9 Ways to Ease Symptoms of Dementia-Related Psychosis
When someone you love has a progressive disease—meaning one that worsens over time—you’ll need you to be open to new treatments as their symptoms change. That’s true of dementia-related psychosis (DRP), where hallucinations and delusions can cause a patient to believe things that aren’t real. At times, medication may be the best option, and it’s important to know what options are available. Other times, small changes to your loved one’s environment and routine really can help ease symptoms. Let’s take a closer look.
Transitions—for instance, literally moving from one activity to another—can be difficult for someone with dementia-related psychosis. The simple gesture of keeping a door open as they move room to room can soothe your loved one’s anxiety. “Some memory care facilities even paint their doors with the perspective of a road that continues, to avoid a patient getting upset and confused about a transition,” says Sue Johansen, SVP, Community Network at A Place for Mom, a senior care referral service based in New York City.
Take Control of Light
One of the biggest pain points for someone dealing with DRP is the transition from day to night. The sudden change from light to dark can cause confusion and aggression. “It’s called sundowners, and it’s very common in those with dementia,” says Johansen. “If you visit a memory care facility, you’ll notice that the drapes are always drawn at 3 p.m., so that transition from day to dusk to night isn’t apparent to the residents.” You may want to try this approach at home for more peaceful evenings.
Improve the Mind-Body Connection
Exercise has been shown to physically benefit seniors with mild dementia, according to a study in Medicine, and pairing movement with cognitive exercise can be particularly beneficial for dementia—and possibly DRP as well. “Therapies that mix small-motor skills with memory-enhancing exercises can be greatly beneficial; when your body is active, it gets your mind involved,” Johansen says. A paired activity, like using chopsticks to “conduct” a symphony while listening to music, can help improve focus on the here and now.
Minimize Mid-Night Confusion
Waking in the middle of the night can cause disorientation if you have DRP. Your loved one might struggle with what time it is or even where they are. Simple things like keeping a clock in the bedroom and a low light on during the night can help your loved one stay oriented. “Many behavioral issues stem from misinterpreting things that happen around you, and becoming fearful as a result, so the clearer you can make an environment, the better,” says Michael Plopper, M.D., a geriatric psychiatrist with Sharp Mesa Vista Hospital in San Diego, CA.
Stick to a Schedule
Hewing to regular exercise and sleep patterns can mean the difference between a good or bad day for those with DRP, says Dr. Plopper. Try taking a walk with your loved one at the same time daily, having meals at the same hour, and keeping a consistent bedtime. If your doctor recommends a sleep aid, it will likely be a low dose on an as-needed basis. Extra sedation can increase disorientation in those with dementia and can contribute to falls, notes Dr. Plopper.
Make a Memory Box
Rifling through keepsakes—photos, souvenirs, reminders of a hobby, letters—can help to orient someone more quickly than numbers or names can. It’s one of the reasons you’ll typically find memory boxes outside long-term residential rooms, says Johansen. “It helps bring patients back to themselves instantly, whereas they may not identify with a name or room number,” Johansen adds. Try curating a handful of special memories in a bowl on the coffee table as happy signposts.
Plan for “Trigger Times”
We all have times of the day when we’re at our best, and times when we’re best left alone. Learning to detect your loved one’s “trigger time” or events that may lead up to a DRP event can help you anticipate and cope with hallucinations or illusions. In the case of general dementia, trigger times may be helped with a prescription. “Taking a medication on an as-needed basis, maybe a couple of hours before a predicted time of dysfunction, can provide some calming effect with minimal side effects,” says Dr. Plopper.
Consider an Rx
Currently, there are no approved treatments for dementia-related psychosis. However, Nuplazid (pimavanserin) is under review by the FDA for the treatment of hallucinations and delusions associated with dementia-related psychosis. A decision on approval is expected in Spring 2021. This once-a-day tablet would be taken with food, and might take several weeks before its effects are evident. So even if you don't see any immediate difference in your loved one’s behavior or the hallucinations are continuing, you'd want them to continue taking the drug for a while to understand its benefits.
Be Good to Yourself
Dementia can be a long, bewildering journey, so remind yourself that you’re doing a great job and regularly take a minute (or 10) to check in with numero uno (yes, that means you). “One of the biggest issues in dementia is caregiver burnout,” says Dr. Plopper. “Be forgiving of yourself, get as much help as you can, and know that we’re getting better and better at ways to manage dementia and find treatments that will work.”
- Dementia-Related Psychosis Overview: Journal of Clinical Psychiatry. (2020). “Epidemiology and Pathophysiology of Dementia-Related Psychosis.” pubmed.ncbi.nlm.nih.gov/32936544/
- Treatment for Dementia-Related Psychosis: World Journal of Psychiatry. (2020). “Pimavanserin for the Treatment of Psychosis in Alzheimer's Disease: A Literature Review.” wjgnet.com/2220-3206/abstract/v10/i7/162.htm