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Complications of Dementia-Related Psychosis

Reviewed by Neha Pathak, MD on March 09, 2021

If you care for someone with dementia-related psychosis, you know about the symptoms and behaviors associated with it, like:

  • Personality changes
  • Delusions
  • Hallucinations
  • Issues with communication
  • Wandering

But the symptoms that you can see and hear are only the tip of the iceberg.

What Could Happen

Many of the complications that your loved one could have won't be obvious. Instead, they'll be things you'll notice over time, such as:

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Memory loss. This is the most common complication of dementia-related psychosis. It also happens in early and mild stages of dementia.

You may notice your loved one may have trouble with short-term memory and recall. In later stages, they may have problems remembering names or faces. Try not to take it personally. Show them photos of friends and family to help them remember.

Disorientation. As their condition gets worse, your loved one will have a hard time remembering time and space. They may:

  • Become easily confused
  • Have trouble dressing
  • Struggle to arrive at an appointment
  • Get frustrated finding an address

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At some point, you may need to spend more time with them so that you can go with them to outings and offer support.

Sundowning. Your loved one's behavior might seem to get a bit worse during the evening. Experts call this "sundowning." It happens because the changes in their brain are breaking their body’s internal clock. (Your doctor might call it their "circadian rhythm.") They may become more agitated in the evening because they’re tired and don’t realize it’s time to rest.

Insomnia. The same things that cause sundowning also take a toll on how well and how long your loved one sleeps. They could cause insomnia, and psychosis symptoms could make it worse. For example, they could be afraid to sleep if they hear voices or think someone is in their home.

Trouble with problem-solving. People with dementia will have a harder time doing everyday tasks, like balancing a checkbook or moving objects. Other symptoms of dementia, like delusions or hallucinations, can make this worse.

Poor judgment. This can include things like impulse shopping and not dressing for the weather.

What to Do

There are some simple things you, your loved one, and other caregivers can do to try to keep things as easy as possible:

Investigate. It’s very important to look closely at each behavior to figure out if there's something that triggers it. It could be something as simple as a change in medication or diet, or it could be a response to something else that's happening to them. Once you think you've found a trigger, work with your doctor to see if there's a change that can make things better.

Evaluate. Each episode may not need a solution. For example, if their memory loss doesn't bother your loved one, it might not need treatment.

Stay calm. It’s critical to remain as relaxed as possible when your loved one is having trouble caused by their dementia-related psychosis. You might try changing the subject, like asking them what they might want to eat. Humor might work, too.

Stimulate. Try to keep your loved one as socially and mentally engaged as possible. Taking a walk, listening to music they like, or playing a game could all help.

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Look at the environment. Some minor changes to their living space could really help. Installing brighter lights and night lights, for example, could lessen shadows and ease aggravation.

Take care of you. Caregiving can be exhausting and stressful. Don’t be afraid to ask for help from friends, relatives, social workers, or your health care team.

It's also very important to contact the doctor right away if you discover any new symptoms. Timely diagnosis and treatment can help lessen or even delay some complications.

WebMD Medical Reference

Sources

SOURCES:

National Institute on Aging: "Alzheimer’s Fact Sheet."

Gerontological Society of America: “Dementia-Related Psychosis: Gaps and Opportunities for Improving Quality of Care,” August 2019.

British Journal of Psychiatry: "Visual hallucinations in dementia with Lewy bodies: transcranial magnetic stimulation study."

Alzheimer’s Association: "Challenging Behaviors," "Memory Loss and Confusion." 

Frontiers in Geriatric Medicine: "Sundowning in Dementia: Clinical Relevance, Pathophysiological Determinants, Therapeutic Approaches."

Current Treatment Options in Neurology: "Treatment of Sleep Disorders in Dementia."

AlzheimersDisease.net: "Early Stage Symptoms: Planning and Problem Solving Issues."

Brain & Life: "What is Dementia-Related Psychosis?"

Clinical Manifestations: "Dementia Related Psychosis in the United States."

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