Physical aggression among people with dementia is not unusual. A study from Lund University in Sweden showed that one-third of patients with the diagnosis Alzheimer’s disease or frontotemporal dementia were physically aggressive towards healthcare staff, other patients, relatives, animals and complete strangers. This manifestation of disease must be both understood and addressed in the right way.

“The prevalences are not surprising, but we noted a difference between the two groups in terms of when in the course of the disease aggressive behaviour manifested and how serious the violence was,” said psychiatry resident Madeleine Liljegren, doctoral student at Lund University and lead author of the study.

The study is based on a review of brain examinations and patient journals of 281 deceased people who between the years 1967 and 2013 were diagnosed with Alzheimer’s or frontotemporal dementia. The researchers have followed the entire duration of the disease for this group, from the patients' first contact with a physician to follow up after death.

“The individuals with frontotemporal dementia displayed physically aggressive behaviour earlier in their disease than people with Alzheimer’s. The difference may be due to the fact that the diseases arise in different parts of the brain. For those with frontotemporal dementia, the damage begins in the frontal parts of the brain, which is where among other things our capacity for empathy, impulse control, personality and judgement reside. Alzheimer’s is accentuated further back in the brain where our memory is located as well as our ability to orientate ourselves in time and space”, said Maria Landqvist Waldö, co-author of the study and one of the supervisors of the project.

The number of patients who displayed physical aggression was greater among those diagnosed with Alzheimer’s. However, individuals with frontotemporal dementia were physically aggressive more often – and the violence exhibited by the people suffering from frontotemporal dementia could also be more serious, and this was particularly evident towards complete strangers.

Twenty-one per cent of the physically aggressive patients with frontotemporal dementia were physically aggressive towards strangers, compared with two per cent of the physically aggressive Alzheimer patients.

“There was an unexpectedly large difference between the groups, even though people with frontotemporal dementia generally are younger when they start showing symtoms of the disease than those with Alzheimer’s disease. There is also a longer delay between the first symptoms and an established diagnosis, which means they are out and about in the community longer without access to the right help and support”, said Madeleine Liljegren, who continued: “A person with frontotemporal dementia can use physical aggression without any provocation, whereas a person with Alzheimer’s generally does this if another person approaches them too fast, for example in a nursing care situation. If you notice socially deviant or criminal behaviour in a person who has previously acted normally, you should be attentive and help the person get examined by a physician, as it could be the first sign of dementia.”