Aggressive Behavior in Some Elderly Patients May Be Tamed With Hormone Therapy
Nov. 22, 1999 (Minneapolis) -- Aggressive behaviors in elderly patients can be difficult for family and health care workers to control. That's why scientists continue to look for effective and safe medications to treat dementia. Characterized by a decline of memory, concentration, and judgment, dementia can result in physical violence such as hitting, yelling, and grabbing people. These behaviors may result in injury to the patient and to the caregiver.
"Agitation and aggression are major concerns for clinicians and families, and [form] the single greatest cause of nursing home admission," Gary Small, MD, director of the Center on Aging at UCLA, tells WebMD. "Current treatments are only partly effective," he says, "so efforts to find innovative approaches to minimize the problem are very important."
Now, a small study by Harvard researchers of 14 patients with dementia has shown promising early results using estrogen, a hormone most commonly used to control the symptoms of menopause in women. Although the investigation was conducted over a short period -- four weeks -- researchers say changes in behavior of the elderly patients after estrogen therapy "were encouraging." In addition, no negative side effects from the estrogen were observed.
Nurses' aides, who worked regularly with the patients, participated in the study by documenting the patients' behaviors. The aides measured five aggressive behaviors: verbal aggression, physical aggression, resistive or defiant behavior, sexually aggressive behavior, and aggression against oneself.
Eight patients received estrogen therapy; six received a placebo, or sugar pill. The patients' average age was 84. Following the one-month study, the researchers found estrogen therapy was associated with a decreased frequency of physical aggression among the patients. In addition, verbally aggressive behaviors were also decreased, although this effect was not as great.
While many patients with dementia are successfully treated with sedative-type drugs, the majority of patients do not respond well to them. "It's important that another treatment option might be helpful for patients with moderate-to-severe dementia but who cannot tolerate or do not respond to other medication," the author of the study, Helen Kyomen, MD, MSc, tells WebMD. Kyomen is a geriatric psychiatrist and is on the faculty of the Harvard Medical School in Boston.
Researchers were "encouraged" by their findings, but larger studies need to be done to provide further support for using estrogen therapy in this way, Kyomen says. Currently, other studies are looking at the possibility that estrogen therapy may reduce the risk of Alzheimer's disease.