The Link Between Dementia and Aggression

Anger, Aggression and Alzheimer’s

From time to time, it seems like the person you once knew is replaced with someone who looks and sounds quite like them, but doesn't act like them.

Instead of the mild-mannered and even-keeled person you knew, this replacement is prone to outbursts of anger. The anger seems to appear without warning, and their irritability builds quickly into an eruption. The verbal and physical aggression is too impactful to ignore.

Unfortunately, many people experience this when their loved one has Alzheimer’s disease. Alzheimer’s is a gradual, incurable type of dementia. In fact, it is the most common form of dementia, accounting for as many as 80 percent of all dementia cases. Alzheimer’s creates functional problems with memory, thinking and behaviors.

Certainly, memory and thinking problems are concerning, but there is a fear-inducing aspect that behavioral changes spark that the others do not. Chief among the upsetting behaviors are anger and aggression — these symptoms may present without notice and without being proportional to their trigger.

Understand the Causes

Their anger will not make sense at first. It is not your job to make sense of it — it is your job, though, to better understand themes and associations related to their responses. If you can gain knowledge about the onset of anger, you might have increased ability to improve the situations.

Generally, the increase in anger comes from the advancing deterioration of brain cells. As these cells fail, their ability to function worsens. Signals cannot be sent or received in typical ways as messages become distorted or eliminated completely.

As this process progresses, three secondary causes emerge: physical discomfort, situational stressors and communication barriers.

For people with Alzheimer’s, physical pain and discomfort will be contributors to their anger and aggression.

The average person will tend to be more irritable or frustrated when pain is present, and this experience is amplified for those with Alzheimer’s because it becomes more difficult to identify the source of the discomfort, to accurately express it to caregivers, and to work towards a remedy. With this being the case, anger becomes a more likely outcome.

The pain can come from many sources related directly or indirectly to their condition, including:

  • People with dementias commonly have infections, like in the urinary tract, leading to discomfort.
  • Fatigue and sleep problems can trigger a high level of physical unease.
  • Medications used to treat Alzheimer’s or unrelated symptoms might generate unwanted symptoms like nausea and headaches.

Situational stressors are the second source of anger and aggression for someone with Alzheimer’s. These can present in a number of ways and forms with themes including:

  • Being in a new, confusing situation.
  • Having trouble completing a task that was previously easy.
  • The environment being loud, overwhelming, chaotic or overly stimulating.

If any of these situations present, the person with Alzheimer’s might react with anger or aggression due to a lack of other available options.

Another stress triggered by the environment is the time of day. People with Alzheimer’s can have tendencies to perform better at certain times of the day than others. If morning is their best time, the afternoon could spark feelings of anger.

The final component of anger for someone with Alzheimer’s is communication. In actuality, communication is such an important factor concerning aggression because a lack of effective communication can drastically reduce functioning in the previous categories.

If your loved one has a pain but cannot verbalize it, the pain will continue without treatment, which leads to anger. If you loved one does not appreciate a certain environment but cannot verbalize it, the overwhelming sensations will continue, which leads to more anger.

Communication is the way all people interact with the others in their world. Without communication there is isolation, loneliness and despair.

 Next page: solutions to consider.

Practice the Solutions

Like with any problematic situation, learning about and understanding the causes is only the first step. To make a difference, you have to take action that is well thought out, consistent, and based on the situations and experiences of your loved one.

If your loved one is undergoing tremendous amounts of physical pain, it doesn’t matter how calm the environment is. No matter of pain relief will reduce the frustration from confusion related to lack of communication. For best results, target the problems directly.

Target Communication

Communication needs to be the major focus at the beginning. It should focus on finding new and creative ways to allow free expression from your loved one.

This process should be addressed during calm periods to translate more intense periods later. Consider options like picture boards if your loved one has trouble forming thoughts into words.

Don’t forget to be a good listener while realizing that many messages will not be verbalized.

Build Empathy

Work to put yourself in their situation and see the world from their eyes. This might yield helpful information that you can use to reduce future anger.

Boost Relaxation

Spending too much time focused on the risk of anger and aggression has the propensity to create more anger and aggression. This is similar to only telling a small child what not to do rather than telling her what to do.

Increasing pleasurable activities for your loved one and providing opportunities for them to relax will accomplish this goal. Remember, sitting in front of the TV is not relaxation.

Avoid Escalation

It is human nature to meet aggression with equal parts of aggression. When it comes to your loved one with Alzheimer’s, your reactions might only escalate the situation.

Strive to manage your emotions, shift their anger in other directions, and allow them the freedom to express their anger without hurting others. Using physical responses or restraints should only be used to limit injury to your loved one or increase their safety.

There is no cure for the aggression that stems from Alzheimer’s. As a caregiver or a loved one, the best use of your limited resources will be to learn the sources and practice the solutions. You won’t eliminate anger, but you might be able to contain it with the best reactions.

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