Nurses report aggression in patients with advanced Parkinson’s disease and related diseases

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

Previous research has shown that people with PDRD experience varying degrees of cognitive and behavioral changes. A significant proportion of patients with PDRD report neuropsychiatric and behavioral disorders including apathy, depression, hallucinations, fatigue, and impulse control disorders.

Changes in behavior in some people with dementia can be accompanied by physical or sexual aggression. Despite these results, few descriptive studies are available to describe the prevalence of aggression in PDRD.

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A team of researchers from the United States examined survey data from nurses who had participated in a clinical trial on ambulatory palliative care for PDRD ( Identifier: NCT02533921). The nurses in this study were asked about the aggression of the patients at the start of the study and interviewed again every 3 months for a period of 1 year.

Study researchers determined the point prevalence based on the baseline responses, while the cumulative incidence of aggression was calculated based on the responses of participants who did not report baseline aggression.

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

The cumulative incidence of physical aggression was significantly associated with depression in the patient (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), burden on caregiver (RE, 1.04; 95% CI, 1.01-1.07), depression of the caregiver (RE, 1.10; 95% CI 1.03-1.17), quality of life of the patient perceived by the nursing staff (RE, 0, 93; 95% CI, 0.90-0.97) and anxiety of the nursing staff (RE, 1.09; 95% CI, 1.03-1.16). In contrast, the study researchers found no significant variables related to the cumulative incident of sexual aggression.

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

The study’s researchers concluded that “neurologists, movement disorder specialists, and palliative care professionals should be aware of the potential for aggression while involving caregivers in routine care.” They added that routine caregiver exposure assessment provides a potential “opportunity to detect, investigate root causes and identify solutions through careful discussions with caregivers”.


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

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