Communication and Dementia-Related Psychosis

Medically Reviewed by Neha Pathak, MD on March 09, 2021
Written by Keri Wiginton
4 min read

It can be hard to talk with your loved one if they believe things that aren’t true. But the right skills can help you communicate with someone who has dementia-related psychosis.

It’s not helpful to argue with your loved one. They might get more aggressive or combative if you confront them about a delusion or hallucination, says Carolyn Fredericks, MD, a neurologist who treats people with Alzheimer’s disease and other memory disorders at Yale Medicine. She suggests you try to find a peaceful way to live with their false beliefs. 

Does that mean you have to make something up to help your loved one feel safe? That depends.

“You can provide an atmosphere of calm without lying to them to move them away from their fear,” Fredericks says. “But little lies do have a place here. It’s because they live in a different reality than we do. And going along with that reality, if that’s something that you feel comfortable ethically doing, is really reasonable.”  

It can be hard to see your loved one lose their grasp on reality. And you might think that you can help boost their memory if you give them the right info. But it usually doesn’t work that way with dementia.

“The wiring is a little bit different now,” says James Lai, MD, associate chief of clinical affairs for geriatrics at Yale School of Medicine.

You might stress your loved one out if you always tell them they’re wrong. What you want to do instead, he says, is to give them support while you let the thought pass. Or you can shift them to a different activity. But that’s not always easy.

“The most difficult thing that family members have to overcome is to resist the temptation to correct their loved ones,” Lai says.

People with dementia may or may not know how bad their forgetfulness is. But in any case, it’s best not to shine a light on it.

Fredericks says someone with later-stage dementia may deny or argue about their memory lapses. But those in the early stages may get really anxious or sad about it.

“You can gently support them by repeating yourself as if you didn’t say it the first time,” she says. “Or, if they’re worried about their memory loss, say it’s no big deal and you can talk about it again.”

It’s a good idea to keep your loved one’s mind active. “But directly challenging the person’s reality can lead you in the wrong direction,” Fredericks says.

For example, it can be nice to go through old family photo albums. But you shouldn’t check to see if your loved one knows who everyone is. Instead, Fredericks says, go through the pictures and ask what they remember about the person or day. And let it slide if they get the details wrong.

“You can just move to the next thing instead of quizzing them,” Fredericks says. “Respect their reality, even if it doesn’t match what you know to be true.”

You don’t need your loved one to explain their false reality in order to help them feel better. Focus on their feelings first.

For example, Fredericks suggests:

  • Do say: You seem scared. Is that what’s going on?
  • Instead of: Who's trying to get in the house to get you?

Arman Fesharaki-Zadeh, MD, a behavioral neurologist and neuropsychiatrist with Yale Medicine, agrees that your loved one’s feelings matter most.

“If you approach things in a compassionate, empathetic, and supportive way, that can diminish some of the emotional output,” he says. “And there’s always an emotional component to these reactions.”

Dementia can make it hard to find the right words. Or your loved one might say one thing when they mean something else. That can be really frustrating for both of you.

“People [with dementia] can still feel the stress of not getting their point across,” Lai says. “Anything you can do to make the communication process easier for them is helpful.”

Instead of asking open-ended questions, Lai offers these tips:

  • Ask yes-or-no questions.
  • Fill in the words for them.
  • Offer up multiple choices.

 

People with dementia might not be able to hear very well, but they might sense your tone of voice. Lai says you should speak in a soothing way that’s loud enough for the hearing impaired. But don’t shout. And remember to smile.

“Subtle things like that can make a big difference,” Lai says.