more common than previously recognized. The identification of mutable factors could fundamentally change the approach to aggression in persons with dementia.

Impacts:
Developing interventions aimed at the identified mutable factors has the potential to prevent aggression, which would be an important alternative approach to the low efficacy, current standard of care - antipsychotic medications.


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