Recognizing Psychotic Symptoms of Dementia

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Many of the 50 million people or so who are living with dementia also have psychosis. You may hear doctors use the term "psychotic episodes." It's when a person struggles with determining what is real and what is not.

It can include things like:

  • A false belief that a caregiver is trying to harm them
  • An insistence that they see someone in their room, like a long-dead sibling or friend, or even someone famous, who isn't there

Often, experts say, the signs of dementia-related psychosis go undetected and untreated for too long. That can have a big impact on both the health of the person with dementia and the well-being of their families and other caregivers.

"If somebody has dementia, the doctor or the family may not take seriously some of the things the [person is] saying, and not recognize that it's a false disbelief or a hallucination, and they just think it's a problem with cognition," says Gary Small, MD, the director of the UCLA Longevity Center.

"People tend to assume that dementia is just a cognitive illness. But it's clear that it affects behavior and all kinds of aspects of the patient's and the family's life."

Know Your Terms

Psychosis is a wide-ranging term. Included in its definition are two main terms:

  • Hallucinations (seeing or hearing things that others don't)
  • Delusions (false beliefs)

The psychosis part of dementia-related psychosis can sometimes be difficult to grasp.

"Oh, my goodness, it's very poorly understood," says Zahinoor Ismail, the principal investigator at the Ron and Rene Ward Centre for Healthy Brain Aging Research at the University of Calgary's Cumming School of Medicine. "People have all sorts of preconceived notions about what these terms mean. They use them interchangeably.

"There's a stigma around them, because they relate them to schizophrenia or major mental health issues that happened earlier in life. It's an area in which often explanation is really required: What are the definitions? What do we mean?"

What to Watch For

It seems pretty clear that if a person with dementia says that a dead spouse came to visit, or that the people in the nursing home are conspiring to poison the food, that's a sign that something's up, and the person's care team needs to know about it. But people with symptoms of psychosis sometimes aren't very forthcoming with that information. Even caregivers may keep things like that to themselves.

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