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Try This Instead of Antipsychotic Drugs for Paranoia in Dementia

Photo: older woman sitting outside smiling

Brain changes from dementia can cause hallucinations, delusions or paranoia. “Paranoia, or having false beliefs, is a common trait of later stage dementia,” says Jared Heathman, MD, a Houston psychiatrist. “However, it can occur in all stages of dementia.”

Paranoia in dementia feels very real for the person living with it. So says Susan London, LMSW, Director of Social Work at Shore View Nursing and Rehabilitation. “There is often no evidence that will convince them otherwise.”

As a caregiver, do not attempt to present “proof” a belief is false. Nor should you deny that the evidence is real. Both approaches could create an intense unfavorable emotional reaction from your loved one.

“Take the example of a woman looking for her deceased husband. She is certain that he is in the house. Telling her that he died a long time ago, or showing his death certificate, will make matters worse,” says London. She may not acknowledge his death to be true, and could be very hurt by that thought. The news could also cause her to re-experience the trauma of his loss. Or, she may strike out in anger, accusing this person of “killing her husband.”

Rule Out Non-Dementia Causes of Paranoia

To understand paranoia in dementia, you need to understand its cause, says Heathman. Rule out possible causes outside of dementia. Schedule an appointment with your family member’s physician to rule out treatable conditions.

“Paranoia can result from urinary tract infections, liver disease, systemic infections and anxiety disorders. In many instances, treating those may put an end to the paranoia.”

If a physician rules out other medical causes, prescription drugs may reduce some symptoms of paranoia. Problematic side effects should be monitored.

Natural, Behavioral Techniques May Help Alleviate Paranoia in Dementia

Caregivers can provide reassurance and support that those suffering are safe and loved.

Do not fall into the trap that detailed explanations, or logical arguments, will help. These will frustrate the caregiver and not appease their affected parent or spouse. Try these behavioral techniques to calm someone living with dementia, who is experiencing paranoia.

Remain Calm

“Remember that you are not to blame for what your loved one is experiencing,” says Heathman. “Although witnessing a hallucination can be scary, it’s important to stay calm. Remember that arguing “something is not real” is not helpful.”

Instead, he suggests trying to stay as calm and collected as possible. Have a plan in place to prevent violence or call for help. If the situation escalates, act on your plan.

Be Cautious Before Responding

Assess the situation before responding to the person’s delusions.

Is anyone at risk of harm?

If not, it’s often best to ignore the behavior stemming from a false belief. “As long as the behavior does not become dangerous, you might not need to intervene,” Heathman says.

Offer Reassurance

What if your loved one becomes agitated, or wants your help dealing with the delusion?

Heathman suggests reassuring him with kind words and a gentle touch.

“You could tell him ‘Don’t worry. I am here and will protect you’.” You could also offer to hold your loved one’s hand . Or shift their attention by lightly patting their back or shoulder. This can calm agitation.

Create a Distraction

“In some instances, it’s possible to put an end to a delusion or for it to drastically subside if the person’s attention is shifted,” says Heathman.

To help your mother snap back into reality, offer to take a walk with her or move to another part of the house.

“You can even try turning on lights or opening blinds. Frightening hallucinations often subside in well-lit areas and if others are present.”

Try talking to your father about his favorite baseball team. Turn on his favorite song. Or suggest you both work on a puzzle together.

Ask Open-Ended Questions

Avoid being judgmental says Becky Siden, LMSW, CDWF a licensed psychotherapist in Birmingham, Michigan. “Asking questions that are open ended is very healing for everyone involved.

When communicating with a loved one with dementia, Siden suggests focusing on being understanding. She says some helpful things to say or ask include:

  • How can I help you to feel safe?
  • Let’s look at this together and see how we can come up with a plan.
  • I know the feeling of being scared and I am here to help.
  • Tell me more about what this is like for you.

Remain Honest

If your spouse asks you about a false belief, Heathman says you should always respond with honesty.

If they ask if you see the person standing in the corner, you should respond by explaining you know that he sees something, but you do not.

Heathman says this approach does not deny what your loved one believes to be true.

Honesty prevents you from having to lie and saying you also see something you do not. Heathman says this could increase the paranoia. Your loved one may become more agitated if he thinks you also see something scary or unusual.

Modify The Environment

“It’s very important to assess the reality of the situation,” stresses Heathman.

•    Glare from a window may look like snow to a person with dementia. Close the curtains to remove the glare.
•    A dark area rug may look like a gaping hole your loved one believes she will fall into. Remove the rug to remove the black hole.
•    Your mother may see a scary stranger in her reflection in the mirror. Cover the mirror with a sheet.
•    Turn on more lights to reduce shadows that could look frightening.

Summary – Do’s and Don’ts for Paranoia in Dementia


  • See a doctor to check for other causes of paranoia.
  • Stay calm and honest.
  • Ask open-ended questions.
  • Acknowledge that you know that they are seeing or experiencing something.
  • Say that you know the feeling of being scared, and are here to help.
  • Modify the home environment to eliminate the source of scary objects.
  • Have a plan in place and someone to call.


  • Don’t be judgemental.
  • Don’t show “proof” that the paranoia is unwarranted.
  • Don’t respond with “logical” explanations.
  • Don’t deny the evidence is real.
  • Don’t say you see something which, in reality, you don’t.

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About The Author

For over two decades, Gina Roberts-Grey has pored over studies and interviewed leading health experts on topics ranging from healthy aging, caregiving and longevity. Having been an active caregiver to her grandparents who lived into their 90’s, Gina is passionate about supporting caregivers through their journeys. Her work has been featured in publications like Woman’s Day, AARP, Oprah, Neurology Now and many more.