Physical aggression and Alzheimer's

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Caregiving involves many challenges and changes, but the most difficult may be when a loved one with dementia becomes physically aggressive. This doesn’t always happen, but as many individuals with Alzheimer’s progress into the middle stages of the disease, behavioral problems such as aggression do surface. Not only is this emotionally disturbing for caregivers – especially if the family member has never been aggressive in the past – but it is also potentially dangerous for the caregiver and the person with dementia.

Researchers led by Dr. Robert Morgan at the University of Texas recently conducted research to try to shed light on what factors increased the risk for a person with Alzheimer’s to become physically aggressive. The team assessed 171 veterans living in the community who had recently been diagnosed with dementia and who had no history of aggression. They also assessed the veterans’ caregivers. What makes this study so exemplary was that the researchers assessed the participants 7 different times over a 2-year period. This allowed them to explore how various factors were related to any emergence of aggression over time.

The team found several factors were directly related to the development of aggression in the person with dementia. Here are those factors, along with ways to address them:

Caregiver burden. The higher a caregiver’s burden was at the outset of the study, the more likely the person with dementia would become physically aggressive. What is caregiver burden? Imagine an umbrella under which you find all of the types of stress that affect you as a caregiver – physical, emotional, financial, and so forth. That umbrella is caregiver burden.

What to do: More research is needed to understand why caregiver burden is associated with increased physical aggression, but the message is that caregivers need to find the support they need so that their burden is lessened. Try joining our forum, find Alzheimer's care services near you, or call the Alzheimer’s Association’s 24/7, toll-free Helpline at 1-800-272-3900.

Pain. As Alzheimer’s progresses, people with the disease become less able to communicate when they are in pain. Physical pain affects mood and can influence how we interact with others. Apparently increased pain in those with Alzheimer’s is tied to increased physical aggression, perhaps because caregivers don’t realize their loved ones are in pain while providing personal care.

What to do: Learn to recognize signs that your family member may be experiencing pain. They include fever, swelling, grimacing, wincing, moaning or shouting, and sleep problems. Report any possible pain symptoms to the doctor immediately.

Agitation. The researchers also found that agitation – which can encompass anxiety, restlessness, and a need to pace and keep moving – was linked to an increased risk of physical aggression. More research is needed to understand why this link exists; for instance, perhaps unsatisfied agitation escalates to physical aggression over time.

What to do: Try to create a calm environment for your loved one that is free of heavy noise or commotion. Monitor the person for hunger, thirst, feeling too hot or cold, and the desire to go to the bathroom so that these basic needs are met. Keep activities and tasks simple, but try to work in some gentle exercise such as walking or gardening for both physical and mental stimulation.


Morgan, R. O., Sail, K. R., Snow, A. L., Davila, J. A., Fouladi, N. N., & Kunik, M. E. (2012). Modeling causes of aggressive behavior in patients with dementia. The Gerontologist, doi: 10.1093/geront/gns129



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