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Dementia-Related Psychosis- Causes, Symptoms, and Treatment

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Dementia-related psychosis affects mental health, and the person with dementia experiences symptoms of psychosis. To know more, read the article below.

Medically reviewed by

Dr. Aneel Kumar

Published At November 14, 2022
Reviewed AtFebruary 12, 2024

Introduction:

The term psychosis refers to a mental disorder that affects an individual's brain, causing them to behave abnormally. It can affect both men and women. Sometimes, it occurs as a side effect of another mental disease called dementia, commonly recognized as forgetfulness. Furthermore, dementia may cause a severe reduction in cognitive ability (mental skills or general intelligence) that affects daily activities. Several underlying neurodegenerative diseases contribute to this illness, including Parkinson's disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies, and Alzheimer's disease.

What Is Dementia-Related Psychosis?

As the name implies, dementia-related psychosis (DRP) is a psychosis that occurs as a result of neurodegenerative diseases (for example, Alzheimer's disease). Neurodegenerative diseases can manifest psychotic symptoms as a side effect of changes in the brain. Psychosis in dementia involves symptoms such as hallucinations, delusions, and other disturbances in thinking that are not consistent with the individual's previous level of functioning. Hallucinations, delusional thinking, agitation, and aggressive conduct are examples of behaviors that fall under the category of dementia-related psychosis. Out of these, delusions and hallucinations most commonly occur in dementia-related psychosis.

What Are the Symptoms of Dementia-Related Psychosis?

People with dementia-related psychosis show changes in their behavior. Researchers believe these people will experience at least one of the behavioral symptoms discussed below.

  • Hallucination: People with dementia often experience hallucinations, which means they see or hear voices or images that do not exist in reality but only exist in their imagination. They believe that whatever imaginary things they hear or see are real. For example, they may see people coming and threatening them. When hallucinations occur, the person finds it very difficult to determine which is real and which is their imagination.

  • Delusional Thinking: This is another common symptom of dementia-related psychosis. People with delusional thinking will have false beliefs. Here, they do not see or hear false images or sounds but will believe something incorrect. For example, they will think someone is trying to kill them or think they are ill, even if they are not.

  • Depression: People with dementia-related psychosis may have prolonged periods of sadness, and everything around them may no longer seem enjoyable to them. They feel hopeless and tired and may have trouble sleeping or sleeping longer than before. Additionally, their mind might be surrounded by suicidal or self-harming thoughts.

  • Aggression and Agitation: This is the most harmful symptom of dementia-related psychosis. People with this disorder will show aggressive behavior and may even become violent. This may affect people surrounding them, like caregivers or family members, and hamper their relationship.

  • Paranoia: This symptom makes the person suspicious about everything. They develop a mistrust of others, which results in anxiety and stress. Too much stress and anxiety result in poor sleep, which affects physical health.

What Causes Dementia-Related Psychosis?

People with dementia are more likely to experience psychosis. Researchers believe several factors contribute to its occurrence, which are discussed below.

  • Biological Factors: These include any neurochemical changes in the brain or alterations or degeneration in the brain cells.

  • Psychological and Social Factors: These include mental stress from the surrounding environment.

  • Genetic Factors: Research has shown genetics can also trigger psychotic symptoms in people with dementia.

Is Dementia-Related Psychosis Common?

Studies have shown that dementia-related psychosis affects roughly one-third of those with neurodegenerative illnesses. Although it can develop at any point as the disease (neurodegenerative) advances, dementia-related psychosis is most frequently found in the later stages. However, Lewy body dementia and Parkinson's disease dementia are exceptions, where psychotic symptoms can emerge relatively early.

What Is the Best Treatment for Dementia-Related Psychosis?

Medicines can improve the symptoms of dementia-related psychosis. However, nonpharmacological treatments are tried before switching to medicines, which include counseling the patient and behavioral and social therapies. These approaches are found to be very effective. Some of the key features of these therapies are listed below.

  • Identifying and Avoiding the Trigger Factor: For example, if psychotic symptoms appear, especially after reading depressive content or being in a dark room, they should be avoided.

  • If any negative conversation or sad news triggers psychotic symptoms, the caregivers should keep the person with dementia-related psychosis away from these triggers.

  • Making the home environment positive and lively helps with behavioral modifications in these patients.

  • During a psychotic episode, if a person becomes violent, extremely aggressive, or experiences hallucinations, the caregivers must not lose their temper. Instead of yelling back, they should distract the person or engage them in another activity.

  • Patients with dementia-related psychosis should not be left alone. They should spend some time outside, not sit idle, keep themselves busy, and not isolate themselves.

The pharmacological approach is used if dementia-related psychosis does not improve with these therapies.

What Drugs Are Approved for Dementia-Related Psychosis?

There are no specific drugs available for treating dementia-related psychosis. Generally, atypical antipsychotic medications are used. However, it has several side effects, especially in elderly patients. The side effects include the following.

  • Excessive drowsiness.

  • Low blood pressure.

  • Heart-related complications.

  • Cognitive decline (memory impairment).

  • Risk of death due to the antipsychotic-associated stroke.

  • Weight gain.

Because of these side effects, the United States Food and Drug Administration (FDA) warned against using atypical antipsychotics on elderly patients in April 2004. According to American and British clinical recommendations, antipsychotics should only be used if the patient poses a threat to themselves or others or creates a situation of distress. These medicines should only be given after assessing the treatment's benefit-risk ratio, which means if the benefits are greater than the risks, then only they are recommended.

The antipsychotic drugs that are approved for improving the symptoms of dementia-related psychosis are listed below.

  • Risperidone.

  • Olanzapine.

  • Quetiapine.

  • Aripiprazole.

  • Escitalopram.

Conclusion:

Alzheimer's disease, vascular dementia, Lewy body dementia, and frontotemporal dementia are among the dementia types that can cause dementia-related psychosis. Certain forms of dementia can be associated with a higher incidence of psychotic symptoms than others. The symptoms of dementia-related psychosis can sometimes be scary for family members or caregivers. It is very important to treat this condition as early as possible because its symptoms progress rapidly and may lead to poor treatment outcomes. A severe form of dementia-related psychosis may lead to admission to the emergency room or long-term care homes. However, with a proper treatment plan and the love, care, and support of family and friends, dementia-related psychosis can be treated.

Frequently Asked Questions

1.

Can Dementia Lead To Psychosis?

Yes, dementia can lead to psychosis. Psychosis is more prevalent in dementia patients. Its occurrence is believed to be triggered by several factors, for example:
- Any neurochemical changes in the brain as well as changes or destruction in brain cells.
- Mental stress from the environment. 
- Genetics can also cause psychotic symptoms in dementia patients.

2.

What Are the Two Most Prevalent Psychotic Symptoms Associated With Dementia?

The two most common psychotic symptoms that occur in people with dementia are listed below:
- Hallucination: People with dementia frequently have hallucinations, in which they perceive sounds or visual pictures that do not actually exist but are the product of their mind.
- Delusional Thinking: Another typical sign of dementia-related psychosis is delusional thinking. False beliefs are characteristic of delusional thinking. Individuals with delusions strongly hold misconceptions about things that are not real.

3.

At What Stage Does Delusion Start to Appear in Dementia?

Delusion usually appears in the mid-stage of dementia. A person may begin forgetting the names of close relatives and have minimal memory of recent events in the mid-stage of dementia. Apart from delusions, compulsions, anxiety, and agitation could be present, and communication is significantly impaired.

4.

Do People With Dementia Experience Manic Episodes?

Yes, people with dementia may experience manic episodes. It is believed that dementia patients are more likely to experience mania or depression. Patients with dementia should undergo comprehensive evaluations for mania so that appropriate therapies can be started.

5.

What Type of Dementia Includes Psychosis?

All forms of dementia can cause psychosis. However, some have a higher incidence than others. These include dementia caused by Parkinson's disease, Lewy body dementia, and Alzheimer's disease. As dementia progresses and other symptoms worsen, psychosis may become more prevalent. However, in certain individuals, psychosis could be a precursor to dementia. 

6.

What Are the Five Psychotic Symptoms of Psychosis?

The five psychotic symptoms of psychosis are listed below
- Delusions. 
- Hallucinations.
- Disordered speech.
- Disordered or catatonic conduct.
- Negative symptoms include alogia (lower efficiency of speech and thought), anhedonia (lack of capacity to experience pleasure), avolition (reduced initiation of goal-directed behavior), and affective flattening (regardless of whether the affected individuals are discussing something upsetting or thrilling; they speak with little to no change in their tone or facial expression).

7.

What Drugs Are Given to Calm Down Patients With Dementia?

Antidepressants, anxiolytics, and antipsychotics are the three drugs used to treat dementia. Dementia patients frequently experience anxiety or restlessness. As a result, caregivers might observe frequent aggressive verbal or physical behavior episodes. Anti-anxiety medications, or anxiolytics, can be used to soothe dementia patients. They can also be used to help people fall asleep. Similarly, antipsychotic drugs are frequently recommended to treat aggressiveness, aggression, delusions, and hallucinations.

8.

When Does Psychosis Occur in an Alzheimer’s Patient?

In Alzheimer's disease, psychosis is unexpectedly common. It can develop as a symptom of the neurodegenerative disease process before dementia, during the mid-stage when mild cognitive impairment occurs, or even earlier.

9.

How Long Can Someone With Alzheimer’s Live?

The average lifespan of someone with Alzheimer's disease is three to 11 years after diagnosis, but some people live for 20 years or longer. The life span may vary depending on the level of disability at diagnosis.

10.

Is It Possible to Live a Normal Life With Alzheimer’s?

Many persons who are diagnosed with early-stage dementia are still able to live at home and function normally. Each person with dementia has a unique experience with it, and each person's symptoms progress at a distinct rate. But many people can live independently for several years if they have access to the correct support when they need it.

11.

How Is Dementia Different From Alzheimer's?

While Alzheimer's is a specific disease, dementia is a general term for a mental deterioration that is enough to cause problems with daily life. The most frequent cause of dementia is Alzheimer's disease. Dementia refers to a set of symptoms associated with a deterioration in memory, reasoning, or other cognitive abilities. Alzheimer's disease is a degenerative brain illness caused by complex brain alterations that occur as a result of cell destruction. It causes dementia symptoms, which progressively get worse over time.

12.

Does Dementia Lead To Death?

According to WHO (World Health Organization), dementia is currently the sixth most common cause of death worldwide among all diseases and one of the main causes of impairment and dependency among older people. A person suffering from dementia is likely to have a weakened immune system. This means they are more likely to contract infections, which can be severe in some situations.  Pneumonia caused by an infection is one of the leading causes of death among people with dementia. 
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Dr. Aneel Kumar
Dr. Aneel Kumar

Psychiatry

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