Objective To explore the current status of violent aggressive behavior among Alzheimer's disease （AD） patients with behavioral and psychological symptoms of dementia （BPSD）， and analyze its related factors. Methods The general data of 126 patients who met the diagnostic criteria for AD and BPSD during their first-time hospitalization at the Chongqing Changshou District Mental Health Hospital from March 2023 to March 2024 were retrospectively analyzed. Patients' aggressive behavior， neuropsychiatric symptoms， and degree of dementia were evaluated using the Modified Overt Aggression Scale （MOAS）， Neuropsychiatric Inventory-Questionnaire （NPI-Q）， and Hasegama's Dementia Scale （HDS）. Patients were divided into violent aggressive group （MOAS weighted total score≥4， n=72） and non-violent aggressive behavior group （MOAS weighted total score＜4，n=54） based on MOAS weighted total score， and the differences in general data， clinical data， NPI-Q score， and HDS score between the two groups were compared. Binary Logistic regression was used to analyze the risk factors of violent aggressive behavior. Results Univariate analysis showed that there were statistically significant differences in gender， disease duration， smoking history， history of violent behavior， and NPI-Q score between violent aggressive group and non-violent aggressive behavior group （all P ＜ 0.05）. Binary Logistic regression analysis showed that gender ［OR=0.281， 95%CI：0.083-0.945， P=0.040］， disease duration ［OR=0.490， 95%CI：0.351-0.683，P ＜ 0.001］， history of violent behavior ［OR=15.280， 95%CI：3.029-77.081，P=0.001］， and total NPI-Q score ［OR=1.138， 95%CI：1.034-1.253， P=0.008］ were influencing factors of violent aggressive behavior in AD patients with BPSD， and the difference was statistically significant. Conclusions The incidence of violent aggressive behavior is high in first-time hospitalized AD patients with BPSD， and male gender， short disease duration， history of violent behavior， and high NPI-Q score are risk factors.