When Alzheimer's Disease Takes a Violent Turn

It’s one thing to know that abuse is a choice made by an abuser—it cannot be blamed on stress, alcohol, mental illness or a bad childhood.

But it’s an entirely other thing to have a once-loving partner turn violent as their brain begins to suffer the effects of Alzheimer’s disease. As a partner and caretaker, how do you process this type of violence? Is it any easier to endure? To forgive?

Violence Stems From Frustration

Alzheimer’s is a degenerative brain disease and the number one cause of dementia. Symptoms include memory loss and a decline in language and problem-solving skills. As Alzheimer’s progresses, the damage to the brain can eventually cause individuals to lose other basic bodily functions, such as walking and swallowing. An estimated 5.7 million Americans were living with Alzheimer’s disease in 2018, most of them over age 75.

Research from the National Institutes of Health showed that up to 96 percent of patients with dementia, studied over 10 years, showed aggressive behavior at some point. CNN Health reported in 2011 that 5 to 10 percent of Alzheimer’s patients exhibit violent behavior at some point. Whether classified as aggressive or violent, this behavior might look like profanity-laden outbursts, kicking, biting, spitting or slapping.

In other words, it looks a lot like abuse.

Amy Berman, registered nurse and expert in geriatric care, as well as the senior program officer at The John A. Harford Foundation, the premier funder of work in the field of aging, says when dementia patients become aggressive, it often stems from frustration.

“There can be a lack of recognition of people that they knew before. Objects that they’re usually familiar with—a fork or spoon—they no longer know how to use. They become frustrated, confused and frightened, and this can project outward.”

The ruthlessness of the disease, says Berman, is that it can take even the most calm, docile person and turn them into someone friends and family don’t recognize.

“Unfortunately, it is a very cruel disease. These changes in behavior, they’re exhibiting out of fear.”

Balancing Your Safety With Theirs

According to the Alzheimer’s Association, more than 15 million Americans provided unpaid care to people with Alzheimer’s disease and dementia in 2016. These caregivers give 18.1 billion hours of care a year, with 65 percent of them saying they do so in order to keep the family member or friend at home.

“Caretakers’ safety is incredibly important,” says Berman. “Even though they understand the disease … they should never just accept that this [violent behavior] is the norm. This can turn your life upside down. It’s important they get the help they need.”

Unlike domestic violence, which is a pattern of abusive behavior used to control or overpower a person, violence stemming from Alzheimer’s disease or dementia can be considered a medical issue. As a result, it may be able to be controlled or stopped with medical intervention.

“Remember that Alzheimer’s is a disease,” says Berman. “There should be a clinical team who are made aware of these behaviors and can address any underlying issues, and can give you the respite you need.”

Look For the Underlying Factor

Someone with Alzheimer’s disease may turn aggressive without warning. In that moment, the first thing Berman says to do is get yourself out of harm’s way. “Also take things out of the environment so the person doesn’t harm themselves or you,” she says. “Move away objects like a glass or butter knife that might be on the table.”

Once safety is established, Berman says a caretaker can try to understand what might be going on with this person who suddenly turned aggressive. Things that might be contributing to a violent outburst include:

• Physical discomfort
• Recent change in medication
• Poor sleep
• Hunger
• Frustration from the inability to convey a problem with one of the above

It may also be an environmental factor, says Berman. Is there loud noise? A lot of people around? Try to reduce the stressors, says Berman, or bring in things that calm the person—a favorite treat, a kind of music they enjoy listening to.

“My uncle, when he had a cognitive impairment, for him it was marshmallows,” says Berman. “They would have a calming effect on him.”

There may also be frustration over a forgotten memory, something communication could resolve. Often times, those with Alzheimer’s forget that someone near them has passed on.

“You can lean into the emotion,” says Berman. “Say, ‘I see you’re looking for your mother. Tell me about her.’ That in itself can relieve the stress.”

Where Do You Draw the Line?

If someone’s behavior is becoming too much for a caregiver to handle alone, it’s important they grant themselves permission to reach out for help. Aggressive or violent behavior can take a daunting emotional toll, no matter the cause. It can be especially triggering for caretakers who have experienced abuse in their past, either in childhood or an intimate relationship. They may even be caring for an abusive partner who has since been diagnosed with dementia, which brings about a whole other conundrum.

“Not only do you want to make sure that person gets the right kind of care, but you need to address your own behavioral health needs,” says Berman, who suggests reaching out to agencies like Alzheimer’s Association (they have a 24-hour helpline at 800-272-3900) or your local Area Agency on Aging, where an advocate can help address your specific needs and circumstances, and connect you with age-specific resources in your area.