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“We are in the paranoia and delusion stage. I am the enemy because I have to keep us safe financially,” one myALZteam member shared.
If you’re caring for someone living with dementia or Alzheimer’s disease, you may have noticed your loved one blaming you or others for imagined wrongs. It’s important to remember that this behavior stems from changes in the brain that affect judgment, memory, and perception, not from malice or a lack of love.
Dealing with these behaviors can be emotionally exhausting for caregivers. You may need to reach out for extra help or support, whether from friends, family, or a caregiver support group. Understanding paranoia and delusions related to dementia can help you respond with more empathy — and take better care of yourself and your loved one in the process.
Delusions are fixed, false beliefs that a person holds very strongly, even when presented with evidence to the contrary. Sometimes, these false beliefs lead to paranoia, an intense fear or suspicion that people are out to harm them.
There are certain common delusions in people living with dementia. For example, your loved one might believe that family members want to hurt them, or they might accuse someone of stealing a treasured item. Sometimes, a person will believe that someone is turning people against them. Some may also insist that their home isn’t really their home (known as delusion of place) or that their partner has been replaced by an imposter (known as Capgras syndrome).
While it might seem like these ideas don’t make sense, they feel completely real to the person experiencing them. Their brain is creating a false reality — and the emotions that come with it, such as fear, anger, or sadness, are entirely real. Recognizing this can make it easier to respond with calmness and compassion, especially when your loved one experiences delusions that lead to agitation, restlessness, or aggressiveness.
Delusions can also happen alongside hallucinations — seeing, hearing, or sensing things that aren’t actually there. These are separate experiences and don’t always happen together. Among people with dementia, visual hallucinations (seeing people or objects that aren’t there) are the most common.
On myALZteam, caregivers often share their experiences supporting loved ones who have paranoia and delusions. These moments can be especially painful when the caregiver becomes the target of suspicion or blame.
“Mum was stuck in such a bad place most of today, thinking her husband of 60 years was somebody else and trying to attack her,” one member shared. “She’s petrified when she thinks I’m leaving her alone with him.”
Another member wrote, “Her latest delusion is that my brother has built her a beautiful big house at the top of Australia and I’m a horrible person because I won’t take her up there to live.”
Situations like these can be heartbreaking for loved ones and caregivers who are doing their best to support someone living with dementia but feel as though their efforts are misunderstood or rejected.
Delusions can also lead to dangerous behavior. One member explained, “He is delusional and says he is God and has superpowers.” Such beliefs can prompt a person with Alzheimer’s to try to do things that are unsafe or beyond their abilities.
These experiences can make daily caregiving tasks more difficult and put stress on the relationship between caregiver and loved one. Even when you know they are experiencing symptoms of dementia, it can feel devastating to be seen as an enemy by someone you love. This sense of mistrust and loss can lead to disenfranchised grief — the deep sorrow caregivers feel when their loved one is physically present but psychologically changed by disease.
Delusions and paranoia are most likely to happen during the middle or late stages of dementia. Paranoia and delusions are most common in people with Lewy body dementia, but they can also happen in people with Alzheimer’s disease or vascular dementia. These symptoms are less common in frontotemporal dementia.
Delusions and paranoia are not typically early signs of Alzheimer’s disease or vascular dementia, while in Lewy body dementia, these symptoms may emerge much earlier in the progression of the disease. Ultimately, when and how these symptoms appear depend on which parts of the brain are affected and what type of dementia a person has.
Researchers believe that paranoia and delusions probably happen because a person is trying to make sense of confusing or incomplete information. As cognitive decline progresses, the person’s brain may have trouble putting together information, and they may end up filling the gaps with imagined explanations that feel real and logical to them — even though they aren’t grounded in reality.
A person may also be struggling with memory loss or being disoriented in time. For example, if they remember their spouse only as they looked decades ago, it can be hard to believe that they are married to the older person next to them. If they don’t remember buying their current house, it may make sense to them that it isn’t really their home. Essentially, the brain’s damaged circuits are forcing them to confabulate — to make up stories to fill in the large gaps in their memory and perception.
However, other factors can also trigger or worsen paranoia and delusions. If your loved one is experiencing any of the following, addressing them may help ease symptoms:
Your loved one’s healthcare provider can help you figure out what’s contributing to the paranoia and delusions. If it’s something that can be changed — such as adjusting medications or improving lighting — they can guide you through those steps. If it’s not changeable, they can help you find ways to manage the symptoms and reduce distress.
Talk to your loved one’s healthcare provider about any behavior changes you notice. They can help you understand whether medications might help and guide family members and caregivers in how to respond to paranoid accusations or delusional beliefs.
In some cases, antipsychotic medications may help manage delusions and paranoia. However, these medications come with significant risks for people with dementia, like a higher risk of stroke or even death. It’s important to know that because these medications carry important risks for older adults with dementia, most of them come with a black box warning from the U.S. Food and Drug Administration (FDA).
Before starting or continuing any of these medications, talk with your loved one’s doctor about their potential benefits and side effects to make the decision that’s best for all of you.
If you know that your loved one experiences delusions and paranoia, it can help to prepare yourself ahead of time. That way, you’ll be able to stay calm during tense moments and prevent the situation from escalating. Below are a few tips for responding in the moment:
Over time, you might learn what tends to trigger delusions and paranoia for your loved one. Then, you can help them avoid those triggers. If they can’t be avoided, or if delusions still happen, remember that they’re probably afraid.
Addressing their fear and reassuring them that they’re safe may comfort them until they’re able to think about something else. When you respond with kindness and go along with your loved one’s version of reality to calm them — for example, reassuring them that their “stolen” wallet is safe — you are using a compassionate care technique known as therapeutic fibbing.
On myALZteam, people share their experiences with Alzheimer’s, get advice, and find support from others who understand.
How have paranoia or delusions affected your loved one living with Alzheimer’s? Let others know in the comments below.
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