Many of the approximately 50 million people who live with dementia also suffer from psychosis. You can hear doctors use the term “psychotic episodes”. It is when a person has difficulty determining what is real and what is not.
It can include things like:
- A false belief that a caregiver is trying to harm you
- An insistence that they see someone in their room, like a long-dead sibling or a friend or even someone who is famous and is not there
Experts often say that the signs of dementia-related psychosis go undetected and untreated for too long. This can have a major impact on the health of people with dementia and the wellbeing of their families and other caregivers.
“When someone has dementia, there are some things that the doctor or family cannot take seriously [person is] say and don’t realize it’s a false belief or hallucination and they just think it’s a perception problem, “says Gary Small, MD, the director of the UCLA Longevity Center.
“People tend to assume that dementia is just a cognitive disease. But it is clear that it affects behavior and all possible aspects of the patient’s and family’s life.”
Know your terms
Psychosis is a broad term. There are two main terms in its definition:
- Hallucinations (seeing or hearing things that others don’t see)
- Delusions (false beliefs)
The psychotic part of dementia-related psychosis can sometimes be difficult to pin down.
“Oh my gosh, it’s very poorly understood,” says Zahinoor Ismail, the senior investigator at the Ron and Rene Ward Center for Healthy Brain Aging Research at the University of Calgary’s Cumming School of Medicine. “People have all sorts of preconceptions about what these terms mean. They use them interchangeably.
“There is a stigma surrounding them for associating them with schizophrenia or serious mental health problems that have emerged earlier in life. An explanation is often required in this area: What are the definitions? What do we mean?”
What to look for
It seems pretty clear that when a person with dementia says that a dead spouse has come to visit, or that the people in the nursing home are conspiring to poison the food, that is a sign that something is wrong and that The person’s care team needs to know about it. But people with symptoms of psychosis are sometimes not very open-minded with this information. Even carers can keep things like this to themselves.
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“I would tell people, I tell people … they might feel fear, shame or stigma about these symptoms: please don’t,” says Ismail. “It doesn’t reflect a loved one with dementia, it doesn’t reflect you. These are just symptoms of the changing brain. It doesn’t mean you’re a bad person, it doesn’t mean you are.” ‘crazy.’ None of them.
“Just as the brain changes and makes them forget, the brain changes and makes them believe things that may not be real.”
In addition to some people’s reluctance to be honest about hallucinations or delusions, some doctors or professional caregivers simply do not have the time, experience, or expertise to deal with symptoms to determine if they are a sign of psychosis or something else are. Combined with the many symptoms of dementia, a diagnosis is not always clear.
“”[These signs] rarely isolated, “says Ismail.” You can have psychotic symptoms with arousal, you can have arousal with psychotic symptoms. One could be primary. For some as [dementia] Advances, you can get them all. “
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To find out whether someone suffers from dementia-related psychosis, experts first ask themselves the following questions:
- How does the person with dementia feel?
- Has anything changed recently?
- What concerns or disturbs the person, if anything?
- Has the person seen or heard things that may not be real, or has they acted in a way that suggests that the person is having delusions or hallucinations?
If the answer to this last question is “yes”, doctors will try to rule out any medical conditions that could lead to delusions or hallucinations. For example, infections of the uterine tract can lead to hallucinations. Severe depression can be accompanied by auditory hallucinations.
“The key is that patients may not tell you if something is wrong. But if the caretaker, caregiver, or nurse ask them about changes, unusual, or something else, they’ll give you the information,” says Dr. George Grossberg, director of geriatric psychiatry in the Department of Psychiatry and Behavioral Neuroscience at Saint Louis University School of Medicine.
“If you ask the right questions and spend the right time, it’s not difficult.”
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