Alzheimer’s & psychosis: any link?

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Psychosis is a condition in which people lose touch with reality, often having impossible ideas or delusions and experiencing hallucinations, where they perceive things that don’t actually exist. The condition occurs frequently in people who have Alzheimer’s disease, especially in the later stages of the disease. Alzheimer’s is a disease in which memory is impaired and thinking becomes difficult, which can affect recognition, speech, planning and movement. As the disease progresses, psychosis can develop in up to 50% of individuals, sometimes along with agitation and aggression. It is thought that when Alzheimer’s and psychosis occur together, this may represent a specific type of Alzheimer’s disease, which may be linked to certain genes.

Different types of psychosis are associated with different diseases. In the case of psychosis and schizophrenia, so-called auditory hallucinations are more common, in which a person hears things, typically voices, that are not really there. With Alzheimer’s and psychosis, people experience visual hallucinations more often, seeing things that aren’t there. Sometimes the hallucinations are pleasant, especially early in the disease, often consisting of sightings of children or pets. As Alzheimer’s progresses, the nature of psychosis symptoms can change to become more overwhelming.

While in schizophrenia the delusions experienced are often bizarre, with Alzheimer’s and psychosis, all delusions commonly concern everyday matters, such as one’s home. Relatively often, delusions arise when people are convinced that they are not actually living in their own home, but have another home elsewhere. It is also quite common for a spouse to be misidentified and thought to be someone else. In one form of paranoid psychosis, a person with Alzheimer’s may experience a delusion that people are breaking into the house and stealing things.

Treatment in a person suffering from Alzheimer’s and psychosis aims to reduce the psychotic symptoms, while reducing the risk of unwanted side effects that could affect the person’s quality of life. Possible complications of drug treatment can include drowsiness, abnormal movements, heart problems and changes in blood pressure, which can lead to falls. Some authorities believe it is better to reserve medication for extreme cases and emergencies and use other methods to manage psychosis instead. Alternative approaches involve educating healthcare professionals and modifying the routine and environment of the person with Alzheimer’s. Strategies that have been shown to work include having a regular routine, in an environment that isn’t too stimulating or too boring, avoiding creating situations known to trigger psychotic symptoms, and learning to prevent the escalation of psychotic behaviors when they arise.

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