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What is Psychosis in Dementia?

K. Willis
K. Willis

Psychosis is a state of mental illness in which a patient appears to have lost contact with reality, or the "reality" the patient is experiencing is very different or distorted from actual reality. Psychotic symptoms may be present all the time or may be episodic. Dementia is an umbrella term describing a wide range of symptoms linked to progressive deterioration in mental functions, such as language, memory and judgment. It often affects emotional behavior and responses.

Psychosis in dementia is common as dementia progresses. Frequently exhibited symptoms of psychosis in dementia include auditory and visual hallucinations. Auditory hallucinations mean the patient is hearing voices that are not there. Visual hallucinations mean the patient is seeing things others are not. These symptoms can be very distressing for the patient.

An elderly woman with dementia.
An elderly woman with dementia.

Auditory hallucinations usually come with unpleasant voices that say awful, upsetting things to the patient. Visual hallucinations are also frequently unpleasant, with the patient seeing things that frighten or anger him, such as swarms of insects, strangers in his bedroom or people from his past. Hallucinations of either type can also be incredibly difficult and upsetting for caregivers to deal with, because a patient may assume auditory hallucinations are coming from the caregiver, and because it is difficult, if not impossible, to convince a patient that the hallucinations are not real.

Psychosis in dementia is common as dementia progresses.
Psychosis in dementia is common as dementia progresses.

Delusions are a common symptom of psychosis in dementia. Delusions are false ideas that the patient very firmly believes. In dementia, this can involve the patient believing he is a child and caregivers are parents, that he is not old but a young adult going about daily life, or that he is a prisoner. Another common delusion is believing that personal property is being stolen.

Fear and paranoia can also indicate psychosis in dementia and can lead to unresponsiveness, withdrawal and aggression. Paranoia refers to a feeling of extreme suspicion, with a patient believing that caregivers or others are trying to poison him, steal from him, physically harm him, or are just generally bad people with a sinister purpose.

These symptoms make it is all too common for cases of abuse to be dismissed when reported by a person suffering from dementia. A patient may inform an appropriate person that he is being physically or emotionally abused, but the claim is dismissed because that patient has a history of making false claims — fueled by his delusions — of abuse and torture. The claim is often ignored as a symptom of his dementia and isn't investigated. On the other hand, dementia patients suffering from psychotic episodes are often underestimated, and caregivers have suffered serious injury after being physically attacked by a patient experiencing a psychotic episode.

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Discussion Comments


This is a great detail (psychosis) that is often left out in articles about dementia.

I am a caregiver of an 84 year man who had been a little "forgetful" to now having bizarre "dreams" that he insists are real such as he "traveled" (in his dream) to his dead father's 1924 car which is supposedly in a pond and he wants to get it out so he can sell it for a pile of money.

Also, he has been insisting that people on TV are "talking to him" and that he "hears" people come into his bedroom at night and claims "they" take him out of his bed even though he wakes up every morning in his bed.

I'm glad find out there is a psychosis aspect to dementia that provides an explanation to his unreal beliefs. I always thought of dementia as just forgetting people you know and common information.

My only problem is how to you reply to psychosis? I don't really want to agree with him because it would be lying to him.

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    • An elderly woman with dementia.
      By: Vladimir Voronin
      An elderly woman with dementia.
    • Psychosis in dementia is common as dementia progresses.
      By: rainbow33
      Psychosis in dementia is common as dementia progresses.