title: Modeling causes of aggressive behavior in patients with dementia.
abstract: OBJECTIVE
  To examine factors predicting development of aggression in patients with dementia as a step toward developing preventive strategies and nonpharmacologic therapies.
  
  
  METHODS
  Study participants were 171 nonaggressive, community-residing VA patients aged more than 60, newly diagnosed with dementia. Patients and caregivers were assessed at baseline and at months 5, 9, 13, 17, 21, and 25. Aggression was evaluated using the Cohen-Mansfield Agitation Inventory. Survival models incorporating direct and indirect effects were conducted to estimate associations between psychosocial factors (baseline and change measures of dementia severity, pain, depression, caregiver burden, patient-caregiver relationship, and nonaggressive physical agitation) and time to aggression onset.
  
  
  RESULTS
  Higher levels of baseline caregiver burden, worst pain, declining patient-caregiver relationship, and increasing nonaggressive physical agitation predicted increased risk of aggression. Baseline dementia severity and depression were indirectly related to onset of aggression. The association between increasing nonaggressive physical agitation and time to aggression onset was independent of the associations between our psychosocial measures and time to aggression onset.
  
  
  CONCLUSIONS
  Potentially mutable factors were associated with development of aggression. The longitudinal design of this study and its sample of newly diagnosed, previously nonaggressive dementia patients strengthen prior findings in the literature.
authors.affiliation: *Address correspondence to Robert O. Morgan, Division of Management, Policy, and Community Health, University of Texas School of Public Health, 1200 Herman Pressler, Rm. E343, Houston, TX 77030. E-mail: robert.o.morgan@uth.tmc.edu.
authors.forename: Robert O
authors.initials: RO
authors.lastname: Morgan
authors.forename: Kavita R
authors.initials: KR
authors.lastname: Sail
authors.forename: A Lynn
authors.initials: AL
authors.lastname: Snow
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Davila
authors.forename: Negin N
authors.initials: NN
authors.lastname: Fouladi
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D015233:Models, Statistical; D010146:Pain / Q000453:epidemiology*; D011595:Psychomotor Agitation / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Structural equation models; Veterans