An Overview of Delusions in Dementia

How you can help your loved one

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Delusions are strong false beliefs in things that aren’t real. Usually a symptom of a medical or mental disorder, delusions can be one of the main signs of dementia. A loved one with dementia is trying to figure out the world around them as their cognitive ability declines. 

Roughly, a third of people with dementia have delusions, and the likelihood of having them increases as the disease progresses.

Symptoms

If your loved one is experiencing delusions, things that are untrue will seem very real to them, even when they have evidence to the contrary. For example, they may be convinced that they are living in the past or in a different place.

Your loved one may also seem paranoid or suspicious of others, even those that they normally trust. For example, they may be insistent that a loved one is having an affair or stealing their money. 

Causes

Dementia can cause your loved one to be confused and have memory loss, both of which can lead to delusions. Delusions can occur with different types of dementia including:

Diagnosis

If your loved one is suffering from delusions due to dementia, make an appointment with their doctor. You may be referred to a psychiatrist or neurologist to help diagnose their condition. This may involve a memory or cognitive test to get a better idea of their ability to reason. Your doctor may also order diagnostic tests such as a CT scan or MRI of the brain. 

Seek help immediately if you think your loved one may cause self-harm or harm to anyone else. Your doctor can work with you on the best course of treatment to help both you and your loved one to stay safe.

Treatment

Your doctor may recommend medication or non-drug treatments depending on your loved one’s condition and the cause of the delusions. Non-drug treatments may include checking on their physical and emotional well-being. It might mean helping them change their surroundings, such as putting their bag in the same place so they don’t misplace it. When delusions are mild, your loved one may just need a simple reassurance, a kind word, and a distraction with something like music or old photos. 

For more severe cases, antipsychotic medications may be effective but may also have a risk of increased stroke and death in older adults with dementia. A medication called Aricept (donepezil), which has been used successfully in delaying the progression of Alzheimer’s disease, has also been used to treat delusions.

Coping

If your loved one is having delusions, it can be difficult to know how to respond. It’s normal to feel frustrated, exhausted, or stressed. 

Remember your loved one can’t control their behavior, so try not to take what they say personally. Don’t argue with them or explain why they’re wrong. The best method is often to listen to what they have to say. Offer simple answers when asked rather than long explanations. Try to redirect them to another topic or activity. 

Remember to make time for yourself as well. Do activities you enjoy. Make sure you’re getting enough rest, nutrition, and exercise. Sharing your thoughts and feelings can be helpful as well, so try to connect with friends, family, a counselor, or a support group. 

A Word From Verywell

Delusions can be stressful for both you and your loved one. Talk with your doctor about treatments for dementia and how they can help with delusions. They can also recommend resources for your well-being, including counselors, support groups, or other professionals in your area. 

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Article Sources
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  1. Rayner AV, O’Brien J, Schoenbachler, B. Behavior Disorders of Dementia: Recognition and Treatment. Am Fam Physician. 2006;73(4):647-652.

  2. Alzheimer’s Association. Suspicions and Delusions

  3. National Health Service. How to get a dementia diagnosis. Updated February 18, 2020.

  4. Cummings JL, Mcrae T, Zhang R. Effects of donepezil on neuropsychiatric symptoms in patients with dementia and severe behavioral disorders. Am J Geriatr Psychiatry. 2006;14(7):605-12. doi:10.1097/01.JGP.0000221293.91312.d3

Additional Reading
  • Cipriani G, Danti S, Vedovello M, Nuti A, Lucetti C. Understanding delusion in dementia: a review. Geriatr Gerontol Int. 2014;14(1):32-9. doi:10.1111/ggi.12105

  • National Institute on Aging. Alzheimer’s and Hallucinations, Delusions, and Paranoia. Updated May 17, 2017.

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