Dementia-Related Psychosis: Strategies That Help

There’s no cure for dementia-related psychosis. But there are steps you can take to help you and your loved one live with the disease and its symptoms.

“Delusions are notoriously hard to treat, whether they’re dementia-related or not,” says Carolyn Fredericks, MD, a neurologist who treats people with Alzheimer’s disease and other memory disorders at Yale Medicine.

“The question is: How can you and [your loved one] live with their false belief or seeing people who aren’t there, or whatever their psychotic symptom may be, in a way that’s as calm and peaceful as possible?”

Here are some strategies that might help.

Change the Subject

People with dementia often forget where they put things. That can trigger delusional thoughts about intruders or theft. Fredericks says that’s their brain’s way of making sense of their memory loss.

They think: “I can’t find this item. Therefore, someone must have stolen it,” she says.

Your first urge might be to convince your loved one that no one took their things. But it’s not a good idea to confront them or deny their reality. Instead, try to help them find their lost item or get them to focus on something else.

“Redirecting or distracting the person is often really powerful,” Fredericks says. “As soon as you really engage them about the delusion, you can get stuck there.”

Validate Their Feelings

Your loved one’s delusions can seem very real and frightening. You should take a moment to acknowledge their emotional state before you shift to a different topic.

“Keeping a tone of calmness and caring is really one of the most important things family members can do,” Fredericks says.

Some helpful things you can say include:

• “I’m sorry you’re feeling scared. Let’s sit and have a cup of tea and turn all the lights on.”
• “I’m so sorry to hear that’s happening. But can you help me fold this pile of laundry?”
• “That sounds scary. Oh, that’s a nice sweater you’re wearing. Who gave that to you?”

Don’t Get Offended

Your loved one might change how they act toward you or forget who you are. They might accuse you of infidelity or think you’re a stranger in their home. That can be hurtful. But try not to take it personally.

“This delusional thought process is part of the DNA of the disease,” says Arman Fesharaki-Zadeh, MD, a behavioral neurologist and neuropsychiatrist with Yale Medicine.

Keep Familiar Faces Around

People with dementia may not keep track of new faces very well. That can cause problems if you have different home health aides who provide care. Your loved one might feel more comfortable if someone they know helps out. 

Fesharaki-Zadeh says you can have familiar figures “take shifts.” For example, a spouse or child could be there for a certain number of hours. Then a grandchild or friend steps in. This isn’t always possible. But he says there are groups that can provide financial aid if you want to provide long-term care for family members with dementia.

You can visit the website of the National Family Caregiver Support Program for more information. 

Create a Routine

People with dementia tend to do better with structure. Their psychotic symptoms might ease if their day-to-day life doesn’t change very much.

“That predictability provides a sense of comfort and an anchor to the environment,” Fesharaki-Zadeh says.

Here are some of his tips:

• Wake them up at the same time every day.
• Have them go to bed at the same time.
• Keep meals on a schedule.
• Have them go to the bathroom at set times.

Add in activities they enjoy doing. That could be sewing, cooking, listening to music, or going for a walk.

“And when it comes to exercise,” Fesharaki-Zadeh says, “I cannot overemphasize how therapeutic it is.”

Remove Triggers

You’ll want to avoid any people, places, or things that make your loved one’s psychosis worse.

James Lai, MD, associate chief of clinical affairs for geriatrics at Yale School of Medicine, says it’s also important to look for subtle things that might affect your loved one’s behavior. He says some everyday things can be stressful or disorienting for those with dementia.

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“A big TV that has people on it can seem very real,” he says. “You’re saying they’re hallucinating. But actually, a TV with a person talking out of a box does seem like someone is in the room, standing there.”

Lai also suggests minimizing reflections in windows and ongoing noise from other rooms.

“You can shut the shades at night,” he says. “And having the radio on all the time is not a good idea.”

Take a Look Back

You shouldn’t ask someone with dementia what they had for breakfast 2 days ago. But childhood events could be a fun topic to bring up.

“They may have lost their short-term memory, but they have no problems talking about that time they went to summer camp,” Lai says. “It’s something they’ve talked about for years.” 

What people with dementia remember can vary. But Lai says older memories — where they grew up, where they used to work — tend to stick around the longest. It’ll take some trial and error to find the right topic for your loved one. But once you do, you can bring it up in times of stress.

“From day to day, you can talk about it over and over again,” Lai says. “But for them, it can be a new thing. And it’s easy to talk about it.”

Remove Dangerous Objects

Fredericks says people with dementia should never have easy access to guns and bullets. And you might want to keep sharp things like kitchen knives out of reach, too.

“If someone has psychotic symptoms and they believe that there are constantly intruders in the house — and you’ve seen them brandishing a knife in the kitchen in the middle of the night — you don’t want someone to walk in and check on your furnace and have your loved one believe that this is someone coming to get them,” Fredericks says.