Consider for a moment a time when you could not do something that you were expected to do or wanted to do. If you were unable, for whatever reason, to do what you wanted to do, what was your response? Did it include frustration and did that frustration ever spill over into anger? Most of us have learned to suppress such responses. When they are not suppressed, the behaviour seems frightening. At certain stages of the diseases, Alzheimer's sufferers may show signs of overt anger and aggression. This may relate to a combination of frustration and lack of normal inhibition. Understanding its origin only partly helps to cope with a behaviour which, in extreme forms, could endanger as well as distress a carer.

As with most disturbing behaviours, this may be a phase of the disease, but there are other factors that can contribute to the problem including

• overtiredness at the time of a request
• sleep deprivation
• pain, fever, illness or constipation
• side effects of medications
• impaired vision or hearing leading to misinterpretation of sights and sounds or hallucinations
• sensory overload - too much noise and activity
• unfamiliar people, places or sounds leading to feelings of insecurity
• change in routine
• alcohol
• upset by arguments between others
• being asked to respond to too many questions or instructions at once
• response to stress or irritability of others
• being scolded or contradicted
• feeling insulted by tone and manner of others or by being treated like a child.