When it happens
Some people show aggressive tendencies beginning in mild-stage dementia; for others the behavior begins in the moderate stage.
Why it happens
Researchers point to a combination of brain changes (which affect personality and cause a loss of inhibition and social appropriateness) and environmental factors. Those with dementia may lash out of they feel threatened, scared, insecure, or uncomfortable. For someone lacking the ability to communicate feelings well with words, hitting and pushing become a physical expression of their mood: "I'm upset."
What you can do
Hard as it can be, try not to take the behavior personally or react in kind. Try not to raise your voice back, threaten, or complain. These responses can cause aggression to escalate.
Try mild, calm comments and a pleasant expression (even a smile) that may feel inappropriate to the situation: "Everything's all right now. Can I help you with something? . . . I'm sorry you're upset. Let's watch the birds out the window until you feel better."
Look for changes in the everyday environment to figure out what set the person off: Has a busy day has left him or her tired? Is he or she in pain? Is it too hot or too cold? Is there a new aide who does things differently? Too much noise and confusion? Focus on what might be new or different.
Beware of new medications. They can intensify aggression, either as a side effect or as an interaction with other meds.
Take steps to avoid "trigger situations" once you've identified them.
Remember that people with dementia often mirror the mood of those around them. Are you giving off stressed or angry vibes yourself, through your expressions or tone of voice?
Step back and give your loved one a wide berth if he or she has a tendency to strike. You must protect yourself.
Never try to restrain your loved one. That usually makes someone fight harder.
Step out of the room for a few minutes if you must to collect yourself. Better that objects are thrown or furniture is upset than you risk injury yourself.
Report dangerous behaviors to your loved one's doctor. Sometimes antipsychotic medications are used to control aggression, but the benefits must be weighed against the risks (increased risk of stroke and death, for example).
Know that for some people, aggressive tendencies get worse. If you don't feel safe, it may be time to consider out-of-home placement.