Aggressive and impulsive behavior in Alzheimer’s disease and progression of dementia

Abstract

SummaryBackgroundThe symptoms of Alzheimer’s disease (AD) are numerous, including worsening of mood, psychotic symptoms, aggressive and impulsive behaviours, and many others. It is generally assumed that there exists a relationship between the severity of dementia and aggressive symptoms. The aim of this study was to assess the relationship between aggressive and impulsive behaviours and cognitive function disorders in AD patients.Material/MethodsForty-eight AD patients living in a nursing home were included in the research group on the basis of NINCDS/ADRDA criteria. The subjects underwent two years of naturalistic observation. The intensity of agitation and aggressive behaviours was assessed on the basis of the Cohen-Mansfield Agitation Inventory (CMAI). The Alzheimer’s Disease Assessment Scale Cog (ADAS-cog) was used to assess cognitive function. Pharmacotherapy administered during the observation period was also taken into account.ResultsThirty-one patients completed the two year long observation. Individuals with more severe cognitive deficiencies demonstrated a greater intensity of aggressive and impulsive behaviours, as assessed using the CMAI scale. Aggression escalated together with the development of dementia disorders. The intensity of dementia disorders was most significantly connected with physical agitation and verbal aggression. The use of neuroleptics and mood stabilisers decreased the progression of aggressive and impulsive behaviours.ConclusionsThere is a relationship between cognitive functioning disorders and the intensification of aggressive and impulsive behaviours. More severe forms of dementia are connected with greater intensification of aggressive and impulsive behaviours as the disease progresses. Periodical administration of pharmacotherapy may reduce the development of aggressive behaviours.

Memantine for treatment of moderate or severe Alzheimer’s disease patients in urban China: clinical and economic outcomes from a health economic model

“…This is a conservative assumption, as memantine has been shown to not only reduce of emergence of agitation (included in this model), but also improve agitation/ aggression in symptomatic patients; thus, overall this assumption likely underestimates the clinical benefits of memantine [16]. However, despite the variability of agitation/aggression symptoms that may be observed in the progressive course of AD, this assumption was considered reasonable and supported by data from observational studies [8,40,41]. The mortality rate per cycle used for the simulation (5.24%) was based on a similar relative risk for moderate and severe patients, as it was the only information available in China.…”

“…Agitation and aggression are key behavioral AD symptoms that are closely linked to disease severity and associated with poor outcomes, such as hospitalization or nursing home placement, and are indicators for high care demands [6,8,9]. Effective management of agitation/aggression is therefore of particular importance to alleviate some of the physical, emotional and economic burden of advanced AD.…”

Influence of gender on the prevalence of behavioral symptoms in patients with Alzheimer's dementia

“…Similar research was conducted by Ryden (1998), which also points to the relationship between cognitive impairment and aggressiveness in patients with dementia. Bidzan et al (2012) report that there is a re-lationship between functional disorders of cognitive function and intensification of aggressive manifestations in a patient with Alzheimer's dementia.…”

A lipid-leakage model for Alzheimer’s Disease

“…Related behavioural evidence pointing towards frontal damage as a factor in both diseases includes personality changes (Bózzola, Gorelick & Freels, 1992;Chatterjee et al, 1992;Oscar-Berman et al, 1997;Moselhy, Georgiou & Kahn, 2001;Talassi et al, 2007;Echeburúa, De Medina & Aizpiri, 2007;Ball et al, 2010), disinhibition and impulsivity (Chen et al, 2007;Ball et al, 2008;Crews & Boettiger, 2009;Dick et al, 2010;Bidzan, Bidzan & Pąchalska, 2012;Finger et al, 2017), confabulation (Kern et al, 1992Brun & Andersson, 2001;Tallberg & Almkvist, 2001;Attali et al, 2009;Maurage et al, 2011;Rensen et al, 2015) and a noticeable tendency towards perseverative behaviour. This last attribute is readily apparent in individuals with AD (Bayles et al, 2004;Serna, Pigot & Rialle, 2007;Pekkala et al, 2008;Kaufman, 2015;De Lucia, Grossi & Trojano, 2015), while studies in adult and adolescent rodents chronically exposed to ethanol (but given a nutritionally adequate diet) point towards a similar pattern of behavioural and neurological deficit Obernier et al, 2002;Crews & Nixon, 2009;Kroener et al, 2012;Acheson et al, 2013;Sullivan & Pfefferbaum, 2014;Badanich et al, 2016), confirming findings in humans (Giancola, Peterson & Pihl, 1993;Oscar-Berman et al, 1997;Fadda & Rossetti, 1998;Ratti et al, 2002;Dirksen et al, 2006;Oscar Berman, 2009).…”