Late Stage Symptom: Aggression

Reviewed by: HU Medical Review Board | Last reviewed: June 2019 | Last updated: October 2020

As Alzheimer’s disease progresses, symptoms can change and become more pronounced depending on the stage. While the physical and cognitive changes can be challenging, the behavioral symptoms can be particularly distressing to you and your partner, family, or caregivers. While there are treatments and strategies to help manage many of the behavioral symptoms, there is no cure for Alzheimer’s disease, and no treatment will slow down the progression of the disease. Instead, the goal of these treatments is to help minimize symptoms. With various lifestyle modifications, these treatments and strategies can help minimize disruption and improve your quality of life.

Aggression, or when a person attacks you verbally or tries to physically attack you, can be common in the later stages of Alzheimer’s disease. The aggression can come on seemingly out of nowhere, for no apparent reason. If you start to develop signs of aggression, it’s important to see your doctor to make sure there’s not an underlying medical reason for the aggression, like medication interactions or adverse side effects. Once an outside cause is ruled out, treating aggression related to Alzheimer’s disease can be assessed and treated.

Causes of aggression

While sometimes aggression can occur for no reason, often times there is an underlying factor, like physical discomfort, pain, overstimulation, or confusion. Some causes of aggression can include1,2:

  • Physical pain
  • Hunger or thirst
  • Soiled undergarments
  • Sudden change in environment or routine
  • Change in caregiver
  • Not getting enough sleep
  • Not having enough interpersonal interaction
  • Overstimulation (too loud, too many people, etc)
  • Confusion

Treatments and strategies for aggression

There are a variety of treatments and strategies to deal with aggression, both drug and non-drug treatments. Non-drug strategies should be tried before medication, since many drugs have side effects that can interfere with cognition and increase risk of falling. Non-drug approaches to aggression include2,3:

  • Modifying the environment to create a calm setting and remove any emotional triggers
  • Check in to make sure all basic needs have been met and toileting needs aren’t being ignored
  • Get enough rest, especially if you’re doing a lot
  • Keep a security object with you that helps you feel safe and calm, if you anticipate any changes

Drug treatments for aggression may include anti-anxiety medications and antipsychotic medications, depending on the specific symptoms and severity. Antipsychotic medications should only be used if no other treatments are effective, and should be used at the lowest possible effective dose, with close monitoring. Not only can medication increase cognitive impairment and risk of falls and fractures, but antipsychotics have been associated with increased risk of stroke and death in older adults with dementia.3 Some doctors prescribe a mood stabilizer that is also an anti-seizure medication known as carbamazepine (Tegretol).3 Whatever the medication prescribed, it’s important to discuss the risks and benefits of the drug, and closely monitor for any medication interactions or adverse side effects. The aim of drug treatments is not to sedate you; it’s to minimize your symptoms using the lowest possible dose of medication.

While aggression in Alzheimer’s is not uncommon, it can interfere with quality of life and be distressing, especially for those around you. If you’re dealing with aggressive symptoms, talk with your doctor about ways to help reduce symptoms and what your options are if non-drug treatments cease to be effective.

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