Documentation, assessment, and treatment of aggression in patients with newly diagnosed dementia

Practice guidelines recommend a search for underlying biopsychosocial causes and initial use of nonpharmacologic interventions. Using guidelines as a benchmark for standard care, we examined medical records to assess the documentation, assessment, and treatment of aggression in patients newly diagnosed with dementia. Study participants were at least 60 years old and diagnosed with dementia at the Michael E. DeBakey VA Medical Center in Houston, TX, from 2001 to 2004. Of 385 eligible patients screened by telephone using 3 probes from the Ryden Aggression Scale, 75 had positive response to 1 or more of 3 probes from the Ryden. Medical records of these patients were reviewed for 12 months before and 3 months after telephone screening. Aggression had been documented in 31 (42%), nonpharmacologic interventions had been used in 11 (35%), and pharmacologic interventions had been used in all 31. Among the 44 patients without previously documented aggression, pharmacologic interventions were used in 34 (79%) patients. Patients with documented aggression had more psychiatric comorbidities and received more psychotropic medications than patients with undocumented aggression. We conclude that dementia patients should be systematically screened for aggression and that new strategies to increase use of nonpharmacologic interventions and decrease use of pharmacologic interventions, particularly antipsychotics, should be identified.