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In this lesson, you will learn the definitions of dementia, anger and aggression. You will learn how anger manifests in dementia and be given examples of reasons that people with dementia exhibit anger and aggression. Following the lesson will be a brief quiz.

What is Dementia?

Mabel is nearing 90 and is the sweetest mother and grandmother in town.

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She is known for her delicious fresh-baked cookies and key lime pie. But Mabel has changed in the past few months. She’s increasingly forgetful. What’s more alarming is that she is also irritable and quick-tempered with her home health nurse, and even with her grandchildren, whom she adores. This is very uncharacteristic of sweet Mabel. What is happening?Mabel is experiencing dementia, which is defined as a long-standing mental disorder that is caused by brain disease, injury, or other medical disorders.

Many people think of dementia as only being associated with memory lapses, but there is so much more that is encompassed in this mental disorder. Symptoms can include impairments in thinking, problem solving, focus, language, communication, social skills, and memory. Dementia can cause shifts in personality and defective thought processing or reasoning. In people over 65, Alzheimer’s disease is the number one cause of dementia.

What is Anger and Aggression?

Anger is a feeling of nuisance, irritation or animosity in response to someone or something that one finds annoying or aggravating. Anger is a completely normal and natural flight or fight response of our bodies in response to a threat. But when anger is not communicated properly, or is expressed in an unhealthy manner, it can turn into aggression.Aggression is a hostile or violent attitude or behavior towards someone else. It can manifest through profanity, criticism, yelling, or physical violence. Sometimes people with dementia are aggressive, even if they were never the aggressive type prior to the dementia.

Why are People with Dementia Angry?

Dementia decreases a person’s ability to communicate their feelings and needs to others. They have needs and wishes like the rest of us, but sometimes their inability to think clearly inhibits their ability to express what they need or want. This can lead to frustration, anger and/or aggression. Following are some other biological, social, and psychological reasons that dementia can cause anger and/or aggression.Biological ReasonsBiological reasons have to do with a person’s bodily needs and medical issues. Here are a few organic reasons that a person with dementia may become angry:

  1. Discomfort or pain – Naomi could not express to her son that she was cold and that her back hurt from sitting in one position all day long.
  2. Hallucinations or delusions – Rosemary is having a delusion that her caregiver is trying to kill her when she gives her her daily medications.

    This is, of course, frightening to Rosemary. She erupts with anger when her caregiver gives her the medications and accuses the caregiver of trying to poison her.

  3. Being over- or under-stimulated – Willie felt irritable and aggravated due to the combination of noises coming from the TV, radio, and phone, but he had trouble communicating this to his grandchildren.
  4. Loss of judgment and self-control – Henry flipped off another customer who he thought skipped him in line. He was quickly losing judgment of appropriate social behavior.
When these clumps, called Lewy bodies, are present in brain neurons, a person can experience hallucinations in dementia.

Lewy bodies

Social ReasonsFrom a lack of social interaction to issues with caregivers, people with dementia can experience anger for different social reasons. Some of these reasons are:

  1. Lack of social interaction, and loneliness – Mary used to drive to church to meet her friends for Bible study, but she can no longer do that. She is frustrated by the lack of social interaction and feelings of loneliness.
  2. Boredom – Jimmy, suffering from a brain injury, in the hospital, snapped at his mother when she came by with dinner. He felt irritable and angry from being incredibly bored in a hospital bed all day.

  3. Frequent change of caregivers – Wilma became confused and frustrated by the fact that the home health nurse company kept sending different carers. She felt like none of them were completely capable of meeting her needs.
  4. Shame – Buddy tried to hide the fact that he had dementia from his friends. When his friend Rob pointed it out, he became angry and defensive.

PsychologicalPsychological reasons have to do with mental processes and emotions that a person with dementia may experience, which can lead to feelings of anger.

Here are a few of these reasons:

  1. Frustration – Mabel became angry at herself when she could not remember her own famous key lime pie recipe. She threw the measuring cups against the wall in frustration.
  2. Fear – Leonard woke up in the hospital and did not know why the nurse was changing his gown. He yelled at her in fear, not knowing who she was or why he was in the hospital.
  3. Feeling disrespected – Lilly’s family took her car keys and put her in a nursing home. She felt like her her family was disrespecting her need for autonomy and taking away her independence.

  4. Misunderstanding – Peter’s home nurse lifted him out of the car to put him in his wheelchair. He screamed in pain and thought his home health nurse was purposely being careless with him. He yelled at his nurse for what he perceived as insensitivity on her part.
  5. Depression – Maude saw her memory and cognition deteriorating right in front of her eyes.

    She started to feel intensely sad, hopeless, and worthless on a daily basis. She started to dislike herself and even stopped liking others, for that matter.

Looking at all of the biological, social and psychological reasons, it is now clear to see why people with dementia may experience feelings of anger and aggression.

Lesson Summary

Dementia is a long-standing mental disorder that is caused by a medical issue, brain injury, or other mental disorders. It presents as cognitive decline, forgetfulness, difficulty focusing and/or lapses in social skills, communication and problem-solving. Anger is a feeling of irritation, aggravation or annoyance about or towards someone or something. Aggression is violent or hostile beliefs or actions towards someone or something. People can experience anger and aggression in dementia because of biological, social or psychological factors.

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