Caregiver Tips for Coping with Paranoid Behavior in Alzheimer's

Health Professional

Paranoid delusions are distressing symptoms for some people with Alzheimer's. They are often more common in the later stages of the Alzheimer's disease. A delusion can be thought of as a false belief that, even in the light of contradictory evidence, remains fixed.  The person with Alzheimer's genuinely believes the delusion is real. The caregiver, who spends many hours with  them, is frequently accused of harming them in some way. The person with Alzheimer's often tells others of their fears and can sew seeds of doubt in the minds of friends and relatives. It can be very embarrassing and upsetting.

The symptoms of paranoid delusions involve the almost constant suspicion of the motives of others. Other people, commonly the caregiver, are viewed as making plans to undermine, poison, steal, or in some way do them harm. The most common delusions are persecutory in nature and involve  beliefs about food or drinks being poisoned, that they are being spied on, or items and  money are being stolen.

Causes of Paranoid Delusions in Alzheimer's Disease

As the brain becomes more damaged and memory loss increases, the person with Alzheimer's becomes more confused and  their capacity to reason and logically solve problems is severely limited.  The behavior of others and what the person  hears or sees can be misinterpreted. Sensory impairments can also contribute to their delusions. People who, prior to the onset of Alzheimer's were more suspicious, may become even  more agitated and distrustful.

Tips for Coping with Delusions

The nature of delusions and the way you cope with them will vary from person to person and also need to be adapted to the stage of Alzheimer's.

Keep in mind that delusions are 'fixed'. This means any attempt to argue the case only causes more distress to everyone and does not result in them changing their mind.

Try to think about the situation. Does the suspicious behavior occur more at different times of the day, for instance in the evening, or at night? Could tiredness, darkness and poor lighting, isolation and fear associated with being alone make their paranoia worse? See if there are any circumstances or  routines that you can change that may reduce their paranoia.

Reassurance is very important to help reduce concerns, although they will probably not stop their delusional belief.

Environment and Paranoia

Keep the environment and routines familiar. Place items such as  clothes back into the same place. As the person with Alzheimer's gets more suspicious they may hide items they believe are at risk of being 'stolen'. They then forget where they have put them, thus compounding the problem and feeding their delusion further. If this is happening, and you are sure the item is 'lost', it may help if the caregiver returns items to its familiar place.

Distraction Techniques for Paranoid Behavior

Ask a question that you feel sure they will have a view on or  interest in. Ideas include reading out a section from the newspaper that is interesting, asking if they will help you with some task, going for a walk in the garden. The distraction will depend on what skills, mobility issues, whether other caregivers are involved who seem to be able to calm and reassure the person easier than others.

Medications and Delusional Behavior

Inform your doctor of any changes in the severity of behavior and get their health checked out. There are medications that may help to settle things. Some of them can cause severe side effects so it is important to work with the doctor to find the right drug with the least side effects. More Information - Alzheimer's Medication and Treatments

Aggression and Paranoid Behavior

If the person becomes aggressive and distraction and soothing words do not work, you need to find a safe strategy for all concerned. Often a strategic retreat from an escalating situation will be helpful. If you are unsure they will be safe do not leave the room, stand back with minimal intervention. You may need to intervene if they try to leave their house or apartment and you feel they are a danger to themselves or others. You must get help from near relatives or from the police if you cannot cope and are in danger from assault. More Information - Aggression and Alzheimer's Disease

Getting Support and Help

Get an accurate diagnosis on the cause of delusional behavior. A physical evaluation by a physician will be important if medications are going to be prescribed. Get help, support and ideas from; healthcare professionals, from your Alzheimer's Chapter, from a support group and, of course, OurAlzheimer'