Anxious feelings and suspicions caused by paranoia, though not anchored in reality, are very real to a person with dementia. Paranoia can get worse as memory loss or dementia progresses. Understanding what it is and what’s causing it can help you know how to help.
What is paranoia?
Paranoia is a state of psychosis that causes a person to become suspicious, fearful, or jealous of other people without good reason or evidence of any real danger. It causes irrational thoughts and feelings, often related to persecution or conspiracy. Paranoia essentially amplifies someone’s fears and makes the world around them feel threatening.
Sadly, these irrational thoughts become so believable to the person suffering from them that nothing can convince them of their delusions. While there are treatments for paranoia, the condition generally causes the person’s life to be limited and isolated.
Is paranoia a symptom of dementia?
Paranoia is often linked to memory loss in people with Alzheimer’s disease and other types of dementia. It’s a fairly common symptom that typically begins in the middle stages of dementia and can last into the later stages. However, experiencing paranoia doesn’t necessarily mean someone has dementia.
Paranoia may not be just a result of dementia-related brain changes. Your loved one’s paranoia could also be caused by a separate underlying disease or condition, such as Huntington disease (HD), schizophrenia, dehydration, or urinary tract infections (UTIs). Your loved one’s doctor can help determine the cause of their paranoia and provide next steps.
What does paranoia look like in dementia patients?
Here are some common types of paranoid thoughts related to memory loss that a person with dementia might experience:
- Others are trying to steal from them. If your loved one forgets where they set something down, their paranoia may lead them to believe someone else has stolen that item.
- Others are using hints or double meanings to threaten them. Dementia often affects a patient’s ability to recognize the people closest to them. They may see you, their family members, or another caregiver as a dangerous stranger and become paranoid that you’re trying to harm or take advantage of them.
- Others are deliberately trying to confuse, upset, or aggravate them. If they forget a set of directions you just gave them, they may believe that you’re trying to trick them.
- Others are out to get them. The severe mistrust that comes with paranoia can lead a person to feel victimized or threatened by others. Someone feeling this way may accuse another person of lying, keeping secrets, talking behind their back, or cheating on them.
Causes
In people with dementia, paranoia is most often brought on by changes in the brain. Dementia patients find it difficult to remember things and stay anchored in the present. Ultimately, memory loss is disorienting and can lead to uneasy feelings like paranoia, as your loved one can no longer accurately interpret and recall the information they receive.
Your loved one might experience strong paranoid thoughts all the time, or they can be triggered by a stressful situation caused by the following:
- Sensory problems, like poor eyesight or hearing
- Side effects from medications
- Unfamiliar environments
- Physical conditions, like infections, fever, pain, constipation, anemia, respiratory disease, malnutrition, or dehydration
- Meeting a new person or an unfamiliar caregiver
- Disruption of familiar routines
- Overwhelming environmental factors, like bright lights, loud noises, or large crowds
Symptoms
Paranoia symptoms can vary from person to person. Paranoia and many other behavioral disturbances commonly peak in the late afternoon or evening in dementia patients. This phenomenon is referred to as “sundowning.” As a dementia caregiver, you can be prepared for these common symptoms of paranoia:
- Irrational feelings of mistrust and suspicion
- Imagined criticism
- Feelings of fear, anger, or betrayal
- Difficulty forgiving others
- Fear of being taken advantage of
- Acting defensive or argumentative
- Difficulty relaxing
In addition to paranoia, people with dementia might also experience hallucinations and delusions. Similar to paranoia, hallucinations and delusions can make people believe things that aren’t real, which may be harmful to their well-being and quality of life. While these can also be symptoms of dementia, they cause entirely different experiences.
These emotions and behaviors are commonly experienced alongside dementia paranoia:
- Agitation
- Wandering
- Aggression
- Apathy and depression
- Sleep problems
- Inappropriate behavior
How is paranoia in dementia treated?
Most dementia paranoia treatments focus on making changes to behavior and the environment to ease symptoms, according to the National Institute on Aging. The following are some examples of such treatments:
- Consistent talk therapy. Therapies such as cognitive behavioral therapy (CBT) can help the dementia patient understand their experiences and develop coping strategies.
- Arts and creative therapies. These can help the patient express how they’re feeling in a therapeutic environment. These therapies are particularly helpful for dementia patients who have trouble talking about their experience.
- Pet therapy and ownership. Pets can have a great effect on seniors with dementia. Playing with and caring for animals can help reduce stress, lower blood pressure, and increase physical activity.
- Environmental changes. Certain environmental stressors, such as loud music or bright lights, can further aggravate someone’s aggressive or paranoid symptoms. A caregiver can remove or minimize these triggers to help redirect the patient's focus and calm them down.
In severe cases where violent behavior is present and all other non-drug treatments have been exhausted, a doctor may prescribe antipsychotic medications to treat paranoia symptoms in a person with dementia. However, experts agree that the use of these medications for dementia patients isn’t recommended, as they pose an increased risk of dementia worsening and even death, according to the National Institute on Aging. Talk to your loved one’s doctor about the best treatment option for them.
How to help someone with dementia paranoia
Watching a loved one’s dementia progress into paranoia is scary and devastating. Keep in mind that your own feelings of distress, frustration, guilt, or exhaustion are very normal when caring for a loved one with paranoia. Fortunately, there are ways of responding to and coping with paranoia that can help reassure your loved one and minimize this behavior.
How to respond to paranoid behavior
Try following these tips from the Alzheimer’s Association to help de-escalate your loved one’s suspicions and delusions that lead to paranoia:
Do: Listen to what may be troubling your loved one. Try to put yourself in their shoes and understand their reality. Be reassuring, and let them know you care.
Don’t: Take offense to anything your loved one says or accuses you of. They can’t control this behavior. While you want to understand where they’re coming from, remember that their paranoid thoughts and feelings aren’t real. This will help you remember to not take it personally.
Do: Allow them to express ideas and concepts freely. Acknowledge their opinions without being condescending or defensive.
Don’t: Argue with them or try to convince them that they’re wrong or delusional. Most likely, this will only frustrate them even more, which can worsen their symptoms.
Do: Share your own thoughts in the form of simple answers.
Don’t: Overwhelm your loved one with lengthy, over-conceptualized explanations and reasons.
Do: Gently direct their focus away from what’s triggering them and to a different object, activity, or setting.
Don’t: Get overly frustrated when your loved one is fixated on a paranoid thought.
Do: Try to replace lost items and buy duplicates of things that often go missing.
Don’t: Scold, punish, or ignore your loved one if they frequently search for the same object. Clearly, this item holds some significance to them.
How to help your loved one cope with dementia-related paranoia
Paranoia that isn’t handled properly could lead to agitation, anger, or aggressive behavior. In addition to treatments from your loved one’s doctor, you can incorporate a variety of helpful techniques at home. The following can help relax your loved one and potentially keep their symptoms more at bay:
- Have them keep a diary. It may be helpful for your loved one to record with pen and paper what their paranoid thoughts are, how they feel about them, and how often they think them. This can also give you better insight into their experience and what may be triggering their paranoid behavior.
- Help them learn to relax. Try relaxation techniques, such as reading a book, practicing mindfulness, painting, taking a walk outside, or gentle exercise such as yoga or swimming.
- Look after their physical health. Getting enough sleep, staying physically active, and eating a balanced diet can help ease feelings of stress or anxiety that may be contributing to their paranoia.
Keep in mind, too, that your aging loved one may actually have a valid reason for acting this way. Sadly, some people do take advantage of the elderly. It’s important to rule out if someone is really trying to abuse or steal from your loved one. You can visit the National Center on Elder Abuse (NCEA) for more information. If you think someone may be in urgent danger, call 911 right away.
When to seek help
Unfortunately, behaviors like paranoia often worsen as dementia progresses, and the need for greater care becomes critical. If your loved one’s paranoia feels unmanageable on your own or if anyone is being put in harm’s way, it may be time to consider seeking additional help. In-home care services and memory care communities are great options for seniors with dementia and other cognitive impairments. These options can provide relief to families and give dementia patients the specialized care they require.
Find some peace of mind in knowing that there are many other caregivers out there going through very similar situations. If you think you could benefit from extra support, then consider joining AgingCare’s Caregiver Forum. Here, you can connect with new and seasoned caregivers who can help answer your questions, offer some comfort, and provide a sense of community. You can also avoid caregiver burnout by caring for yourself, practicing mindfulness, and setting clear boundaries.
Sources:
How Is Alzheimer’s Disease Treated? (https://www.nia.nih.gov/health/how-alzheimers-disease-treated)
Alzheimer’s and Hallucinations, Delusions, and Paranoia (https://www.nia.nih.gov/health/alzheimers-and-hallucinations-delusions-and-paranoia)
Paranoia (https://www.mind.org.uk/information-support/types-of-mental-health-problems/paranoia/about-paranoia/)
Hallucinations and false ideas (https://www.dementia.org.au/about-dementia/carers/behaviour-changes/hallucinations)
Huntington disease: Clinical features and diagnosis (https://www.uptodate.com/contents/huntington-disease-clinical-features-and-diagnosis)
Management of neuropsychiatric symptoms of dementia (https://www.uptodate.com/contents/management-of-neuropsychiatric-symptoms-of-dementia)
Paranoia and Delusional Disorders (https://mhanational.org/conditions/paranoia-and-delusional-disorders)
Treating Psychotic Symptoms in Elderly Patients (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181181/)
Suspicions and Delusions (https://www.alz.org/help-support/caregiving/stages-behaviors/suspicions-delusions)
Elder Abuse (https://www.nia.nih.gov/health/elder-abuse)