Estrogen Therapy: An Approach to Treatment-Resistant Aggressive Behaviors in Patients with Dementia

One of the most challenging aspects in the care of patients with dementing illnesses is management of the neuropsychiatric symptoms, which may include aggression. Aggressive behaviors in elderly patients with dementia may include verbal abuse to caregivers or other patients, inappropriate sexual behaviors, or acts of physical violence (Guay, 2008; Shelton & Brooks, 1999). These behaviors often lead to resistance in activities of daily living for the patient & are distressing to patients, family members, & caregivers alike. Medications currently used to treat neuropsychiatric symptoms, including aggression, include selective serotonin reuptake inhibitors (SSRIs) & antipsychotic agents (Kverno, Rabins, Blass, Hicks, & Black, 2008). However, atypical antipsychotic agents have been associated with an increased risk of cerebrovascular events in patients with dementia, & now include a black box warning regarding this risk (Schneider, Dagerman, & Insel, 2005; Schneider et al., 2006). Other agents used in the management of aggressive symptoms in patients with dementia include benzodiazepines, lipophilic beta blockers, & mood stabilizing agents. (Kverno et al., 2008; Shelton & Brooks, 1999) Treatment responses are variable, & tolerability issues can lead to discontinuation of treatment. Adapted from the source document.