Physical aggression among patients with dementia, neuropathologically confirmed post‐mortem

Liljegren, Madeleine; Waldö, María Landqvist; Englund, Elisabet

doi:10.1002/gps.4777

Cited by 18 publications

(21 citation statements)

References 55 publications

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“…Prevalence rates of 6-21% (PA) (Isaksson et al, 2011) and 11-30% (vocalizations) (Beck et al, 2011) have been reported in nursing homes. Several correlates have been described for PA and vocalizations, such as higher age (Beck et al, 2011;Voyer et al, 2005), more dementia severity (Liljegren, Landqvist Waldo, & Englund, 2018;Voyer et al, 2005), psychotropic drug use (PDU) (Isaksson et al, 2011;Voyer et al, 2005), and positive associations with other neuropsychiatric symptoms, e.g. depression and psychotic disorders (Bourbonnais & Ducharme, 2008;Leonard, Tinetti, Allore, & Drickamer, 2006), whereas conflicting results have been found for sex (Beck et al, 2011;Isaksson et al, 2011;Voyer et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Very frequent physical aggression and vocalizations in nursing home residents with dementia

Veldwijk-Rouwenhorst

Zuidema

Smalbrugge

et al. 2020

Aging & Mental Health

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Objectives: We investigated the 2-week prevalence and correlates of very frequent physical aggression (PA) and vocalizations in nursing home (NH)-residents with dementia. Method/Design: This cross-sectional study used combined data of 2074 NH-residents from four studies, collected from 119 dementia special care units in 26 Dutch NH. Very frequent PA was defined as scoring 6 or 7 on the items 'hitting', pushing', 'biting' and 'kicking' of the Cohen Mansfield Agitation Inventory; very frequent vocalizations as scoring 6 or 7 on 'screaming' and 'making strange noises'. We compared NH-residents with very frequent PA or vocalizations with residents with less frequent PA or vocalizations, assessing correlates using univariate and multivariate multilevel logistic regression analyses. Results: We found a 2-week prevalence of 2.2% (95% confidence interval (CI): 1.63-2.89) of very frequent PA and 11.5% of very frequent vocalizations (95% CI: 10.23-12.98). Very frequent PA was only associated with apathy (odds ratio (OR)¼1.93, 95% CI: 1.04-3.61). Correlates of very frequent vocalizations were age (OR ¼ 0.97, 95% CI: 0.951-0.998), dementia severity (overall p-value 0.020), antipsychotic drug use (OR ¼ 1.56, 95% CI: 1.08-2.26), antiepileptic drug use (OR ¼ 2.75, 95% CI: 1.34-5.68) and euphoria (OR ¼ 2.01, 95% CI: 1.22-3.31). Conclusion: Characteristics of NH-residents with very frequent PA or very frequent vocalizations differ from those of NH-residents with less frequent PA or vocalizations. Frontal lobe damage, boredom, pain and/or external factors may explain several of the found associations, but further research is necessary. Our findings may contribute to better care for these residents and thereby to improving their quality of life.

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Section: Introductionmentioning

confidence: 99%

Very frequent physical aggression and vocalizations in nursing home residents with dementia

Veldwijk-Rouwenhorst

Zuidema

Smalbrugge

et al. 2020

Aging & Mental Health

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“…This review highlights the importance of systematic examination of cognitive function as part of a comprehensive clinical assessment of older homicide offenders, which does not appear to be current standard practice. It seems likely this results in underestimating the prevalence and contributory role of dementia in offenders, particularly regarding the diagnosis of dysexecutive syndrome which has been associated with aggression [5, 14, 40]. On the other hand, bedside cognitive tests (such as the Mini-Mental State Examination and Frontal Assessment Battery, validated screening tools in specific populations) were sometimes incorrectly referred to as diagnostic tools [25, 27, 29].…”

Section: Discussionmentioning

confidence: 99%

Homicide and Dementia: A Systematic Review

Sundakov-Krumins

Lubbe

Wand

2022

Dement Geriatr Cogn Disord

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Background: Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a progressive neurological condition which may amplify behavioural disturbances such as aggression. This systematic review aims to evaluate the factors associated with homicide committed by people with dementia in order to inform clinical practice. Summary: MEDLINE, PsychINFO, Embase, and PubMed databases were searched in accordance with PRISMA guidelines for empirical studies examining the characteristics and circumstances of people with dementia who committed homicides. Data on factors associated with the homicide were extracted and the quality of each study rated using standardized criteria. A total of 499 papers were screened and thirteen studies met the inclusion criteria. Study design included case reports (seven studies), case series (four studies), and two retrospective cohort studies, indicative of low levels of evidence. Sample sizes were 1–70. Study findings were predominantly descriptive. Quality ratings ranged from 50 to 100%. Factors associated with disinhibition such as dysexecutive syndrome, alcohol use, and delirium may predispose to severe impulsive aggression. Psychosis and personality pathology appeared to influence targeted assaults resulting in homicide by people with dementia. Victim vulnerability was also a key element. Key Messages: The current evidence examining risk factors for homicide committed by people with dementia is limited. However, there are common characteristics reported in these descriptive studies including psychiatric factors and cognitive states causing disinhibition. Recommendations for clinical practice include early assessment of older people with dementia and changed behaviours to allow management of comorbidities and reversible risk factors, alongside education, and advice to carers (who may be targets of aggression). Specialized geriatric forensic psychiatry services and care settings should be developed.

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“…First, as mentioned, a study of the same cohort has already been published on the matter. 7 Second, physical aggression is prevalent among patients with a neurodegenerative disorder and is often exhibited when receiving intimate care. Many of the patient notes considered in this study were taken in nursing homes; therefore, a high number of notes regarding physical aggression was to be expected.…”

Section: Discussionmentioning

confidence: 99%

“…Our analysis included an extensive postmortem examination of cases recorded between January 1, 1967, and December 31, 2017; this patient cohort has been described in a previous study. 7 We added 22 additional cases of FTLD to the 97 cases considered in the previous study. All patients had earlier been referred to specialists in geriatric psychiatry or cognitive medicine at the Memory Clinic (previously the Psychogeriatric Department) in Lund and closely monitored during the entire course of disease, as recorded in longitudinal research studies.…”

Section: Methodsmentioning

confidence: 99%

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Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort

et al. 2019

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Physical aggression among patients with dementia, neuropathologically confirmed post‐mortem

Abstract: The patterns of manifested physical aggression thus differ between the frontotemporal dementia and Alzheimer's disease patient groups in this study. Knowledge about such differences may be of value in decision making in patient care.

Cited by 18 publications

References 55 publications

Very frequent physical aggression and vocalizations in nursing home residents with dementia

Very frequent physical aggression and vocalizations in nursing home residents with dementia

Homicide and Dementia: A Systematic Review

Association of Neuropathologically Confirmed Frontotemporal Dementia and Alzheimer Disease With Criminal and Socially Inappropriate Behavior in a Swedish Cohort

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