Dementia and Paranoia: A Guide for Providing Care and Support

Dementia and Paranoia: A Guide for Providing Care and Support

June 17, 2024

Your elderly father is convinced you’ve let a strange, angry man into the house and allowed him to “live in the wall.” Puzzled, you ask him to show you what he means. He takes you to a mirror and points at his reflection, which he doesn’t seem to recognize as himself. Then he yells at you, accusing “both” of you of trying to steal from him.

Experiences like these can be heart-wrenching. Maybe you were aware of his dementia but hadn’t seen such a clear element of paranoia before. Dementia and paranoia together can be a tough combination.

You aren’t alone. The presence of dementia-related psychotic symptoms such as paranoia, hallucinations and delusions among people with dementia has been estimated from 30% in a 2020 Alzheimer’s Association study to 63% published in a 2023 journal on dementia.

Paranoia alters a person’s perception of reality, leading to suspicion, anger and even aggressive behavior. A usually calm and loving parent could start making baseless accusations against you, other family members and even strangers. Understanding the interplay between dementia and paranoia is crucial for providing compassionate care and support.

Overview of Dementia

Dementia isn’t a disease. It’s a group of symptoms caused by various brain disorders, the most common of which is Alzheimer’s disease. Others include vascular dementia and Lewy body dementia. The development of paranoia can happen with any kind of dementia but is especially prevalent in frontotemporal dementia.

The percentage of older people with dementia is decreasing 1% to 2.5% per year, but it’s offset by the sheer number of aging adults right now. Estimates vary, but based on demographic and health trends, more than 9 million Americans could have dementia by 2030 and nearly 12 million by 2040.

As dementia progresses, it disrupts the brain's ability to process information correctly, leading to confusion, impaired judgment and memory loss. This can result in misinterpretations and false perceptions of reality, and these increase the likelihood of paranoia. 

What Paranoia Looks Like in Dementia

Paranoia refers to intense, irrational and persistent feelings of fear and suspicion. In the context of dementia, it often involves excessive mistrust and false beliefs.

The neurological deterioration associated with dementia often fuels paranoid thoughts, leading to aggression, false accusations and heightened suspicion. Together, this can cause emotional distress and strain relationships.

There are many ways to break down how paranoia takes shape in people with dementia, but here are three of the most common:

  • Misinterpretations: Dementia patients may misread facial expressions, gestures, innocent actions or scenarios as frightening or threatening.

  • Delusions: Dementia patients may develop false beliefs, such as thinking someone is stealing from them, stalking them or plans to abandon or harm them.

  • Hallucinations: Dementia patients may experience false sensations and see, hear, smell, taste or even feel something that isn’t really there.

While delusions or hallucinations can lead to paranoia, paranoia sometimes occurs on its own.

Causes of Paranoia in Dementia

It’s not always clear why someone with dementia begins to experience paranoia. There can be multiple causes:

  • Dementia-Related Neurological Changes: Structural and chemical changes in the brain due to dementia can cause damage that distorts how the brain processes information.

  • Sleep Disruption or Deprivation: The lack of quality sleep can exacerbate existing feelings of paranoia because sleep is usually the time the brain recovers from stress.

  • Memory Impairment: Unrecoverable or false memories can generate confusion and suspicion about other people’s intentions, especially if the person doesn’t recognize familiar faces.

  • Visual or Hearing Loss: Sensory deterioration can lead to misunderstandings and misinterpretations, which can feed paranoia.

  • Difficulties in Communicating: As a person’s cognitive abilities decline, they may struggle to express their thoughts and understand others clearly. This can foster feelings of isolation and mistrust, contributing to paranoid responses.

  • Emotional and Psychological Stress: People with dementia can experience heightened anxiety and stress due to their decreasing abilities to manage daily activities on their own. This can exacerbate fear and suspicion that something is being done to them.

  • Unfamiliar Settings: Changes in routine can provoke anxiety and paranoia. People with dementia may perceive these changes as threats, leading to defensive behaviors.

  • Social Isolation: This cause can create a spiraling situation in that social isolation can lead to increased paranoia, and paranoia can lead to increased social isolation.

  • Certain Medications: Medicines and combinations of medicines can have side effects that cause paranoia symptoms. Discuss the possibility with a health care provider and ask for frequent medication reviews.

The unique combination of dementia and paranoia symptoms can complicate existing issues and create new ones. It can mean heightened stress and strain for both the person with dementia and their caregiver.

The Toll of Paranoia

Most people with dementia already live at home, and paranoia can mean withdrawing even more from social interactions. Paranoia combined with dementia, then, can increase feelings of stress and loneliness, which are known to harm physical and mental health.

For caregivers, particularly those whose loved one lives with them, the emotional burden can be significant. They may feel overwhelmed, stressed and hurt by ongoing or unresolved accusations and mistrust. Finding the right balance between empathy and maintaining boundaries is crucial. Caregivers in all situations need to protect their own mental health but especially so in cases where dementia and paranoia intersect.

Coping with dementia and paranoia

For the children of aging parents and other caregivers, you may be able to take some steps to defuse situations where dementia combines with paranoia:

  • Try Not to Take Offense: Their paranoia-driven actions are not about you; they’re connected to their disease. Be sure to explain this to others.

  • Listen and Reassure: Understand their reality and reassure them of your care and support. Recognize that their accusations and concerns feel valid to them. Confirm their feelings without reinforcing the paranoia.

  • Avoid Telling Them They’re Wrong: For someone experiencing paranoia, their delusion is their reality. It’s often not something you can logically reason with. Acknowledge their distress and try to get them to talk through their thoughts and feelings.

  • Distract and Redirect: Acknowledge the situation but try to engage them in a different activity. You could ask them to help with a chore that simply must be done now or say you’ve been meaning to ask them to tell their favorite story again.

  • Use Gentle Physical Contact: Use lightweight, nonrestrictive touches and gestures to show affection and reassure them of their safety.

Beware, however, that you don’t automatically jump to the conclusion that paranoia is the only explanation for their behavior. Criminals often take advantage of elderly people, particularly if they’re easily confused. If accusations have a ring of truth, consider investigating.

Approaches for Avoiding Paranoia Episodes:

  • Have a Place for Everything: Designate one place for things that become lost easily, such as keys or glasses. Make it a habit to ensure the items are returned to the proper spot. This can help a person to find things readily and avoid the delusion someone has stolen them.

  • Buy Multiples of Frequently Lost Items: If your loved one is always misplacing an item that’s important to them, such as a particular scarf or reusable cup, buy several.

  • Ensure Regular Eye and Hearing Exams: Your loved one may not communicate that they aren’t seeing or hearing as well as they used to. Make sure they get check-ups and that they wear prescribed glasses or hearing aids.

  • Minimize Unnecessary Changes: Keep everything familiar. This may mean balancing the benefits of making your home dementia-friendly with how your loved one will respond to changes.

Dementia and Paranoia: Seeking Medical Help

If your loved one is showing signs of paranoia, turn to health care professionals who specialize in dementia care. They can offer tailored strategies to manage paranoia effectively and let you know if medication or other therapies would help.

Also regularly ask your pharmacist or clinician to review all the prescribed and over-the-counter medications your loved one takes to check for potential interactions. New medications can lead to delusions as can certain combinations of medicines and homeopathic treatments.

The interplay between dementia and paranoia can significantly impact both affected individuals and their caregivers, emphasizing the need for understanding. Awareness about this complex relationship can help you better provide compassionate care.

Find a dementia-care partner in BrightStar Care®

At BrightStar Care, we keep up with evolving research so that we can give our clients the very best care. We are committed to providing care for all stages of dementia. Whether you're looking for in-home care services or assisted living for your loved one or a reliable medical staffing partner for your organization, our experienced local care team members are ready to help. Find a location near you, contact us online or call (866) 618-7827 to learn more about how BrightStar Care offers A Higher Standard®.