Alzheimer's patients can lash out, but killings rare.
Millie La Poma's husband of 54 years never became violent as he descended into the darkness and fog of Alzheimer's disease.
But as his memory faded and his brain cells died, Robert La Poma often became angry and irritable, never more so than when he was forbidden from driving his car, she said.
"He was very angry at himself, angry at what was happening," La Poma said. "He didn't know how to fix it. ... Why didn't he remember? Why couldn't he drive the car?"
As Alzheimer's disease progresses, it's not uncommon for behavior to change, from irritability and restlessness to belligerence and even physical violence.
But the kind of deadly attack that erupted last week at an Alzheimer's care center in Eugene is an anomaly, experts say.
Frank Kuykendall, 86, shot and killed 80-year-old Joe Bruscia a week ago at Alpine Court Memory Care Community. He then returned to his room and killed his 86-year-old wife, Ruby, before turning the gun on himself. Kuykendall and Bruscia had earlier run-ins, and Kuykendall reportedly didn't like Bruscia calling on his wife, police said.
All three had some form of dementia, police said.
"In close to 15 years I've been here I can't think of a single case close to what we're talking about" in Eugene, said Dr. Katherine Wild, a clinical psychologist and researcher at Oregon Health & Science University's Aging and Dementia Assessment Clinic.
"Violence is rare in the Alzheimer's world," said Kathleen O'Brien, a senior vice president with the national Alzheimer's Association in Chicago.
Alzheimer's is a progressive, irreversible neurological disorder that afflicts up to 4.5 million Americans, most over age 65. As it destroys brain cells, it causes gradual memory loss, impairment of judgment, disorientation, personality change and loss of language skills.
Behavioral problems are common among Alzheimer's patients as they deteriorate, Wild said.
"People do exhibit aggressive behaviors because they don't understand what's happening around them," she said, "so it's not unusual to have troublesome, disruptive behaviors."
A 1997 study at the University of Bristol in England examined 262 Alzheimer's patients and found 53 percent exhibited some aggressive behavior: 35 percent were reported to be verbally aggressive, and 18 percent physically assaulted caregivers.
Another 1997 study, conducted by researchers at Veterans General Hospital-Taipei in Taiwan, looked at 133 patients suffering from dementia and found that 16 percent exhibited delusional jealousy.
And while deadly violence is rare, it's not unheard of: An 85-year-old Palo Alto, Calif., man suffering from Alzheimer's allegedly strangled and stabbed his wife to death in October, the San Jose Mercury News reported.
In January 2001 in Eugene, an Alzheimer's sufferer and another person got into a dispute over ice cream at a Eugene care center. The fight turned into a shoving match and one person fell to the floor, hitting a table on the way down. The person died from a head injury, Eugene police Sgt. Scott McKee said. No charges were filed.
In cases involving extreme violence, other factors could be at play, Wild said.
"It's not typical for someone out of whole cloth to become a physically violent person to that extreme, so often there's some underlying psychiatric diagnosis that may not have been detected," she said.
O'Brien of the Alzheimer's Association said these kinds of tragedies underscore the importance of having well-trained staff and family members who are knowledgable about the disease so they can monitor behavioral problems.
"For the most part, this kind of very aggressive behavior can be prevented if you keep them in a quiet environment," she said.
And guns shouldn't be kept where an Alzheimer's patient would have access to them, O'Brien said. Guns should be removed from the home or kept in a gun safe and out of sight.
Investigators are investigating how, when and why Kuykendall obtained the .22-caliber handgun used in the Alpine slayings.
It's also important to remember that the disease affects different people different ways as it works on different parts of the brain, O'Brien said.
"Someone with Alzheimer's disease can be very docile and demure and the world is going on around them," she said. "Another person can be restless and irritable and exhibit annoying, disruptive behavior."
Robert La Poma's easy-going manner changed as his disease progressed, Millie La Poma said. Her husband had a great sense of humor and made friends easily. He loved to play golf. The couple spent their adult lives in New York and New Jersey and moved to Eugene nine years ago.
Millie La Poma, 75, said she started noticing changes in her husband's behavior: He didn't speak clearly; he drove too fast; he would get lost. Sometimes he would go to bed at 7 p.m. and get up two hours later, thinking it was morning.
He became progressively forgetful and would argue about little, insubstantial things. Eventually, the doctor told him he could no longer drive - which he couldn't accept, La Poma said.
Sitting in the passenger seat, he would badger and second-guess his wife as she drove, she said. At night, he would sneak out to the car and try to open the door with a screwdriver.
He once grabbed his wife around the arms, demanding to know where the car keys were.
"It got to the point where he got very hard to handle," she said.
One night, Robert La Poma refused to come back in the house. Millie La Poma said she had no choice but to call the police.
Her husband was pleasant when officers arrived, even as he sat on the curb and was handcuffed, she said. Police took him to the emergency department at Sacred Heart Medical Center and doctors admitted him to the hospital's Johnson Psychiatric Unit.
He stayed there eight days, and every time Millie La Poma visited him, he would demand that she take him home.
When he got out, she put him in Southtowne Living Center, which specializes in Alzheimer's care. He wanted out, once finding a way to climb onto the roof in an apparent desperate effort to escape.
La Poma spent much of his time at Southtowne sleeping, sometimes on the floor, sometimes in other residents' rooms. He died Aug. 24 at age 76. The cause of death was listed as stroke.
Millie La Poma said she misses her husband terribly.
"I hated to see him go, but on the other hand, I hated to see him suffering," she said.
The Eugene office of the Alzheimer's Association will offer an education and memory screening program from 1 p.m. to 4 p.m. Saturday, Dec. 13, at Lone Oak Assisted Living Facility, 2615 Lone Oak Way, near Fred Meyer off River Road and Belt Line Road. People concerned about their memory and cognitive status can attend with a loved one or caregiver. For more information or to register, call Cathy at Lone Oak, 463-7700.
The association also can direct caregivers and Alzheimer's patients to resources, such as counselors, support groups and respite care. A 10-class seminar for caregivers and early-stage Alzheimer's patients also will be offered. Call 345-8392.
The national Alzheimer's Association Web site www.alz.org and 24-hour toll-free hot line, (800) 272-3900 also offer tips.
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|Title Annotation:||Health; Aggression among patients is not too uncommon, but last week's violence was|
|Publication:||The Register-Guard (Eugene, OR)|
|Date:||Dec 5, 2003|
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