Caregivers Report Aggression in Patients With Advanced PD and Related Disorders

Nurse standing by elderly woman sitting on wheelchair. Caregiver and disabled senior female are looking through window. They are in bedroom.
Study researchers sought to estimate the prevalence of caregiver-reported aggression among patients with advanced Parkinson disease and related disorders.

Caregivers reported physical and sexual aggression among patients living with advanced Parkinson disease and related disorders (PDRD), according to a summary of caregiver reports published in Neurology Clinical Practice.

Previous research established that individuals with PDRD experience varying degrees of cognitive and behavioral changes. A substantial proportion of patients with PDRD report neuropsychiatric and behavioral disturbances including apathy, depression, hallucinations, fatigue, and impulse control disorders.

Behavioral changes in some patients with dementia can coexist with physical or sexual aggression. Despite these findings, few descriptive studies are available to describe the prevalence of aggression in PDRD.

A team of researchers from the United States examined survey data from caregivers who participated in a clinical trial of outpatient palliative care for PDRD ( Identifier: NCT02533921). Caregivers in this trial were surveyed at baseline regarding patient aggression and were surveyed again every 3 months over a 1-year period.

Study researchers established point prevalence using baseline responses, while cumulative incidence of aggression was calculated with responses from participants who did not report baseline aggression.

Approximately 18.2% (n=31) and 10.6% (n=18) of caregivers reported physical and sexual aggression, respectively, in patients. The 1-year cumulative incidence for physical aggression was 21.1% and the cumulative incidence for sexual aggression was 16.0%.

The cumulative incidence for physical aggression was significantly associated with patient depression (risk estimate [RE], 1.13; 95% CI, 1.07-1.19), patient-reported quality of life (RE, 0.94; 95% CI, 0.91-0.97), caregiver burden (RE, 1.04; 95% CI, 1.01-1.07), caregiver depression (RE, 1.10; 95% CI, 1.03-1.17), caregiver-perceived patient quality of life (RE, 0.93; 95% CI, 0.90-0.97), and caregiver anxiety (RE, 1.09; 95% CI, 1.03-1.16). Contrastingly, the study researchers found no significant variables associated with the cumulative incident of sexual aggression.

Given the study’s methodology, the researchers were unable to identify causality between aggression and caregiver and patient characteristics.

The study researchers concluded that “neurologists, movement disorder specialists, and palliative care providers should be cognizant of the potential for aggression while incorporating caregivers into routine care.” They added that routine evaluation of caregiver burden represents a potential “opportunity for detection, prompting investigation of root causes and identification of solutions through careful discussions with caregivers.”


Macchi ZA, Miyasaki J, Katz M, et al. Prevalence and cumulative incidence of caregiver-reported aggression in advanced parkinson disease and related disorders. Neurol Clin Pract. Published online July 1, 2021. doi:10.1212/CPJ.0000000000001110