Donald Weaver / en U of T expert on dementia's hidden darkness: Violence and domestic abuse /news/u-t-expert-dementia-s-hidden-darkness-violence-and-domestic-abuse <span class="field field--name-title field--type-string field--label-hidden">U of T expert on dementia's hidden darkness: Violence and domestic abuse</span> <div class="field field--name-field-featured-picture field--type-image field--label-hidden field__item"> <img loading="eager" srcset="/sites/default/files/styles/news_banner_370/public/2018-11-13-dementia-resized.jpg?h=58088d8b&amp;itok=XbjEXr6h 370w, /sites/default/files/styles/news_banner_740/public/2018-11-13-dementia-resized.jpg?h=58088d8b&amp;itok=6SvF1wPu 740w, /sites/default/files/styles/news_banner_1110/public/2018-11-13-dementia-resized.jpg?h=58088d8b&amp;itok=Ps-tdrhw 1110w" sizes="(min-width:1200px) 1110px, (max-width: 1199px) 80vw, (max-width: 767px) 90vw, (max-width: 575px) 95vw" width="740" height="494" src="/sites/default/files/styles/news_banner_370/public/2018-11-13-dementia-resized.jpg?h=58088d8b&amp;itok=XbjEXr6h" alt="Photo of older person with black eye"> </div> <span class="field field--name-uid field--type-entity-reference field--label-hidden"><span>noreen.rasbach</span></span> <span class="field field--name-created field--type-created field--label-hidden"><time datetime="2018-11-13T12:49:42-05:00" title="Tuesday, November 13, 2018 - 12:49" class="datetime">Tue, 11/13/2018 - 12:49</time> </span> <div class="clearfix text-formatted field field--name-field-cutline-long field--type-text-long field--label-above"> <div class="field__label">Cutline</div> <div class="field__item"> Dementia patients are often the perpetrators and often the victims of abuse. Research also shows that a medical history of head injury can more than double the risk of developing Alzheimer’s disease in some populations (photo by Shutterstock)</div> </div> <div class="field field--name-field-author-reporters field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/authors-reporters/donald-weaver" hreflang="en">Donald Weaver</a></div> </div> <div class="field field--name-field-topic field--type-entity-reference field--label-above"> <div class="field__label">Topic</div> <div class="field__item"><a href="/news/topics/our-community" hreflang="en">Our Community</a></div> </div> <div class="field field--name-field-story-tags field--type-entity-reference field--label-hidden field__items"> <div class="field__item"><a href="/news/tags/department-chemistry" hreflang="en">Department of Chemistry</a></div> <div class="field__item"><a href="/news/tags/faculty-arts-science" hreflang="en">Faculty of Arts &amp; Science</a></div> <div class="field__item"><a href="/news/tags/research-innovation" hreflang="en">Research &amp; Innovation</a></div> <div class="field__item"><a href="/news/tags/conversation" hreflang="en">The Conversation</a></div> </div> <div class="clearfix text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"><p>Every week in my neurology clinic, I see patients and their families who are dealing with the realities of dementia. Of the many people I encounter, these three stories highlight a growing health issue that I feel is neglected – the complex relationship between dementia and domestic violence.</p> <p>The first is a story of confusion:&nbsp;“Dad is a nice guy, always has been. But now, because of the Alzheimer’s, he’s confused most of the time – and Mom isn’t coping. She doesn’t know what to do and she is frustrated. It started with her twisting his arm to get him to do things, but now she even hits him sometimes.”</p> <p>The second is a story of public safety:&nbsp;“The dementia has changed him – he’s not the same man I fell in love with and married so many years ago. He gets suspicious and angry a lot. He screams at me, he yells at our son, he shouts at the postman. He has even punched the caregiver who comes to help him bathe. I suppose we can cope, but I’m worried. We have two shotguns and a rifle in our basement – what do you think I should do with them?”</p> <p>The third is a scene of abuse: “I got divorced a long time ago because he used to hit me … a lot. He would get drunk every Saturday night and beat me up. He even knocked me out cold, probably five or six times. I haven’t seen him in more than 30 years, but I still feel that he is hurting me. Do you think all of these beatings caused my dementia? Did that bastard cause my dementia?”</p> <p>These stories are united by a common theme: the complex relationship between dementia and domestic violence. Today, both are commonplace. <a href="https://www.alz.org/media/HomeOffice/Facts%20and%20Figures/facts-and-figures.pdf">One in 10 people over 65 years of age in the United States have dementia</a>, typically Alzheimer’s disease (AD), and about one in four women and one in seven men in the U.S. <a href="https://www.cdc.gov/violenceprevention/pdf/nisvs_executive_summary-a.pdf">experience severe physical abuse by an intimate partner</a> at some point during their life.</p> <p>Alarmingly, evidence now suggests that there may be a complex but definitive link between dementia and domestic abuse. Notably, <a href="https://doi.org/10.1159/000093894">one case-control study</a> that I carried out with colleagues shows that spousal abuse could be associated with the development of Alzheimer’s.</p> <h3>Caregiver abuse</h3> <p>Abuse of older people is not a new problem. Elder abuse is a growing concern on a societal level, with <a href="https://www.cbc.ca/news/canada/elder-abuse-a-growing-dilemma-in-an-aging-population-1.1050233">more seniors reporting incidents of abuse and violence</a>. The abuser may be a partner, a relative, a friend or a paid caregiver.</p> <p>Most abuse tends to take place in the privacy and supposed safety of the home – and so it’s typically a hidden problem. Yet, anywhere between <a href="https://doi.org/10.1093/ageing/afm194">five to 20 per cent of seniors globally may be physically abused, while up to 55 per cent may be abused in other ways</a>.</p> <figure class="align-center "><img alt src="https://images.theconversation.com/files/244413/original/file-20181107-74754-w7m92u.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip"> <figcaption><em><span class="caption">Needing help with simple everyday tasks can be a huge blow to the sense of self and pride of someone dealing with dementia</span>&nbsp;<span class="attribution"><span class="source">(photo by Shutterstock)</span></span></em></figcaption> </figure> <p>Patients with dementia are especially vulnerable to this disturbing trend. Unsurprisingly, caring for patients with dementia requires time and patience and, as with any advanced medical care, practice.</p> <p>Dealing with dementia’s intellectual impairments can be especially challenging for unprepared caregivers and family members, and this frustration can sometimes lead to abuse.</p> <h3>Violent mood swings</h3> <p>Conversely, sometimes the person with dementia is the initiator of the violence rather than the recipient. The onset of dementia is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345875/">known to coincide with the development of aggressive and angry tendencies</a>. One study found that <a href="https://www.ncbi.nlm.nih.gov/pubmed/18258723">almost 20 per cent</a> of new dementia patients have behaved aggressively towards caregivers, including loved ones they’ve known for years.</p> <p>It’s not hard to understand why. In the early phases of the disease, patients are acutely aware of the changes happening to their memories and thoughts and regularly feel overwhelmed. As the disease progresses, they may need help dressing, bathing or performing simple everyday activities, which they have done for themselves, without help, for all of their lives.</p> <p>This can be devastating to a person’s pride or sense of self; sometimes these emotions can manifest as unusually aggressive or hostile behaviour. Dementia can also trigger violent mood swings and outbursts. At times, these can be extreme; a patient may seem perfectly fine one moment, then be screaming and overtly physical the next.</p> <p>As yet, it’s a mystery as to why these outbursts occur. But it is possible that changes in the brain’s neurochemistry may destabilize moods and cause more violent emotions.</p> <h3>‘Punch drunk’</h3> <p>Finally, there is the possibility that abuse that occurred decades ago could be contributing to the onset of dementia today. There has been much debate as to whether head trauma can lead to dementia or Alzheimer’s disease later in life.</p> <p>Typically, associations have been vague, and it seemed unlikely that trauma from years ago, with no other apparent effects, could somehow lead to dementia. But we now appreciate that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221805/">head trauma can be a major risk factor for dementia and Alzheimer’s</a>. In fact, as far back as 1928, the term <a href="https://jamanetwork.com/journals/jama/article-abstract/260461">“punch drunk”</a> was introduced to describe a disorder of progressive dementia that was first seen in boxers.</p> <p>This was later called “dementia pugilistica” and is known today as <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/chronic-traumatic-encephalopathy-(cte)">chronic traumatic encephalopathy (CTE)</a>. Recent research suggests that concussions and other <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835563/">traumatic brain injuries may increase the early brain pathologies that lead to the development of Alzheimer’s later on</a>.</p> <figure class="align-center "><img alt src="https://images.theconversation.com/files/244414/original/file-20181107-74763-ttksee.jpg?ixlib=rb-1.1.0&amp;q=45&amp;auto=format&amp;w=754&amp;fit=clip"> <figcaption><em><span class="caption">‘Punch drunk’ was a term used to describe the behaviour of boxers who had suffered repeated severe blows to the head&nbsp;</span><span class="attribution"><span class="source">(photo by Shutterstock)</span></span></em></figcaption> </figure> <p>Also, a medical history of <a href="http://dx.doi.org/10.1136/jnnp.74.7.857">head injury can more than double the risk</a> of developing Alzheimer’s disease in some populations, even after many years.</p> <p>With the <a href="http://apps.who.int/iris/bitstream/handle/10665/112325/WHO_RHR_14.11_eng.pdf?sequence=1">World Health Organization estimating that up to 30 per cent of women worldwide have experienced violence from an intimate partner</a>, the global burden of domestic abuse on Alzheimer’s may be a critical factor.</p> <h3>A call to action</h3> <p>Despite its obvious significance, this dementia and domestic violence overlap remains under-recognized and incompletely understood. It’s not a new problem, but because it tends to be conveniently ignored, it has yet to garner proper scientific scrutiny.</p> <p>The growing prevalence of both dementia and domestic violence is worrisome. We need to appreciate the clear relationship between Alzheimer’s and domestic violence.</p> <p>As science grapples with these uncomfortable questions over the years to come, stopping the spread of domestic violence seems like an obvious, and feasible first step.</p> <p>Dementia is more than just three stories or some ambiguous science; it is a call to action.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img alt="The Conversation" height="1" src="https://counter.theconversation.com/content/104308/count.gif?distributor=republish-lightbox-basic" style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important" width="1" loading="lazy"><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: http://theconversation.com/republishing-guidelines --></p> <p><em><span><a href="https://theconversation.com/profiles/donald-weaver-566502">Donald Weaver</a>&nbsp;is a professor of chemistry at the Ƶ and&nbsp;director of Krembil Research Institute, University Health Network.</span></em></p> <p><em>This article is republished from <a href="http://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/dementias-hidden-darkness-violence-and-domestic-abuse-104308">original article</a>.</em></p> </div> <div class="field field--name-field-news-home-page-banner field--type-boolean field--label-above"> <div class="field__label">News home page banner</div> <div class="field__item">Off</div> </div> Tue, 13 Nov 2018 17:49:42 +0000 noreen.rasbach 147056 at