Aggression - which can include verbal or physical violence - often emerges without warning, experts said, and is one of the most troublesome behavioral changes. It can sometimes be triggered by the agitation and frustration that often accompanies dementia. Such behavior can also be caused by a change in surroundings, experts said, or having too much or too little stimulation or talking.

Experts advise that caregivers address aggression by first maintaining a safe environment, removing dangerous objects, providing space to the person who is upset and speaking to them in a soothing voice. Next they should try to figure out the cause of the behavior and make attempts to address it, whether it be altering the environment or focusing on a new activity that does not upset the person.

Sometimes the aggression can be caused by a physical discomfort that the person with Alzheimer's is unable to verbalize. Because of this, caregivers need to consult a doctor and look for underlying medical causes, experts said. Barbara Vogel, program coordinator for the Neuwirth Memory Disorders Center at Zucker Hillside Hospital at North Shore LIJ, said doctors first try to figure out if there's an infectious process going on in the body that the patient can't communicate so "like small children who get sick and uncomfortable, they act out."

In cases where the person is violently aggressive, patients are often brought in to a psychiatric hospital and the behavior is addressed with medication. This is often a difficult time for family members, Vogel said. When they see the reaction to the medication - which, among other side effects, can make a person lethargic or result in the loss of other functions - many feel their loved one is being overmedicated, she said.

"Unfortunately we don't have a perfect answer and we choose between the lesser of the evils," Vogel said. "If they are aggressive, acting out, a danger to themselves, a danger to their caregivers, a danger to their families, we have to do something."

Vogel said family members can feel as though the medication is a punishment, but in truth, it allows caregivers to be safe and the situation at home to be manageable once again.

Most importantly, experts said, caregivers must remember that behavior changes such as aggression are not deliberate. Those who have Alzheimer's or other dementias frequently must deal with failure, they said, so caregivers should respond in a way that preserves the person's dignity.

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