A caregiver survey found that 75 per cent of caregivers said physical violence was the most serious problem they faced, even more than failing cognitive abilities, according to Dr. Nathan Herrmann, Head, Division of Geriatric Psychiatry at Sunnybrook Health Science Centre and at University of Toronto.

The Cohen-Mansfield Agitation Inventory Classifies Agitated Behaviours Into Four Categories:

1. physical/aggressive behaviours: hitting, kicking, grabbing, biting, etc.
2. physical/non-aggressive behaviours: pacing, wandering, inappropriate dressing, etc.
3. verbal/aggressive behaviours: screaming, cursing or making verbal sexual advances
4. verbal/non aggressive behaviours: repetition, strange noises, complaining, etc.

What Can You Do Before Resorting to Drug Therapy? (according to Dr. Herrmann)

1. Accurately describe the behavior to give you a baseline.
2. Rule out any physical or medical cause for the behaviour. Is there any infection, pain or drug toxicity present?
3. Rule out any environmental cause -- too much noise, too many tasks?
4. Is the behavior serious enough to warrant drugs -- in other words, is the patient or caregiver at risk of injury?
5. Is the behavior responsive to medication? Not all are. In general, wandering, vocal and nuisance behaviors do not improve with drug therapy unless doses are high enough to cause sedation which in turn can lead to other problems such as falling and the need for more physical care.

How can Violent Aggression Be Controlled?

1. Through environmental manipulations. The environment should be consistent, supportive, with the right level of stimuli. This is different for each sufferer and it will take trial and error to determine what the correct level of stimuli is.
2. Through behavior modification approaches. If used properly, drugs can have an amazing effect on violent behavior. Unfortunately drugs are often overused; it's easier to give someone a pill than to make the effort to find another way to relieve agitation.
3. Through careful monitoring of the medications of a person with AD. Ensure they are reviewed frequently, often every six months. AD has definite phases, which can be alleviated by different drugs. Doctors have found that patients can often come off drugs which have been effective in a certain phase of the illness. After that phase passes, however, the drugs no longer serve the same purpose.