Have you ever seen an elderly person like your mother, father, or grandparents suddenly start talking to someone in a place where there is no one around? Or, do you constantly worry that someone is coming to bother them or stealing their things? It's normal to feel shocked, scared, and sad when you see things like this. But this is actually part of the illness itself. Your loved one is not "crazy," they are sick. Let's get this straight.
What is 'Dementia-Related Psychosis'?
These words sound a little scary, don't they? Let's break this down into simple terms and understand.
First of all, what is Dementia?
Simply put, dementia is a general term for a range of conditions that are caused by changes in the brain. Some doctors also call it a ``Neurocognitive disorder.'' In this condition, thinking skills, memory, and problem-solving skills gradually decline. Eventually, you may become unable to perform daily tasks on your own.
There are several types of dementia. Alzheimer's disease, which we have all heard of, is the main and most well-known type. In addition:
- Lewy body dementia
- Frontotemporal dementia
- Vascular dementia
There are other types like.
So what is 'Psychosis'?
Psychosis is a mental condition in which a person is unable to distinguish between what is real and what is not . It has two main characteristics:
1. Delusions: These are things that are not true at all, but the person believes very strongly. For example, they may strongly believe that "the person in the house who stole my food is poisoning me" or "someone is coming at night and stealing my money." No matter how much you explain the truth, it is difficult to change that belief.
2. Hallucinations: This is seeing, hearing, feeling, or smelling something that is not really there. For example, asking "Who's in the corner" when no one is in the room, or hearing someone talking to you when no one is talking.
"When things like this happen to your loved one, don't think they're 'crazy.' They're sick. Their brains aren't working properly. This is part of the disease itself. It's important that we understand that and help them."
That is, `Dementia-Related Psychosis` is when these symptoms of delusions or hallucinations appear along with dementia.
What are the main symptoms of this condition?
When dementia and psychosis come together, a variety of symptoms can occur. Let's look at these clearly in a table.
| Characteristics category | Explanation and common examples in Sri Lanka |
|---|---|
| Dementia symptoms (decreased brain function) | - Memory loss: forgetting one's own child's name, forgetting whether or not they ate. - Lack of attention: inability to continue one thing, forgetting something in the middle of a conversation. - Speech difficulties: Using strange words like 'that liquid' for a glass of water. |
| Symptoms of psychosis (Inability to recognize reality) | - Delusions: Strong beliefs such as "My children are trying to steal my land", "The people in my family are casting spells on me". - Hallucinations: Seeing/hearing a dead person come into the house and talk, seeing animals walking on the walls. |
| Behavioral problems caused by this | - Aggression: Sudden anger, attempts to kick with the hand. - Anxiety: Constantly feeling restless and afraid. - Sleeplessness: Walking around the house at night without falling asleep. - Apathy: Lack of interest or desire for anything. |
How do you recognize this exactly?
If your loved one has these symptoms, the first thing to do is see a doctor , because sometimes these symptoms can be caused by other illnesses.
Imagine, when an elderly person develops a urinary tract infection (UTI), it can also cause things like restlessness and hallucinations. So the first thing the doctor does is check if there are other causes like that.
Then, diagnosing the disease is like detective work. The doctor will ask you, the person taking care of the patient, a lot of questions.
"I never see a patient alone," says one specialist. "I always talk to someone who cares for them. It could be a husband, a wife, or a child."
A doctor might ask questions like these:
- "It's been about 3-4 months since I last saw you and your mother. How are things going now?"
- "Have you or he noticed anything unusual or different lately?"
- "Maybe Mom, are you saying he sees and hears things that you can't see or hear?"
These questions are asked to understand the situation. Sometimes patients try to hide their symptoms for fear of being ostracized by society. Therefore , it is very important to tell the doctor what you see and hear without hiding anything .
Do I need both medications? How is the treatment done?
This is a very important question. There is still no complete cure for dementia. Therefore, the first treatment for `Dementia-Related Psychosis` is not medication.
In fact, sometimes if these hallucinations or delusions do not bother the patient or others, there is no need to treat them.
Imagine your mother seeing her own image in the mirror and being scared, "There's someone else in the room." If you had covered the mirror with a cloth at that time, wouldn't that problem be solved? Another patient thought that someone was peeking through the window. That wasn't the case. When the window curtain was lowered, the problem was solved.
Simple things like this are the ones to try first.
- Environmental modification: Removing things from the environment that make the patient fearful or anxious (e.g., closing mirrors, changing light bulbs that cast shadows).
- Calm Redirection: If the patient is getting agitated while talking about a superstition, try to get them out of that state of mind by saying something loving, "Oh, please stop that, let's have some tea, shall we?"
Only if these methods are unsuccessful, and the patient's condition is at a level that is harmful to him or others, will the doctor decide to prescribe medication.
Important: There are no specific medications approved for the condition `Dementia-Related Psychosis`. Doctors use medications that are used for other mental illnesses. These medications do not work for everyone. They can also have a high risk of side effects. Therefore , doctors will prescribe these medications only after careful consideration and when there is nothing else to do.
Living with this condition is a challenge. However, understanding that this is part of the disease and caring for the person with kindness, patience, and love can bring great relief to both the patient and you.
Take-Home Message
- `Dementia-Related Psychosis` is a common manifestation of dementia itself. It is not "crazy", it is a medical condition.
- Delusions and hallucinations are the main symptoms.
- As soon as you notice symptoms like these, be sure to see a doctor to rule out other causes, such as a urinary tract infection.
- Treatment does not start with medication. Try simple things first, such as creating a calm environment for the patient and distracting him.
- Medication is only used when there are no other options and under the strict supervision of a doctor.
- Your love, patience, and understanding are the best medicine you can give your loved one on this journey.
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