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Am J Psychiatry 1996; 153:243-247
Copyright © 1996 by American Psychiatric Association
Relationship of aggressive behavior to other neuropsychiatric symptoms in patients with Alzheimer's disease
D Aarsland, JL Cummings, G Yenner and B Miller
Department of Neurology, UCLA School of Medicine, USA.
OBJECTIVE: This study explored the relationship between aggressive behavior
and other neuropsychiatric symptoms in patients with Alzheimer's disease.
METHOD: Consecutively assessed outpatients with probable or possible
Alzheimer's disease (N = 75) were assessed with the Behavioral Pathology in
Alzheimer's Disease Rating Scale and the Hamilton Depression Rating Scale.
RESULTS: Twenty-five patients (33%) had verbal outbursts and 13 patients
(17%) engaged in physical aggression in the month prior to assessment.
Aggressive patients and nonaggressive patients did not differ regarding
age, education, gender, level of depression, or severity of dementia. In
the entire group, dysphoria was found in 33%, delusional ideation in 39%,
and hallucinations in 16%. Aggressive behavior was more frequent among
patients with hallucinations than among those without. Scores on
hallucinations and activity disturbance predicted 12% of the variance in
total aggressive behavior. When data from patients taking psychotropic
medication were excluded from the analysis, hallucination and delusion
scores predicted 22% of the variance in the aggression score. Physical
aggression was associated with activity disturbance and hallucinations, and
verbal aggression was associated with delusional ideation. No other
clinical correlates of aggression were identified. CONCLUSIONS: Aggressive
behavior is a frequent behavioral symptom in Alzheimer's disease. About
one-fourth of the variance in aggression could be attributed to psychosis.
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