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Original Research

Causes of Aggressive Behavior in Patients With Dementia

Mark E. Kunik, MD, MPH; A. Lynn Snow, PhD; Jessica A. Davila, PhD; Avila B. Steele, PhD; Valli Balasubramanyam, PhD; Rachelle S. Doody, MD, PhD; Paul E. Schulz, MD; Jagadeesh S. Kalavar, MD; and Robert O. Morgan, PhD

Published: March 9, 2010

Article Abstract

Objective: To examine factors predicting development of aggression.

Method: 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.

J Clin Psychiatry

Submitted: September 11, 2008; accepted March 30, 2009.

Online ahead of print: March 9, 2010 (doi:10.4088/JCP.08m04703oli).

Corresponding author: Mark E. Kunik, MD, MPH, Houston Center for Quality of Care & Utilization Studies, Michael E. DeBakey VAMC (152), 2002 Holcombe, Houston, TX 77030 (

Volume: 71

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