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Paranoia and Delusions in Alzheimer's Disease

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Updated March 08, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What Is Paranoia?

Paranoia is an unrealistic fear or concern that harm is imminent or that others are out to get you. A paranoid person does not generally accept other explanations and may blame you if you try to use logic to reason away their fears.

Some people experience paranoia if they have a psychological disorder like schizophrenia. Others develop it in relation to different medical conditions, including Alzheimer’s, other dementias or delirium.

What Are Delusions?

Delusions are fixed (not easily changed) false beliefs. Dementia often results in paranoid delusions, where there may be a fixed belief that someone is poisoning the food or stealing money. Other delusions, infrequently experienced by those with dementia, include delusions of grandeur, where there is the false belief that one has extra power or a higher position in society or the world.

An Example of Paranoia and Delusions in Alzheimer’s

Alzheimer’s can change the way others are perceived. For example, you may have always had a good relationship with your father and are trying to help him with his finances. Instead of being grateful for your assistance, your father, who has Alzheimer's, might accuse you of trying to take his money or "pull one over" on him.

Common Delusions in Dementia

  • Spouse/partner is being unfaithful.
  • Someone else is living in their home.
  • Their belongings/money are stolen.
  • Others are out to get them.
  • Food is poisoned.

Prevalence of Delusions in Alzheimer’s Disease

Approximately 30% to 40% of people with Alzheimer’s will develop delusions at some point during the disease, many of them being paranoid delusions. The incidence may be increased in those who have a history of abuse or trauma.

Delusions appear to be more common in Parkinson’s-related dementia, vascular dementia and Lewy Body disease (LBD), with up to 70% of people with LBD experiencing delusions or hallucinations.

Could Paranoia or Delusions Be a Sign of Delirium?

If paranoia or delusions are a new behavior for your loved one or someone you’re caring for, consider the possibility that she might be experiencing delirium. Delirium is a sudden change in thinking and orientation, usually quite reversible, brought on by a physical condition such as an infection, surgery or other illness.

How Can You Decrease the Likelihood of Paranoid Delusions in Alzheimer’s?

Be careful what television shows are playing in the background. To you, it might just be background noise, but to a person who’s confused, violent or fear-provoking shows may trigger fear and paranoia for that person. For the person with Alzheimer’s, the line between reality and fantasy can easily become blurred.

Ensure that your loved one is receiving the correct medication doses. Too much or too little medication can affect a person’s mental and emotional stability.

If you’re providing care for someone in a facility, try to keep the routine as consistent as possible. A regular rhythm of the day and familiar, consistent caregivers help reduce anxiety and stress for people.

Responding to Paranoid and Delusional Behavior in Alzheimer’s

  • Provide reassurances.
  • Remain calm.
  • Explain any procedures before performing them.
  • Avoid laughing or whispering near the person.
  • Don’t agree with the person that you did something that you didn’t do.
  • Use a behavior log (a way to track behaviors) to identify triggers and times of day they occur.
  • Don’t argue.
  • Use distraction.
  • Enter into their world. Put yourself in their shoes.
  • Help them look for things they think are stolen or missing.
  • Have duplicates of things they lose and think are stolen.

You may also need to consider the possibility that their fears are accurate - that someone is actually taking advantage of them. Older adults can be vulnerable to different types of abuse, including financial and physical. Most delusions in dementia really are delusions, but a healthy awareness (not constant suspicion) of others is the better part of wisdom.

Sources:

DementiaGuide. Delusions and Paranoia. Accessed February 20, 2012. http://www.dementiaguide.com/symptomlibrary/behavior/delusionsparanoia/doctorsdiary/

Loddon Mallee Region Dementia Management Strategy Overview. Hallucinations, Delusions and Paranoia. Accessed February 20, 2012. http://www.dementiamanagementstrategy.com/Pages/ABC_of_behaviour_management/Management_strategies/Hallucinations__delusions_and_paranoia.aspx

Millikin, C. Moments of Sheer Terror: When People with Dementia Act on Delusional Beliefs. Accessed February 20, 2012. http://search.yahoo.com/r/_ylt=A0oG7lZb6EJPQAYA2lBXNyoA;_ylu=X3oDMTE2YzZzZjR1BHNlYwNzcgRwb3MDNTIEY29sbwNhYzIEdnRpZANWSVAxMjhfMjYx/SIG=11ugkkk7r/EXP=1329813723/**http%3a//www.alzheimer.mb.ca/handouts/1e.ppt

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