Behavioural changes in persons living with dementia can occur as a result of changes in their brain.

The Department of Psychological Medicine from Changi General Hospital (CGH), a member of the SingHealth group, explains the common symptoms displayed by persons with dementia and offers caregivers tips on how to better manage these behaviour changes when caring for their loved ones with dementia.

Paranoia and delusion in persons with dementia

Paranoia refers to the perception or suspicion that the person with dementia may have about other people having ill motives against them when there is no reason for these suspicions.

For example, the person with dementia may:

  • Believe that their caregiver is trying to harm him or her

  • Believe his or her spouse is being unfaithful

  • May hide or hoard things as they believe someone is trying to steal their possessions

Delusion describes the fixed ideas that are not based on reality, but which are thought to be true by the person with dementia.

For example, the person with dementia may: 

  • Often think that other people around them are stealing their money or other possessions

  • Think that other people have the intention or are trying to harm them.

9 Tips to manage paranoia and delusion in persons with dementia

1. When the person with dementia accuses the spouse of having an affair

As the person's spouse and caregiver, try to reply with either of the following:

  • With some humor, “You think there will be anyone else who will fall in love with me?” or

  • With empathy, “I can see you are upset with that, who wouldn’t be?” or

  • Distract with other topics

2. When the person with dementia accuses the caregiver or family member of poisoning his/her food and drink

  • Allow the person with dementia to participate in preparing the meal;, such as allowing him/her to watch you cook and scoop food onto his/her plate.

3. When the person with dementia accuses the caregiver or family member of stealing items he/she had misplaced

  • Verify that the accusations are untrue

  • Do not scold the person for losing objects or hiding things

  • “Investigate” what are the stolen items and allow your loved one to keep the items in a place easily available to them e.g. a box or a bag for “easy inspection”

  • Keep a spare set of missing items such as glasses, purse, keys to allow extra time in locating the items

  • Try to find out where are your loved one’s favourite hiding places so you can help to find the “missing” items

4. Avoid arguing with the person with dementia

Do not argue with your loved one who has dementia as what he/she is going through is very real to him/her.

5. Keep changes to a minimal

Try to have the same regular caregivers for persons with dementia.

6. Help others to understand your loved one's condition

Take time to explain to other family members and caregivers that suspicious accusations are part of the dementia and not to take it personally

7. Try going beyond words

Try using non-verbal reassurances for your loved one with dementia such as a gentle hug or a gentle touch if he/she is willing to accept this.

8. Respond positively to accusations

Respond to the feeling behind the accusation rather than the accusation itself, “I see this frightens you. I can help you in locating the missing items”

9. Avoid changing environments frequently

Try to maintain a familiar environment. If the person with dementia has to relocate, bring along some familiar things from the previous residence to the new one.

Possible reasons for paranoia and delusion in persons with dementia

  • Disease progression of dementia

  • Memory loss. As people with dementia are unaware that their memory is poor, they will often create an interpretation in which someone or something else is to be blamed

  • Sense of insecurity and anxiety

  • Sensory defects, e.g. poor eyesight or hearing

  • Change of environment or caregiver

Remember: Paranoia is very common in persons with dementia. Just try to imagine how frustrating and frightening it must be to live in a world where your things constantly seem to disappear, have someone else control your finances, make decisions for you, have conversations that often don’t make sense, or feel like you are waking up every morning in a strange place. This is what a person with dementia may have to go through.

About BPSD (Behavioural and psychological symptoms of dementia)

Behavioural and psychological symptoms of dementia (BPSD) are neuropsychiatric symptoms and behaviours displayed by persons with dementia.

These symptoms constitute a huge aspect of dementia irrespective of its subtype, and they demonstrate a strong correlation with the degree of functional and cognitive impairment.

Learn how to manage anger and aggressionclick here.

Learn how to manage apathyclick here.

Learn how to manage inappropriate (disinhibited) behavioursclick here.

Learn how to manage hallucinationsclick here.

Learn how to manage repetitive behaviourclick here.

Learn how to manage sundown syndromeclick here.

Learn how to manage wandering behaviour, click here.

​Ref: H24