When Elizabeth Edgerly’s mother was living with memory loss, Edgerly had to help her with daily care activities like getting dressed. At times, her mother became frustrated and couldn’t communicate what she needed.
“I remember a couple instances in which she went to hit me with a cane,” says Elizabeth Edgerly, the senior director of care and support for The Alzheimer’s Association.
People with Alzheimer’s Disease (AD), dementia, or other forms of memory loss can display aggression or agitation in moments of frustration. Although there isn’t a cure, scientists are learning more about what causes aggression in people with memory loss and a better understanding of how caregivers can cope.
What Causes Aggression in Dementia Patients?
Most patients with memory loss who show aggression or agitation do not have a history of violence or other antisocial behaviors. But dementia causes neurodegeneration, and depending on the disease type, the structural changes can occur in the parts of the brain involved with regulating emotions and impulses.
Medical care professionals typically define violence as any use of physical force against oneself or another. Violence can also include the threat of physical force.
Dementia patients are vulnerable, and they become more fragile as the disease progresses. However, they increasingly lack judgment, and advocates say threats of violence should be taken seriously.
Memory Loss and Criminal Behavior
In a 2015 study in JAMA Neurology, researchers examined data from 2,397 memory loss patients from 1999 to 2012 to determine if they exhibited violent behavior during that time period and if specific memory loss diseases made a patient more prone to aggression, agitation, or criminal behavior such as shoplifting or trespassing.
Only about 8 percent, or 204 participants, had documented criminal behavior during the study period. Of these participants, about 37 percent had a behavioral variant of frontotemporal dementia, meaning the dementia was located in a part of the brain in which behavioral changes were expected.
Memory Loss and Confusion
In the JAMA Neurology study, qualitative analysis examined the types of criminal or aggressive behavior displayed by memory loss patients. There were instances of violence as well as lesser crimes such as shoplifting, public urination, traffic violations, and trespassing.
In some of these instances, the person struggled to comprehend their surroundings or their actions. An 83-year-old woman, for example, was accused of shoplifting a pie. She had purchased a pie previously at the store but brought it back and received a credit for a new pie.
When she opted to redeem her credit, she selected a pie, bypassed the cashier, and tried to leave. In another instance, she loaded up her cart to make a donation to the food bank. She expected the store had a donation bin on-site, and when she learned items had to be directly donated to the food bank, she wheeled her cart out of the store without paying.
Read More: The 4 Main Types of Dementia
Why do Dementia Patients Get Frustrated?
For Edgerly, her professional background enabled her to understand that it wasn’t her mother who was raising the cane in frustration. It was the disease.
“She got caught up in the robe. It was a disaster; it was not funny, and it was annoying or embarrassing. The only thing she could do in that moment was let me know,” Edgerly says.
When a dementia patient raises their hand in frustration or tries to push away a caregiver, Edgerly says they are unable to articulate their needs, so they resort to “really loud communication.”
“I realized the behavior started talking to me when my mom wasn’t able to talk to me,” Edgerly says. “I stopped what I was doing and thought, just don’t push through it. That is not the way to handle it.”
Edgerly compares the confusion a dementia patient experiences to a common scenario — trying to find an unfamiliar destination in a crowded, noisy city. Concentration is needed, so most people turn off the radio until they have the situation under control.
Dementia patients can’t articulate their needs or manipulate the environment, so they resort to a physical reaction. And without the same insight or impulse control they used to have, they are no longer able to consider their actions and how they can hurt others.
Changing Tactics
After her mother raised her cane in frustration, Edgerly says she stepped back to evaluate the situation. Something in the moment was causing her mother distress, and she decided to switch her strategy, so the goal was no longer about getting her mom into the robe but making sure she felt comfortable and was having a positive experience.
When memory loss patients show agitation or aggression, analyzing the environment can help a caregiver determine what is frustrating the patient. There might be too many distractions, or they may need their helper to move more slowly. Simple changes may remedy the problem.
“One major driver of behavior is pain and discomfort,” Edgerly says. Relieving pain can calm a memory loss patient. If environmental changes do not work, Edgerly says there is now an FDA-approved drug to address agitation in memory loss patients.
Read More: How to Talk to Someone With Dementia
Caring for Caregivers
For Edgerly, seeing her mother raise her cane in frustration was initially “jarring,” but her professional background enabled her to not take it personally.
Many caregivers, however, may need help in understanding what is happening to their loved ones and why they are acting in such a manner. In a 2023 literature review in the Journal of Clinical Nursing, the authors highlighted empirical evidence that found caregivers with an aggressive or agitated family member can experience anxiety, depression, and post-traumatic stress disorder.
In these instances, emotional support is needed for the caregiver, particularly so they can cope with their family member’s behavior due to neurodegeneration.
“We say, ‘it’s the disease. It’s not your dad that just said that to you,” Edgerly says. “We try to help them understand the changes in the brain. It’s not that they don’t love you anymore.”
Read More: How to Care for a Loved One With Alzheimer's
Article Sources
Our writers at Discovermagazine.com use peer-reviewed studies and high-quality sources for our articles, and our editors review for scientific accuracy and editorial standards. Review the sources used below for this article:
JAMA Neurology. Criminal Behavior in Frontotemporal Dementia and Alzheimer Disease
The Neuroscience of Dementia. Genetics, Neurology, Behavior, and Diet in Dementia
Senior director of care and support for The Alzheimer’s Association. Elizabeth Edgerly
The Alzheimer’s Association. Aggression and Anger
Journal of Clinical Nursing. Aggressive behaviour of persons with dementia towards professional caregivers in the home care setting—A scoping review
Emilie Lucchesi has written for some of the country's largest newspapers, including The New York Times, Chicago Tribune and Los Angeles Times. She holds a bachelor's degree in journalism from the University of Missouri and an MA from DePaul University. She also holds a Ph.D. in communication from the University of Illinois-Chicago with an emphasis on media framing, message construction and stigma communication. Emilie has authored three nonfiction books. Her third, "A Light in the Dark: Surviving More Than Ted Bundy," releases October 3, 2023 from Chicago Review Press and is co-authored with survivor Kathy Kleiner Rubin.
