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Recognize the psychotic symptoms of dementia

Recognize the psychotic symptoms of dementia

Many of the 50 million people living with dementia also have psychosis. You may hear doctors use the term “psychotic episodes”. A person is struggling to determine what is real and what is not.

It can include the following:

  • The false belief that the caregiver is trying to harm you
  • Emphasize that someone in their room, a long-dead sibling or friend, or even a celebrity, is not there

Experts say that often the signs of dementia-related psychosis have not been detected and treated for a long time. This can have a profound effect on the health of the person with dementia as well as the well-being of their families and other carers.

“If someone has dementia, the doctor or family may not take some things seriously [person is] say, and don’t acknowledge that it’s a false disbelief or hallucination, and they think it’s a problem with cognition, ”says Gary Small, MD, director of the UCLA Longevity Center.

“People tend to assume that dementia is just a cognitive disease. But it’s clear that it affects behavior and all aspects of the patient’s and family’s life.”

Know your requirements

Psychosis is a broad term. There are two main terms in its definition:

  • Hallucinations (seeing or hearing things that others do not see)
  • Illusions (false beliefs)

Part of the dementia-related psychosis is sometimes difficult to understand.

“Oh my God, it’s very misunderstood,” says Zahinoor Ismail, principal investigator at the Ron and Rene Ward Center for Healthy Brain Aging Research at Cumming Medical School in Calgary. “People have all sorts of prejudices about what those terms mean. They use variables.

“There’s a stigma around that, because they relate to schizophrenia or major mental health problems that happened earlier in life. It’s often an area where explanations are really required: what are the definitions? What do we mean?”

What to see

It seems pretty clear that if a person with dementia says they have come to visit a deceased spouse or that people in a nursing home are conspiring to poison food, it is a sign that something is going on and the person’s care team needs to know about it. But sometimes people with psychotic symptoms do not receive much of this information. Caregivers can also keep things like this to themselves.


“I would tell people, I tell people … they may feel fear or embarrassment or stigma around these symptoms: Please don’t,” Ismail says. “It doesn’t reflect on a loved one with dementia, it doesn’t reflect on you. These are symptoms of a changing brain. It doesn’t mean you’re a bad person, it doesn’t mean you’re ‘crazy.’

“Just as the brain is changing and causing it to forget, the brain is changing and maybe making them believe things that aren’t real.”

While some people may not be willing to be honest with hallucinations or deceptions, some doctors or professional caregivers may not have the time, experience, or experience to dive into symptoms to find out if they are a sign of psychosis or something else. Combined with the many symptoms of dementia, the diagnosis is not always clear.

“[These signs] it rarely happens in isolation, “says Ismail.” You may have psychotic symptoms with agitation, you may have agitation with psychotic symptoms. One could be the main one. For some, like [dementia] it moves forward, they can get it all. “


Experts say that to find out if someone may have dementia-related psychosis, first ask yourself questions, such as:

  • How does a person with dementia feel?
  • Has anything changed recently?
  • What, if anything, is it that worries or disturbs the person?
  • Has the person seen or heard things that are not real, or has the person acted in a way that may suggest that they have deceptions or hallucinations?

If the answer is “yes” to the latter, the doctor will try to rule out any medical condition that may cause deception or hallucinations. Uterine infections, for example, can cause hallucinations. Severe depression can come with auditory hallucinations.

“The key is, maybe the patients themselves won’t tell you anything is wrong. But if the caretaker, or caring partner or caregiver, asks you about changes, something unusual, or something else, they’ll give you the information,” says George Grossberg, MD, Psychiatry at Saint Louis University School of Medicine. and the director of geriatric psychiatry in the Department of Behavioral Neuroscience.

“If you ask the right question and give it the right time, it’s not difficult.”

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