Development and treatment of aggression in individuals with dementia [2020]

• Aggression is the most serious and prevalent noncognitive symptom of the behavioral and psychological symptoms of dementia

• The onset of aggression is a combination of various biologic, psychosocial, caregiving, and environmental factors

• Several assessments exist to quantify the frequency and severity of aggressive behaviors

• Atypical antipsychotics are most often used off-label to treat aggression

• Current practice guidelines suggest nonpharmacological treatments as first-line therapies

Behavioral and psychological symptoms of dementia (BPSD) are a group of non-cognitive symptoms and behaviors that often occur with a diagnosis of dementia. Aggression is the most prevalent and serious of these noncognitive symptoms. However, the development and treatment of aggression in this population are not always clear and the type of dementia does not further help to clarify this problem. There are biological, psychosocial, and environmental factors that attribute to the development of aggression, but identification has proven difficult due to the homogeneity of symptoms. Few studies have compared the type of aggression across the four most common types of dementia: Alzheimer’s Disease (AD), vascular dementia (VaD), dementia with Lewy body (DLB) and frontotemporal dementia (FTD). Results indicated that those with AD are more likely to be physically aggressive, but other factors play a role in how and why it is exhibited. Treatment for aggression in dementia has focused on pharmacological and nonpharmacological methods. Atypical antipsychotics are the most frequently prescribed, nevertheless, these medications come with severe risks. The more recent Nonpharmacological treatments have shown promising results shown in conjunction with psychosocial approaches. Aggression in dementia is associated with a variety of factors and can be treated in multiple ways. Future research is needed in terms of identifying the etiology and presentation of aggression in AD, VaD, DLB, and FTD, developing safe pharmacologic treatments, and evidence-based nonpharmacological methods.

Meghan C. Gilmore, Lisa Stebbins, Soledad Argüelles-Borge, Brizel Trinidad, Charles J. Golden
Aggression and Violent Behavior, Volume 54, September–October 2020