title: Causes of aggressive behavior in patients with dementia.
abstract: OBJECTIVE
  To examine factors predicting development of aggression.
  
  
  METHODS
  Community-dwelling patients over 60 years of age in a Veterans Affairs Medical Center who had a documented ICD-9-CM code for dementia within 12 months of screening and no other dementia codes recorded for 2 preceding years but no aggressive behavior during the 12 months preceding study initiation were assessed every 4 months for 24 months for aggression, depression, pain, patient/caregiver relationship quality (mutuality), involvement in pleasant events, and caregiver burden. The study was conducted from September 5, 2003, to June 10, 2005.
  
  
  RESULTS
  Of 215 patients, 89 (41%) developed aggression. In individual models, high baseline mutuality decreased risk of aggression; high burden and pain increased risk. Increases in depression and pain and declines in total mutuality also increased risk. In a full model and step-wise model, high levels of baseline caregiver burden, worst pain, and decline in mutuality over time increased risk of aggression.
  
  
  CONCLUSIONS
  Many dementia patients become aggressive. Higher levels of worst pain, caregiver burden, and declining mutuality over time increase risk of aggression.
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Health Services Research and Development Services, Houston, TX 77030, USA. mkunik@bcm.tmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.forename: Avila B
authors.initials: AB
authors.lastname: Steele
authors.forename: Valli
authors.initials: V
authors.lastname: Balasubramanyam
authors.forename: Rachelle S
authors.initials: RS
authors.lastname: Doody
authors.forename: Paul E
authors.initials: PE
authors.lastname: Schulz
authors.forename: Jagadeesh S
authors.initials: JS
authors.lastname: Kalavar
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
mesh_terms: D000368:Aged; D000374:Aggression / Q000523:psychology*; D000544:Alzheimer Disease / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D017028:Caregivers / Q000523:psychology; D015331:Cohort Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005195:Family Relations; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D008960:Models, Psychological; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012931:Social Environment