United States Department of Veterans Affairs
 Health Care
Early Diagnosis of Aggression in Elderly Veterans Could Improve Treatment Options, Study Shows
woman talking with elderly Veteran
Family members and caregivers should know the warning signs of dementia.

All his life, Hubert was a soft-spoken, mild-mannered guy with hardly any temper at all.

But then on a day his wife, Margaret, will never forget, he balled up his fist and said, “If you don’t move from that door, I’m going to knock the hell out of you.”

This is aggression in dementia.

Dr. Mark Kunik, a psychiatrist at the VA Medical Center in Houston, recently concluded extensive research on this painful problem in order to help Veterans and their families deal with it in the future. He believes early treatment of elderly Veterans with dementia could improve their quality of life.

In a study published in The Journal of Neuropsychiatry and Clinical Neurosciences, Kunik reported results of research underscoring the importance of effectively treating aggression in individuals with dementia.

“Our study confirms findings of earlier studies that aggression is common in persons with dementia,” said Kunik, primary author of the article.

“Veterans with dementia have memory problems, and when they can’t remember how to do something, they become very frustrated and that can lead to aggressive behavior.”

Margaret, who participated in Kunik’s research, verifies this. Her husband, Hubert, an 81-year-old Veteran, became very frustrated when he could not remember her or their son, Jay.

Kunik reminds caregivers and family members that aggression in dementia is not a willful act. “Our brain controls how we act and make decisions...how we see the big picture...and a person with dementia can get angry when they can’t do that.”

Kunik’s study emphasizes the importance of early diagnosis and effective treatment of aggression as a means of preventing or minimizing consequences such as injuries, use of psychiatric medications and nursing-home placement; all of which can have a profound impact on an individual’s quality of life.

For Margaret, the impact could not be more profound. Hubert, with advanced Alzheimer’s disease, is now in a hospice and losing weight daily. Yet she keeps a calm voice of acceptance and awareness of his situation. “When I visit him, sometimes he seems to recognize me and says, ‘Hi, Babe.’ We have to take it one day at a time.”

Kunik encourages family members and caregivers to know the warning signs of Alzheimer’s and to contact their family doctor when any of the signs appear. A complete list is available at the Alzhiemer’s Association website.

photo of Dr. Kunik
Dr. Mark E. Kunik, VA Psychiatrist

Study findings

Kunik’s study compared those who did and those who did not develop aggression in 215 Veterans, older than 60, mostly male patients who had been diagnosed with aggression in the past year.

By examining the time before and after patients developed aggression, researchers found that the 88 patients who became aggressive also had significantly increased use of psychiatric medications, more injuries to themselves and caregivers, and higher nursing-home placement.

“Almost twice as many aggressive as nonaggressive patients were admitted to nursing homes,” said Kunik.

Researchers also found that patients who became aggressive had a 10-fold increase in rate of injuries to themselves and caregivers, and a significantly increased use of psychotropic medications.

For two years, Kunik and his team would visit the homes of the Veterans every four months to check the progress of the patient and, just as importantly, their caregiver and family.

“We were equally concerned with the emotions and attitudes of the caregivers. We needed to know how they were doing. There were some instances of abuse by aggressive Veterans, which we needed to monitor,” Kunik noted.

Margaret believes the research will be very helpful to Veterans and their families in the future. “It was helpful to learn all the particulars of Hubert’s condition and be made aware of the services that were available.”

‘There is no aggression gene’

Kunik states, “There is no aggression gene. There are no absolute indicators in a person’s history that they will develop aggression. It is not directly connected to combat duty or PTSD.”

Hubert was in the Navy in the ’50s and served on a ship that saw combat action during the Korean War but never developed or reported any symptoms of PTSD.

“Taking care of Hubert as we took part in the research has been an eye-opening experience,” Margaret says. Now battling cancer, she remains strong and resilient. “I would encourage the families of Veterans to help out with these VA research projects. Participating in the support groups teach you that we all have a story to tell, and that’s ultimately good for everybody involved.”

Kunik, who has been with the VA for 17 years and is affiliated with VA South Central Mental Illness Research and Education Center (MIRECC), emphasizes the need for further research to prevent aggression and its consequences, thus reducing the suffering of both patients and caregivers, minimizing the side-effects of medications, and reducing the risk of injury to patients and their loved ones.

“I would like for Veterans’ families to know that there is lot of hope out there for Veterans with aggression and that we are looking for ways to improve the lives of their loved one...and their own lives as well.”

By Hans Petersen, VA Staff Writer

Related links:
  Alzheimer’s Association
  Alzheimer’s and Dementia Care
  Mental Illness Research, Education and Clinical Centers