Dementia-Related Psychosis: Strategies That Help

There is no cure for dementia-related psychosis. But there are steps you can take to help yourself and your loved one cope with the disease and its symptoms.

“Delusions are notoriously difficult to treat, whether or not they are related to dementia,” says Carolyn Fredericks, MD, a neurologist who treats people with Alzheimer’s disease and other memory disorders at Yale Medicine. .

“The question is: how can you and [your loved one] live with their false belief or see people who are not there, or whatever their psychotic symptom is, in as calm and peaceful a way as possible?

Here are some strategies that might help.

Change the subject

People with dementia often forget where they put things. This can trigger delusional thoughts about intruders or theft. Fredericks says it’s how their brain makes sense of their memory loss.

They think, “I can’t find this item. Therefore, someone must have stolen it, ”she said.

Your first urge might be to convince your loved one that no one has taken their things. But it’s not a good idea to confront them or deny their reality. Instead, try to help them find their lost item or get them to focus on something else.

“Redirecting or distracting the person is often very powerful,” says Fredericks. “As soon as you really involve them in the illusion, you can get stuck there.”

Validate their feelings

Your loved one’s delusions can seem very real and frightening. You should take a moment to recognize their emotional state before moving on to another topic.

“Keeping a tone of calm and caring is really one of the most important things family members can do,” says Fredericks.

Some useful things you can say include:

  • “I’m sorry you’re scared. Let’s sit down and have a cup of tea and turn on all the lights.”
  • “I’m so sorry to hear that this is happening. But can you help me fold this pile of laundry?”
  • “It sounds scary. Oh, it’s a nice sweater you’re wearing. Who gave it to you?”

Don’t be offended

Your loved one might change the way they deal with you or forget who you are. They might accuse you of infidelity or think you are a stranger in their home. It can be hurtful. But try not to take it personally.

“This delusional thought process is part of the DNA of the disease,” says Arman Fesharaki-Zadeh, MD, behavioral neurologist and neuropsychiatrist at Yale Medicine.


Don’t jump in to defend yourself, even if your loved one is really hostile. Instead, says Fesharaki-Zadeh, the first thing to do is to help them feel safe. Tell them you know it’s scary that they don’t recognize you.

After that he says you can give them some “flash-bulb moments”. These are things like old photos or video clips of great memories.

“It could be a disarming and compassionate way to bring them back to reality,” he says.

Keep the familiar faces around you

People with dementia may not follow new faces very well. This can cause problems if you have different home health aides providing care. Your loved one may feel more comfortable if someone they know helps them.

Fesharaki-Zadeh says that you can ask familiar characters to “make changes”. For example, a spouse or child might be there for a certain number of hours. Then a grandchild or a friend steps in. It is not always possible. But he says there are groups that can provide financial assistance if you want to provide long-term care for family members with dementia.

You can visit the National Family Caregiver Support Program website for more information.

Create a routine

People with dementia tend to do better with structure. Their psychotic symptoms may improve if their daily life does not change much.

“This predictability provides a sense of comfort and an anchor in the environment,” says Fesharaki-Zadeh.

Here are some of his tips:

  • Wake them up at the same time every day.
  • Ask them to lie down at the same time.
  • Keep meals on a schedule.
  • Ask them to go to the bathroom at set times.

Add activities that they like to do. It could be sewing, cooking, listening to music, or going for a walk.

“And when it comes to exercise,” says Fesharaki-Zadeh, “I can’t stress enough its therapeutic nature.”

Remove triggers

You will want to avoid people, places, or things that make your loved one’s psychosis worse.

James Lai, MD, assistant chief of clinical affairs for geriatrics at the Yale School of Medicine, says it’s also important to look for subtle things that might affect your loved one’s behavior. He says some everyday things can be stressful or disorienting for people with dementia.


“A large TV that has people on it can look very real,” he says. “You say they’re hallucinating. But in fact, a television with a person talking outside of a box looks like someone is in the room, standing there. “

Lai also suggests minimizing glare in windows and the continuous noise from other rooms.

“You can close the blinds at night,” he says. “And having the radio on all the time is not a good idea.”

Take a look back

You should not ask someone with dementia what they ate for breakfast 2 days ago. But childhood events could be a fun topic to talk about.

“They might have lost their short-term memories, but they have no problem talking about when they went to summer camp,” Lai says. “It’s something they’ve been talking about for years.”

What people with dementia remember can vary. But Lai says the oldest memories – where they grew up, where they previously worked – tend to stick around the longest. It will take some trial and error to find the right topic for your loved one. But once you do, you can talk about it in times of stress.

“Day to day, you can talk about it over and over again,” Lai says. “But for them it may be something new. And it’s easy to talk about it.

Remove dangerous objects

Fredericks says people with dementia should never have easy access to guns and bullets. And you might also want to keep sharp items like kitchen knives out of reach.

“If someone has psychotic symptoms and thinks there are intruders around the house all the time – and you’ve seen them wield a knife in the kitchen in the middle of the night – you don’t want to someone comes in and registers on your furnace and trick your loved one into believing someone is coming for them, ”says Fredericks.

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