Recognize psychotic symptoms of dementia

More than 55 million people worldwide have dementia, and many have psychosis as well. You may hear doctors use the term “psychotic episodes.” It is when a person struggles to determine what is real and what is not.

It can include things like:

• Misconception that the caregiver is trying to harm them
• Their insistence on seeing someone in their room, such as a long dead sibling or friend, or even a famous person, is not present

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

“If someone has dementia, the doctor or family may not take some things seriously [person is] “He says, not realizing it’s false blasphemy or a hallucination, and they just think it’s a problem of perception,” says Gary Small, director of the UCLA Longevity Center.

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

Psychosis is a broad term. Its definition includes two main terms:

• hallucinations (seeing or hearing things that others do not)
• delusions (false beliefs)

It can sometimes be difficult to understand the psychosis part of dementia-related psychosis.

“Oh, my God, it’s so bad,” says Zahinour Ismail, principal investigator of the Ron and Renee Ward Center for Healthy Brain Aging Research at the University of Calgary-Cumming School of Medicine. “People have all kinds of preconceived notions about what these terms mean. They use them interchangeably.

“There’s a stigma around them, because they associate them with schizophrenia or major mental health problems that occurred earlier in life. It’s an area where interpretation is often really needed: What are the definitions? What do we mean?”

It seems pretty clear that if someone with dementia says a dead spouse has come to visit, or people in a nursing home are conspiring to poison food, that’s a sign that something is going on, and the person’s care team needs to know about it. But people with symptoms of psychosis sometimes don’t provide this information very well. Even caregivers may keep things like this to themselves.

“I would say to people, I say to people … who may feel fear or shame or stigma about these symptoms: please don’t,” Ismail says. “It doesn’t reflect on a loved one with dementia, and it doesn’t reflect on you. These are just symptoms of a brain change. It doesn’t mean they’re a bad person, and it doesn’t mean they’re ‘crazy.'” None of this.

“Just as the brain changes and makes them forget, the brain changes and makes them believe things that may not be true.”

In addition to some people’s unwillingness to be honest about hallucinations or delusions, some physicians or professional caregivers do not have the time, experience, or expertise to look at symptoms to see if they are a sign of psychosis or something else. Along with the many symptoms of dementia, the diagnosis isn’t always straightforward.

“[These signs] It rarely happens in isolation, Ismail says. “You can have psychotic symptoms with agitation, and you can have agitation with psychotic symptoms. One of them may be primary. For some, like [dementia] Go ahead, they can have it all.”

To find out if someone has dementia-related psychosis, experts say, first ask yourself questions, such as:

• How does a person with dementia feel?
• Has anything changed recently?
• What, if any, is causing the person anxiety or distress?
• Did the person see or hear things that may not be real, or act in a way that might suggest that the person is experiencing delusions or hallucinations?

If the answer is “yes” to the last question, then the doctors will try to rule out any medical conditions that might be causing the delusions or hallucinations. Urinary tract infections, for example, can lead to hallucinations. Severe depression may be accompanied by auditory hallucinations.

“The key is that the patients themselves may not tell you if anything is wrong. But [as] A caretaker, a care partner, a caregiver, if you ask them about any changes, anything unusual, anything different, they will give you information,” says George Grossberg, MD, director of Geriatric Psychiatry in the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine.

“If you ask the right kind of questions, and put in the right time, it’s not hard.”