Dementia Delusions: What They Are and How to Deal With Them

If you are a caregiver for someone with dementia, you may be familiar with dementia delusions. These are common hallucinations or false beliefs that occur in people with dementia, including Lewy Body Dementia, Alzheimer’s and other dementias. They can be scary and make the person feel like they are in danger. There is often no real reason that they feel that way. Dementia delusions often make the person think that people around them are out to get them. They might feel like they are being watched or that people are out to hurt them.

They often involve thinking that their spouse is cheating on them. This makes it particularly hard on the caregiver to be accused of things that are not true. Delusions can also be in the form of Capgras syndrome when they think that someone is an imposter. People with these delusions sometimes think that people are stealing from them. If you are a caregiver, it is important to stay calm and try to reason with the person.

What are dementia delusions?

Dementia delusions are false beliefs that a person with dementia holds on to despite evidence to the contrary. They can be related to the person’s past, present, or future and can be about people, places, things, or events. Dementia delusions can be very distressing for both the person with dementia and their caregivers and may cause paranoia, agitation, or aggression.

It is important to try to understand the delusion from the perspective of the person with dementia and to gently correct them without invalidating their feelings. In other cases, it is best to not disagree but try to redirect or go along with them. If the delusions are causing significant distress or behavior changes, it is important to speak to a doctor or dementia specialist.

The Most Common Types of Dementia Delusions

There are three types of dementia delusions: persecutory, referential, and somatic.

Persecutory delusions are beliefs that someone is out to get the person with dementia, often because they think the person has done something wrong. Referential delusions are beliefs that outside cues, such as TV or radio broadcasts, are actually speaking directly to the person with dementia. Somatic delusions are beliefs that the person with dementia has a physical ailment or condition, even when there is no medical evidence to support this belief.

Examples of Dementia Delusions

• Thinking that a spouse is cheating on them. This can even be that they think they are cheating with another family member. It can cause the person to say vulgar things and lash out at their spouse.
• Believing that the neighbors are bugging their house.
• Thinking that people are out to get them and do medical experiments on them
• Thinking that something is going to happen to the house and everyone must stay away from the windows.
• Believing that their home health aid is trying to poison them.
• Thinking that things that are happening on a television program are really happening in their house.
• Believing that a spouse is a witch and they will not come out of their room because they are frightened.
• Thinking they are in another city from where they are.
• Thinking they have won the lottery and need to go pick up the money.
• Thinking someone is sending emails or posting online on their account.
• Thinking that family members are trying to kill them.

Real-Life Example of Dementia Delusions

One of the delusions that my loved one had was that his ex-wife was here. He was upset about it. It was not an hallucination where he saw her, but he felt that she was there. One night he was complaining again about it. I told him I had a talk with her and told her to leave. He was so relieved and thanked me for taking care of it.

Another time he thought people were trying to get to him to take his body parts out. This was a much harder issue to deal with. It took new medications and quite some time till this stopped.

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How to Deal with Dementia Delusions

Dementia delusions can be very distressing, but there are ways to try to manage them. If possible, try to engage the person in reality-oriented activities, such as watching television or reading together. You can also try to reframe the delusion in a less threatening way. For example, if someone with dementia believes that their caregiver is trying to poison them, you could explain that they are just giving them food or medications to help them feel better. Ultimately, it is essential to be patient and understand that dementia delusions are part of the disease and not something the person can control.

Dealing with delusions can be difficult for both the person with dementia and their caregivers. It is important to keep in mind that the person with dementia is not deliberately trying to deceive or annoy others. Instead, delusions are usually a symptom of the underlying disease. There are a few ways to deal with delusions:

• Try to redirect the conversation to another topic. This can be effective if the delusion is only momentary or mild.
• Validate the person’s feelings without agreeing with the delusion. For instance, you might say something like “I know you’re feeling scared right now.”
• Challenge the delusion directly if it is causing distress or interfering with daily life. However, this approach should only be used if you feel safe. It is important to maintain a calm and respectful tone when challenging a delusion.
• In the early stages, it might be possible to challenge the delusion but often the delusions are so wrong and so frightening that it is best to agree with them and play along. Perhaps have suggestions that will do away with the thoughts. If they think that someone in a delusion is trying to hurt them, you could try telling them that you told them they had to leave and you got rid of them.
• If they think they are not in their real home, you can try taking a short drive and announcing when you get home that this is their real home where they live.
• Check for a UTI, this can often cause delusions and hallucinations.

Medications for Dementia Delusions*

There are some medications that work to slow down or stop dementia delusions. But it is not a one size fits all. What works for one may not work for someone else with the same type of dementia. Especially with Lewy Body Dementia there are big differences in what works. Depending on the person some medications can even make things worse. Working with your doctor to find the right medication is best, but it is sometimes difficult to find what works.

Clozapine (Clozaril®). Clozapine is a drug that has been approved for the treatment of schizophrenia. However, it can also be used “off-label” for other conditions, such as Lewy Body Dementia or Parkinson’s Disease. Clozapine may help to improve symptoms in a week or two, but it can often take two to three months to get full results. Clozapine is generally well-tolerated, but side effects can include dizziness, drowsiness, and dry mouth. Clozapine should be used with caution in patients with a history of seizures, as it may increase the risk of seizures. Clozapine should also be used with caution in patients with heart conditions, as it may increase the risk of heart arrhythmias.

Quetiapine (Seroquel®). Quetiapine is an atypical antipsychotic medication used to treat schizophrenia, bipolar disorder, and major depressive disorder. Quetiapine rebalances serotonin and dopamine to help with delusions and hallucinations. This leads to an increase in the levels of these neurotransmitters, which helps to improve symptoms. Quetiapine is typically taken once or twice a day, with or without food. The most common side effects include drowsiness, dry mouth, and constipation.

Risperidone (Risperdal®). Risperidone is an antipsychotic prescription that is also used to treat dementia delusions. Risperidone works by blocking dopamine receptors in the brain. This action results in a decrease in the number of hallucinations and delusions a person experiences. Risperidone is most effective when it is used as part of a comprehensive treatment plan that includes other forms of therapy and support. When used in this way, Risperidone can help people with dementia to manage their delusions and live more meaningful lives.

Pimavanserin (NUPLAZID®). Nuplazid is a medication used to treat delusions and hallucinations that are associated with Parkinson’s disease. It is one of the newer drugs on the market and has been shown to be effective in reducing these symptoms. It works by blocking dopamine receptors in the brain, which helps to reduce the intensity of delusions and hallucinations. The medication is typically taken once daily.

CBD Oil. CBD, or cannabidiol, is a naturally occurring compound found in the cannabis plant. CBD oil is extracted from the plant and can be used therapeutically. CBD theoretically works to regulate pain, cognition, and mood. Some say that it could alter the course of psychosis. CBD studies are inconclusive at this point but some people have found it beneficial in dealing with dementia delusions. CBD oil is not psychoactive like THC and will not get you “high.” More research is needed to assess the full potential of CBD oil.

Please note that not all drugs are good for all people or all types of dementia. For example, Haloperidol (Haldol®) is a drug that physicians recommend is not ever taken by Lewy Body Dementia patients. Always consult with a doctor/neurologist that you trust.

Tips for Caregivers and Loved Ones of those with Dementia

Dementia is a devastating diagnosis for both the patient and their loved ones. It can be difficult to know how best to care for someone with dementia, but there are some general tips that can be helpful. First, it is important to try to maintain a regular routine. This can help to provide a sense of stability and calm for the patient. Secondly, be patient and understanding. Dementia can cause changes in behavior and cognition, and it is important to respond with patience and compassion.

Finally, it is important to provide support and assistance with activities of daily living. This can help the patient maintain their independence for as long as possible. By following these tips, caregivers and loved ones can provide much-needed support to those with dementia.

Sometimes these delusions can cause violence and emergency services might need to be called. It is a good idea to alert your local police department that the person does have dementia and that you want them taken to a hospital, not jail. If your loved one has dementia, you can alert your local police department at any time to tell them, so it is in their records that there is a dementia patient at that address. They can then be more prepared to deal with the dementia in case of an emergency.

In conclusion, dementia delusions can be frightening, both for the person who has them and for their caregivers. However, there are ways to deal with dementia delusions that can help make the situation more manageable. If you or someone you know is dealing with dementia delusions, consider discussing medication options with a doctor as one way to potentially lessen the intensity of the delusionary experiences.

Do you have experience caring for someone with dementia? Share your tips in the comments below to help other readers who may be struggling with similar issues.

*Always consult your physician for any medical or prescription advice. We are not physicians here at Lewy Talk.

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