Contextual factors in the assessment and management of aggression in dementia patients

Aggressive behaviors associated with dementia present serious problems for patients and caregivers. Aggression, which has often been assumed to be an inherent feature of dementia, may actually be adaptive for dementia patients who have limited skills available to manage an environment that becomes increasingly complex as cognitive deterioration progresses. When aggression in dementia patients is examined within a functional analytic framework, it emerges as an adaptive, albeit undesirable, means of communicating distress or discomfort. Idiographic assessment of the influence of setting events, environmental antecedents, and consequences associated with aggression may assist in the development of proactive interventions that modify environmental influences associated with aggressive behavior. Modifying environmental precipitants rather than relying on interventions that attempt to directly eliminate aggression from the patient's already impoverished behavioral repertoire is presumed to be more humane.