ABSTRACT
Given that behavioural disturbance is a
complex interplay between the patient,
symptoms, and response of those caring for
them there is unlikely to be a simple ‘cause’ of
behavioural disturbance. To take just one
example – aggression – understanding can be
sought at a neurobiological, clinical, or
environmental level. Thus specific neuronal
loss is reported in aggression in AD (Forstl et
al, 1994) and altered adrenergic function
could affect aggression; one study suggests
that alpha-2 adrenergic receptors are increased
in aggressive AD patients at post mortem
relative to patients without aggression (Russo-
Neustadt and Cotman, 1997). At a clinical
level, aggression has been shown to correlate
very highly with psychosis (Aarsland et al,
1996) and the presence of delusions are the
best clinical indicator for occurrence of
aggressive features (Gilley et al, 1997;
Gormley et al, 1998). However, it is also true
that aggression in patients is frequently in
response to some other event – a carer trying
to help the patient to dress or admission to a
new day-centre, for example. Similarly,
changes in levels of apathy or agitation may be
due to selective neuronal loss, to an
underlying depression, or to an external cause
such as a change in carer or physical illness
(Mintzer and Brawman Mintzer, 1996).
