Study Probes Differences in Aggression Among Dementias

New research provides insight into how the course of illness in those with Alzheimer’s or frontotemporal dementia impacts physical aggression.

The study from Lund University in Sweden suggests that one-third of patients with the diagnosis Alzheimer’s disease or frontotemporal dementia were physically aggressive towards health care staff, other patients, relatives, animals, and complete strangers.

Researchers note that his manifestation of disease must be both understood and addressed in the right way.

“The prevalences are not surprising, but we noted a difference between the two groups in terms of when in the course of the disease aggressive behavior manifested and how serious the violence was,” said psychiatry resident Madeleine Liljegren, a doctoral student at Lund University and lead author of the study.

Investigators reviewed brain examinations and patient journals of 281 deceased people who between the years 1967 and 2013 were diagnosed with Alzheimer’s or frontotemporal dementia. The researchers examined data associated with the entire duration of the disease, from the patients’ first contact with a physician to follow-up after death.

“The individuals with frontotemporal dementia displayed physically aggressive behavior earlier in their disease than people with Alzheimer’s. The difference may be due to the fact that the diseases arise in different parts of the brain,” said Dr. Maria Landqvist Waldö, co-author of the study.

“For those with frontotemporal dementia, the damage begins in the frontal parts of the brain, which is where among other things our capacity for empathy, impulse control, personality, and judgement reside. Alzheimer’s is accentuated further back in the brain where our memory is located as well as our ability to orientate ourselves in time and space.”

The number of patients who displayed physical aggression was greater among those diagnosed with Alzheimer’s. However, individuals with frontotemporal dementia were physically aggressive more often, and this behavior was particularly evident toward complete strangers.

Twenty-one percent of the physically aggressive patients with frontotemporal dementia were physically aggressive towards strangers, compared with two percent of the physically aggressive Alzheimer’s patients.

“There was an unexpectedly large difference between the groups, even though people with frontotemporal dementia generally are younger when they start showing symptoms of the disease than those with Alzheimer’s disease,” Liljegren said.

“There is also a longer delay between the first symptoms and an established diagnosis, which means they are out and about in the community longer without access to the right help and support.”

She said someone with frontotemporal dementia can use physical aggression without any provocation, whereas a person with Alzheimer’s generally does this if another person approaches them too fast, for example in a nursing care situation.

“If you notice socially deviant or criminal behavior in a person who has previously acted normally, you should be attentive and help the person get examined by a physician, as it could be the first sign of dementia,” Liljegren said.

Source: Lund University/EurekAlert