Monday, May 10, 2021

Dementia: what is dementia-related psychosis?

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Over 2 million Americans suffer from dementia-related psychosis. If you have a loved one who suffers from dementia, you know it can be a frightening illness – both for those who are going through it and for their caregivers. When they also have to deal with psychotic episodes, it can be even more confusing.

“But instead of thinking of the psychotic characteristics as this taboo and disgusting topic, I just want people to understand that this is a normal manifestation of these illnesses. An expected demonstration. A disease that speaks ”, explains Pierre N. Tariot, director of the Alzheimer Banner. Institute in Phoenix, AZ.

“Your beloved is not ‘mad’. They are sick. Their brains are not functioning properly. And we can evaluate it, and we can help you figure that out. And we can help alleviate distress – yours and that of your loved one. “

What it is

To understand dementia-related psychosis, it helps to break down the terminology:

Some experts now call dementia a “neurocognitive disorder”. But doctors still use the word dementia. It is a broad term that encompasses a wide range of conditions caused by changes in the brain.


Alzheimer’s disease is perhaps the most well-known form of dementia. But there are others, including:

  • Lewy body dementia
  • Frontotemporal dementia
  • Vascular dementia

These conditions include a decline in thinking and problem solving that often make daily living and independent living difficult.

Common symptoms of dementia include:

  • Lack of memory (forgetting the name of a loved one, for example)
  • A decreasing attention span
  • Difficulty communicating (using unusual words, for example, to refer to familiar objects)

Basically, psychosis occurs when a person has a hard time understanding what is real and what is not. People with psychosis may have delusions, such as a firm false belief that someone is trying to kill them. They might also be hallucinating – seeing or hearing something or someone that other people don’t have.

“There is a huge lack of understanding and knowledge of these terms,” says Gary Small, MD, director of the UCLA Longevity Center. “These terms are scary. Dementia seems pejorative. And a term like psychosis or psychotic is scary too.

“What I’m trying to do is explain what these things are, what these phenomena are, and try to help them understand them.”


As the term might suggest, people with dementia-related psychosis have the declining thinking and problem-solving skills of dementia, as well as delusions or hallucinations of psychosis. (Delusions are more common.)

All of this can trigger other problems, like:

  • Apathy
  • Anxiety
  • Aggression
  • Insomnia
  • Agitation
  • Lack of inhibition


The first step in knowing if your loved one has dementia-related psychosis is to make sure that a hallucination or delusion is not the result of something else. An infection of the uterine tract, for example, can lead to hallucinations.

The diagnosis of dementia-related psychosis is primarily about gathering information; exclude other causes; then observe, listen and ask questions.

“What I do is I never see [people] on their own, “says George Grossberg, MD, director of geriatric psychiatry at St. Louis University School of Medicine.” I always see them at least with one or more – but at least with one – personal caregiver. or care partner. Usually it is a spouse or an adult child.

“I ask them about the kinds of things they notice about loved ones with dementia.”


What could these questions be?

“I could say, ‘It’s been about 3 or 4 months since we last saw mom and you. How is it going?

“‘Did you notice anything unusual or different?

“Has mom perhaps heard or seen things or imagined things that concern you because you cannot see them, hear them or imagine them?”

“And that gives them sort of a whole space for them to talk.”

Its not always easy. People with dementia may hide their symptoms for fear of the stigma that often accompanies mental health problems. Others – nurses, doctors, professional caregivers – may not detect the signs for a variety of reasons. This makes it even more important to observe, speak, and ask the right questions – for everyone involved.

“I tell all of my interns, medical students and residents, ‘This is detective work,’ says Zahinoor Ismail, MD, senior researcher at the Ron and Rene Ward Center for Healthy Brain Aging Research at the University of Calgary.

“You have to watch, and you have to actually ask for information from all sources.”


There is no cure for Alzheimer’s disease and other dementias. So the first line of treatment for dementia-related psychosis is not drugs or medicine.

In fact, sometimes people with milder psychosis may not need treatment. If a hallucination or delusion does not bother the person with dementia, it often does not need to be treated. If this bothers them, some simple methods – such as making sure the environment around the person with dementia does not trigger the episode – may help.

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Tariot remembers a woman with dementia who thought someone was in the room with her. In fact, the woman had caught a glimpse of her own reflection. Covering a mirror alleviated his anxieties. In another case where someone thought someone was spying on them, Small says lowering a window shade made the problem easier.

Also effective for some with dementia: it is enough to get rid of an episode that can upset them.

“The best way to respond is in a calm manner, to distract people,” Small says. “I often remind them what it was like when their kids were young and rowdy. You redirected them, with a game to play, or so on.”


If these types of methods do not work, doctors may choose to prescribe medication. The FDA has not approved any drug specifically for dementia-related psychosis. Instead, doctors often go “off-label” to prescribe antipsychotic drugs that are not specifically for dementia-related psychosis.

“Or [methods that involve drugs] does not work, we resort to drugs. The problem is the drugs we have… they just don’t work very well, “says Tariot.” They have, at best, about a 1 in 5 chance of helping enough to notice, and about 80 or 90 percent likely to cause damage. “

Psychosis with dementia can be difficult to diagnose and treat. But understanding it, realizing its effects on both the person with dementia and those around them, and using care and compassion to treat it can make things better for everyone involved.

“I have people asking me all the time, ‘Gee, Dr Grossberg, I know you specialize in Alzheimer’s disease. How do you do that? Don’t get depressed? Don’t be discouraged?” “Said Grossberg.

“And I say, ‘No. Just the opposite. ‘ There is a lot that we can do to really improve the quality of life for [person] and care partners, to really make the remaining days more enjoyable and comfortable. It gives me a lot of satisfaction. “

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