Recognizing Psychotic Symptoms of Dementia

Many of the roughly 50 million people with dementia also suffer from psychosis. You may hear doctors use the term “psychotic episodes”. It’s when a person has a hard time figuring out what’s real and what isn’t.

This 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 brother or friend, or even someone famous, who is not there

Often, experts say, the signs of dementia-related psychosis go undetected and untreated for too long. 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 of the [person is] saying, and not acknowledging that it’s false disbelief or hallucination, and they just think it’s a cognition issue, ”says Gary Small, MD, director of the UCLA Longevity Center.

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

Know your terms

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

  • Hallucinations (seeing or hearing things that others do not have)
  • Delusions (false beliefs)

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

“Oh, my God, this is very misunderstood,” says Zahinoor Ismail, senior researcher at the Ron and Rene Ward Center for Healthy Brain Aging Research at the Cumming School of Medicine at the University of Calgary. “People have all kinds of preconceived notions about what these terms mean. They use them interchangeably.

“There is a stigma around them because it connects them to schizophrenia or major mental health issues that happened earlier in life. This is an area in which often an explanation is really needed: what are the definitions? What do we mean?

To monitor

It seems pretty clear that if someone with dementia says that a deceased spouse has come to visit them, or that the people at the nursing home are conspiring to poison the food, it is a sign that something is going on and that the person’s healthcare team should be aware of. he. But people with symptoms of psychosis are sometimes not very receptive to this information. Even caregivers can keep things like this to themselves.


“I would tell people, I tell people… they may feel fear, shame or stigma around these symptoms: please don’t do it,” Ismail says. “It doesn’t reflect a loved one with dementia, it doesn’t reflect your personality. These are just symptoms of the evolution of the brain. That doesn’t mean he’s a bad person, doesn’t mean they’re ‘crazy.’ None of that.

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

In addition to the reluctance of some people to be honest about hallucinations or delusions, some doctors or professional caregivers simply do not have the time, experience or expertise to delve into the symptoms to see if they are. are a sign of psychosis or the like. Combined with the many symptoms of dementia, the diagnosis is not always clear.

“[These signs] rarely occur in isolation, “Ismail says.” You can have psychotic symptoms with restlessness, you can have restlessness with psychotic symptoms. One could be primary. For some, like [dementia] progresses, they can have them all. “


To find out if someone may be suffering from dementia-related psychosis, experts say, start by asking yourself questions, like:

  • How does the person with dementia feel?
  • Has anything changed recently?
  • What, if any, worries or bothers the person?
  • Has the person seen or heard things that might not be real, or acted in a way that might suggest they are having delusions or hallucinations?

If the answer is “yes”, on this last question, doctors will try to rule out any medical conditions that could cause delusions or hallucinations. Infections of the uterine tract, for example, can lead to hallucinations. Severe depression can be accompanied by auditory hallucinations.

“The key is that the patients themselves may not tell you if there is something wrong. But if the caregiver, or the care partner or the caregiver, if you ask them about changes , something unusual, something different, they’re going to give you the information, ”says George Grossberg, MD, the director of geriatric psychiatry in the Department of Psychiatry and Behavioral Neuroscience at the School of Medicine. Saint Louis University.

“If you’re asking the right kind of questions and having the right time, it’s not difficult.”

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Jothi Venkat

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