Aggression May Be Linked to Psychosis in Elderly Persons with Dementia
Up to 90% of patients with dementia experience behavioral changes during the course of their illness, and aggression is among the most prevalent comorbidities. Developing a better understanding of the causes of aggression might lead to more effective treatment and preventive strategies. This study examined the evidence on whether delusions or hallucinations contribute to the development of agitation or aggression in persons aged 65 and older with dementia. Investigators conducted a literature review that resulted in 18 studies for analysis, including cross-sectional, longitudinal, and randomized controlled treatment trials. Most studies showed a statistically significant association between psychosis and aggression. Findings also showed that the use of antipsychotic medications in the setting of agitation/aggression and psychosis among patients with dementia is not uniformly supported. Authors note that given the multifactorial etiology of psychosis and aggression with other comorbid symptoms in dementia, it is important to understand the various contributing factors to facilitate more effective treatment interventions with least possible risk. They also suggest that prospectively designed studies looking at the temporal relationship of psychosis with aggression in dementia patients with psychosis are needed to make a stronger causal argument.
Shub D, Ball V, Abbas A, Gottumukkala A, and Kunik M. The Link between Psychosis and Aggression in Persons with Dementia: A Systematic Review. Psychiatric Quarterly June 2010;81(2):97-110.
This study was supported by HSR&D. Drs. Shub and Kunik are part of HSR&D’s Houston Center for Quality of Care and Utilization Studies.