Drug Therapy of Aggressive Behaviors Accompanying Dementia

Abstract

Aggressive behaviors often accompany dementia in the elderly, institutionalized patient. These may include any number of verbal or physical acts, and range from swearing, threatening, to harming self, others, or property. Identifying specific target behaviors for treatment is important in selecting the appropriate therapeutic option. The major neurotransmitters involved in aggression include gamma-aminobutyric acid (GABA) and serotonin, which inhibit aggression, and dopamine, norepinephrine and acetylcholine, which increase it. Drug therapy for control of aggressive behaviors has traditionally included the antipsychotics and benzodiazepines. However, additional, newer therapies are also useful. Among these are the anticonvulsants carbamazepine and valproic acid, various beta-blocking agents, antidepressants, and buspirone. These medications may be needed when nondrug therapy for control of behavioral problems fails or is insufficient. Determining which behaviors are problematic and need treatment, knowing which medications are indicated for those problems, and noting contraindications for particular drug therapies will lead to the best therapeutic option for a given patient.