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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.

PubMed Logo 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.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.