Dementia and Paranoia in the Elderly

July 06 2020

What is Dementia?

Dementia is actually quite a broad term and doesn’t actually refer to a disease. Rather, it is used to describe a set of symptoms that could arise when somebody develops Alzheimer’s disease, has a series of strokes, or is damaged in some other way. Some symptoms are more common than others, but they generally depend on what part of that brain has been damaged and (if applicable) what disease the person is suffering from.

Is Paranoia a Symptom of Dementia?

If you know somebody who started to display paranoia, you might be wondering if the paranoia is an early sign of dementia. Yes, paranoia can be one of dementia’s symptoms, but there is much more to dementia than just this. Here are some common symptoms found in people who have dementia. Remember, it is not necessarily true that a dementia patient would have every single one of these symptoms.

Cognitive Symptoms

1. Memory loss: Typically, this symptom is first noticed by a dementia patient’s spouse or friends first.
2. Difficulty Finding the Right Words: With this, the person may feel as if a word is “on the tip of their tongue” at a far higher rate than normal.
3. Poor Spatial Ability: The person could begin getting lost while navigating, even when traveling along familiar routes.
4. Difficulty Solving Problems and Planning: As dementia progresses, the patient could begin to have trouble planning things or finding solutions to problems. For example, the elderly person may have a hard time balancing a budget, developing a meal plan, and so on.
5. Complex Tasks are Harder: A dementia patient could begin to have difficulty following multi-step processes, such as cooking a meal from scratch.
6. Coordination Problems: The person could begin to act in a clumsy manner, and their motor skills could degrade.
7. Disorientation: The patient might be confused and not understand why they are in a certain place.

Psychological Symptoms

1. Paranoia: Paranoid delusions in the elderly dementia patients may begin to arise. Perhaps they begin to believe that you are stealing from them, or that a stalker is watching their every move.
2. Depression: The person who has dementia may begin to lack the motivation to do even basic tasks. They may begin to experience depressive thoughts.
3. Anxiety: The dementia patient could start to exhibit high levels of anxiety, which might be expressed in a physical manner – pacing, restlessness, agitation, and so on.
4. Hallucinations: It is possible that somebody with dementia could experience visual or auditory hallucinations (seeing or hearing things that aren’t really there.)

So, as you can see, dementia and paranoia in the elderly don’t necessarily go hand in hand – there are a whole host of other symptoms that might arise instead.

A Closer Look at Paranoia

Perhaps your loved one’s doctor has told you that dementia is causing them to display paranoia, but you aren’t quite sure what that entails. Put simply, when a person is paranoid, they might harbor suspicions towards nearby people. They could even accuse you of trying to steal from them or harm them.

What can you expect from somebody who has paranoia and dementia? Well, you can anticipate that they will hold on to their paranoid delusions very strongly. The delusions are quite real for them; they aren’t making things up to get attention. Somebody with dementia is simply trying to make sense of the world around them while equipped with declining brain function.

What Should You Do If You Think Somebody Has Dementia-Related Paranoia?

If you are noticing troubling signs of paranoia, your first step should be to contact their doctor as soon as possible. This is especially important if you think that the person could potentially harm themselves or a caregiver. It is necessary for them to undergo a medical evaluation in order to determine if they have to take medication.

Medication is usually not the first approach to dementia and paranoia that doctors will recommend, because antipsychotic medications can be dangerous for older adults. They even come with the risk of stroke or death, so they must be used very carefully. There are non-drug approaches that you can discuss with a physician before resorting to medicine. Such interventions include therapy, redirection, reassurance, environment modification, and more. Keep reading to see our best tips for soothing paranoia in people who have dementia.

Tips for Soothing Paranoia in Older Adults

If an elderly person in your life is suffering from dementia and paranoia is one of the symptoms, do not lose hope! Don’t try to reason with somebody who has paranoid delusions, as it can lead to frustration and sometimes make the problem worse. Instead, try these behavioral techniques.

Validation

Rather than contradicting what the person is saying or trying to provide them with evidence to soothe their delusions, the best thing that you can do is validate the way that they feel. Note, this does NOT mean to lie to them – that could just lead to even more confusion. Two good validation techniques are:

1. Acknowledge the patient. Work off the famous improv tactic “yes, and…” to develop the conversation and get their mind away from the delusions. For instance, if the person is asking where her deceased spouse is, you could ask them what their favorite thing about their spouse is. Saying that the spouse is dead could cause confusion, frustration, anxiety, and more.
2. Honor their emotion. Rather than just answering their question, really listen and try to determine the emotional intent behind the query. If the person with dementia is saying that they want to go home, don’t say that the facility they are in is their new home. Instead, say that their old home sounds lovely, and ask them to tell you more information about it. This will give you insight as to whether the patient is hungry, afraid, and so on. If they say they loved the bountiful pantry of their old home, they may currently be hungry.

Stay Calm

When interacting with somebody who has paranoia and dementia, the last thing you want to do is yell at them or show any kind of aggression. Arguing with them won’t be fruitful, so stay calm instead. If you are finding yourself growing frustrated, perhaps take a few deep breaths before you respond to their paranoia.

If you still find that you can’t remain calm, you could try looking into meditation techniques. By meditating during your free time, you learn the skills necessary to stay at peace when times get tough. Here are some techniques you could try:

• Focused Attention Meditation: With this type of meditation, you concentrate on something, whether it be a repeated mantra, an object, or simply the flow of your breath. Focusing on something allows your mind to ease and unwinds tension.
• Open Monitoring Meditation: When you practice this kind, you observe the thoughts that pop into your mind. Don’t try to block out your thoughts; embrace them but observe them from afar.
• Compassion Meditation: With compassion meditation, you put your inward focus on feeling love for yourself and love for others.

Once you have learned how to meditate, perhaps you could even show the basics to a person with dementia. Meditation can actually reduce the rate of Alzheimer’s disease progression, in addition to numerous other brain-boosting benefits.

Assess the Situation Carefully

Before responding to somebody who is suffering from paranoid delusions, think out your answer carefully. Assess what is going on and see if it could lead to physical harm. If so, then the behavior requires intervention.

Distraction

If somebody with dementia is not willing to talk it through with you, you may want to try shifting their attention. It doesn’t have to be anything dramatic; simply opening the curtains or turning on some music will do. However, if it doesn’t work, don’t try the distraction technique over and over again – this will just lead to the person feeling more frustrated.

Ask Some Open-Ended Questions/Give Reassuring Statements

This is an important part of maintaining healthy communication with somebody who has dementia. You should make sure that you are clearly expressing that you understand them and that you want to help. Here are some excellent things you could say:

1. I understand what you mean. I’m here to help.
2. How can I help you feel better?
3. Tell me more, please.
4. Let’s come up with a plan to fix this.

Check the Environment

Sometimes there may be visual cues in the room that could trigger somebody with dementia to have paranoid delusions. For instance, if the light is reflecting off of a window, they may think that there is a UFO outside. Or perhaps they see their reflection in the mirror and think that somebody is watching them. You can rectify this situation by closing the curtains or by covering up the mirror.

What Else Should You Know About Paranoia and Dementia?

Dementia-related paranoia can trigger agitation, which can be stressful to try to abate. However, there are some techniques that you can use. Some of these include:

• Limiting the amount of sugar, caffeine, and junk food that the person with dementia consumes
• Reducing the amount of clutter in a room
• Maintaining a daily routine
• Avoid rearranging furniture; try to keep things in the same places to instill familiarity
• Maintain a soft, calming tone to your voice
• Play soothing music or do other calming things with the person, such as reading aloud or going on strolls
• Keep any unsafe objects out of reach
• Encourage the person with dementia to be as independent as possible, without pushing them too far
• Distract the agitated person with a fun activity or a favorite snack

You can also work on building trust with the person who is suffering from paranoia. If you find that they are suspicious of you, here are some strategies that you can implement:

• Avoid arguing with them
• If they are receptive to it, try a gentle hug
• Help them look for something they think you stole, before distracting them with another activity
• Let them keep money in a handbag. If they think you stole money from them, you can help them “find” it in the bag.