Aggression in Parkinson's disease patients: causes, manifestations and solutions

What is the link between Parkinson's disease and aggression?  

Parkinson's disease is a progressive neurological disorder characterised by the degeneration of nerve cells in one of the brain regions. This degeneration leads to a reduction in the production of dopamine, an essential neurotransmitter involved in controlling the body movements.

Classic symptoms of this disease include tremor, muscle rigidity, bradykinesia (slowness of movement) and balance problems.

But Parkinson's disease can also affect the behavioural and emotional aspects of patients' lives.

The aggressive behaviour in Parkinson's disease patients is due to various biological, neurological, psychological and social factors: several mechanisms may be involved.

What causes the aggressive behaviour in Parkinson's disease patients? 

Neurological changes

Parkinson's disease is associated with changes in the brain, particularly in the regions responsible for controlling a person's emotions and behaviour. These changes can disrupt emotional regulation and lead to aggressive reactions.

More specifically, Parkinson's disease causes a progressive reduction in the production of dopamine in the brain. Dopamine is a neurotransmitter involved in regulating our mood and behaviour, so a disturbance in the dopaminergic system can contribute to aggression in patients with Parkinson's disease.

Side effects of the medication 

Certain drugs used to treat the symptoms of Parkinson's disease, such as dopamine agonists (Motilium®, metoclopramide), can cause side effects which affect the patient's behaviour, causing such symptoms as unusual aggression.

Stress and anxiety 

Living with a chronic illness such as Parkinson's disease can be a source of constant stress and anxiety. Chronic stress can trigger aggressive responses in some people, exacerbating the aggressive behaviour associated with Parkinson's disease.

Cognitive changes 

Cognitive changes common in Parkinson's disease, such as impaired thinking and memory, can also contribute to aggression by disrupting emotional processing and impairing judgement and decision-making.

What are the signs of the aggressive behaviour in Parkinson's disease patients? 

Aggression in Parkinson's patients can manifest itself in different ways: angry outbursts, verbally aggressive behaviour, or even physical violence.

These manifestations can have a significant impact on the patient's quality of life, their relationships and emotional well-being.

Manifestations of aggression in patients with Parkinson's disease depend on the patient themselves and the severity of the disease. Nevertheless, here are some common symptoms:

• Increased irritability: patients may become easily frustrated or upset, overreacting to situations that would not have bothered them before,
  
• Impulsive behaviour: acting without thinking, which can lead to aggressive reactions,
  
• Verbal or physical hostility: this can include nasty words, threats or even acts of violence towards others,
  
• Intense and sudden mood swings: patients may go from calm to agitated or angry in an instant.

How can aggressive behaviour caused by Parkinson's disease be managed? 

Managing aggression in patients with Parkinson's disease may include drugs to treat symptoms related to depression and anxiety, as well as non-drug treatments such as cognitive behavioural therapy (CBT).

Patients may be offered a reassessment of their drug treatment. In some cases, adjusting the medication used to treat Parkinson's disease can help reduce aggression. This may involve changing the dosage or switching to different drugs.

Regular physical exercise brings calm and reduces chronic fatigue. There are many types of exercise suitable for Parkinson's disease patients, such as walking, swimming or cycling, and relaxation exercises such as meditation, yoga or deep breathing.

Offering psychological support to patients and their families can help them cope with the emotional impact associated with Parkinson's disease.

Family and friends of people with Parkinson's disease and their medical team play an essential role in managing aggression. It is important for them to understand the different factors that contribute to the development of aggressive behaviour in patients, learn some of the effective communication strategies and seek professional support if necessary.

Aggressive behaviour is an underestimated problem in Parkinson's disease. This is why it is important to raise awareness among patients, healthcare professionals, carers, and families.