Dementia and Paranoia
June 26, 2024
People with dementia may develop paranoia as a symptom, and this can manifest in many ways
Paranoia directed toward staff or unknown others
One lady I know would think that staff were stealing from her. She would hide her pocketbook in a drawer or somewhere else in her room. Then she would be unable to find it and that would confirm her suspicions. One of the workers had stolen it! Her daughter would help her look and they would always find it. Even upon finding it, her mother would use this as an affirmation that someone had hid it in her room. When her daughter suggested that maybe she had put it there and forgotten, she would deny that as even a possibility. Someone had hid it. They must have hid it and were going to take it when someone else happened by, so they stashed it in order to come back and steal later.
Another woman I know said that a staff had assaulted her in the night. In investigation, this woman had no injuries, no bumps and bruises, and nothing that would have resulted from getting beat up in the way she described. She also didn’t seem scared by this as a person likely would be. She was quite matter of fact about it. She said she knew who did it. She was shown all of the staff who worked there and to each one she said “No, that’s not them.” But if she saw the offender, she was sure she’d know them. On seeing many of the staff, she had only positive comments. It seemed strange that the situation was both very real to her and also not. She was quite clear and certain that the incident had happened, but she also didn’t act like she had experienced it. She didn’t act worried or shaken up by a beating she said had occurred.
I was talking to a woman the other day who started hiding silverware, strangely enough it was almost always spoons. She was living with her daughter when this began. Her daughter laughs now, but it would get frustrating not being able to find a spoon. Her mother moved out and several months later, her daughter was still occasionally finding spoons hidden around the house. This woman moved into Emerald Crest when she left her daughter’s home. Initially she was quite paranoid about many things but slowly she has become comfortable in her new home with almost all her paranoia gone. But old habits die hard, it seems. She still tucks away spoons at times. It is uncertain why silverware, and spoons in particular, are something she thinks people would take. Regardless, she doesn’t want to be without a spoon, even though she may not know where they are hidden.
Paranoia directed at family and friends
When not directed towards staff at a facility, this paranoia often gets directed at someone close to them. People worry about their kids stealing their money, selling their things and using this money to live a lavish lifestyle. That is a painful feeling for both the person with dementia and also for their family, who is often doing so much for them. The ones who are caring for their loved one can be accused of betrayal and theft.
“Caregivers can become so busy caring that they can’t think of
anything else, let alone considering and searching for long term help.”
One man I know was caring for his wife while at home for many years. As is often the case with couples, one spouse cares for the other long after it is safe or healthy for either of them. But these things creep up. The care starts out small and very manageable but it grows slowly, and the caregiving spouse doesn’t even realize how much they are doing for their husband or wife. Responsibility continues to grow, until it engulfs the caregiver, and they can’t see the forest for the trees. Caregivers can become so busy caring that they can’t think of anything else, let alone considering and searching for long term help. In this situation, the man’s wife was fine most of the day, and she was still quite self-sufficient while in their home, but in the evening and night she would often become paranoid. She would sometimes forget who her husband was. Sometimes, to her, he was a different relative or a friend. But sometimes he was a stranger. And sometimes he was an intruder. This husband finally decided that the move into memory care for his wife was necessary after a frightening incident. In the middle of the night, she was awake and, in the kitchen, when he came to check on her. She pulled a knife out and tried to stab him thinking he was an intruder there to hurt her.
How memory care can help
Many times, being in an appropriate memory care facility can alleviate much of this paranoia. A good environment with structure in which meal, sleep and activity patterns are assisted by friendly staff really can help. Knowledgeable medical and nursing staff can help with some medications at times that alleviate many of these symptoms. Staff who understand dementia and can acknowledge feelings of betrayal without reinforcing them can also help the paranoid person feel heard, and that can help to diminish paranoid feelings as well. The structure, expertise and objectivity of a memory care community can support the reduction of paranoia and related symptoms.
Paranoia, one of the first symptoms?
Sometimes paranoia can be one of the first noticeable symptoms of dementia. I know another man, who while he said he was not always a perfect husband, had a very good relationship with his wife. He had never been unfaithful to her, but the first really strong symptom of dementia his wife experienced was that she believed he was cheating on her. She would say that she knew he had been seeing another woman. He couldn’t reason with her to believe otherwise. To make matters worse, he said, after a long discussion about this, she would tell him that she forgave him but that he could never do it again. So now not only was he a cheater but she was faithful despite his imagined infidelity. It wasn’t until other symptoms appeared that a neurologist was seen and a diagnosis given. It was only then that this husband realized the accusations were a part of his wife’s dementia. They had gone through a lot of heartache in the meantime.
Unfortunately, for some people, it seems that the only 100% cure for their paranoia is the inevitable progression of dementia. There are not many certainties with most forms of dementia, but one is that it will progress. Sometimes disease progression is a mixed bag. It is sad that a condition worsens and that there are losses for everyone, but also there can be an alleviation of worry. Symptoms of paranoia can pass for people with dementia as the disease progresses.
Reverend Arlen Solem
Chaplain and Campus Pastor
For questions about our spiritual care program, or if you would like spiritual care and support for you or your loved one, contact Chaplain Arlen Solem.
