Main content

    Dementia Symptoms & Caregiver Strategies: Suspicions, Delusions and Paranoia and Cognitive Impairment

    A person who experiences delusions may become suspicious of those around them, even accusing others of theft, infidelity or other improper behavior. While accusations can be hurtful, remember that an underlying medical issue may be causing these behaviors and try not to take offense.

    What to expect

    Delusions (firmly held beliefs in things that are not real) can be common in people who are experiencing cognitive difficulties. Confusion and memory loss — such as the inability to remember certain people or objects — can contribute to these untrue beliefs. A person experiencing cognitive challenges may believe a family member is stealing his or her possessions or that he or she is being followed by the police. Although not grounded in reality, the situation is very real to the person with these delusions. Keep in mind that the person is trying to make sense of his or her environment with less than optimal cognitive function.

    Make sure family members and caregivers understand that suspicions and false accusations are being caused by an underlying illness and are not a reflection of them.

    A delusion is not the same thing as a hallucination. While delusions involve false beliefs, hallucinations are false perceptions of objects or events. When individuals have a hallucination, they see, hear, smell, taste or even feel something that isn't really there.

    How to respond

    • Don't take offense.
      Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the individual know you care.
    • Don't argue or try to convince.
      Allow the person with cognitive impairment to express ideas. Acknowledge his or her opinions.
    • Offer a simple answer.
      Share your thoughts with the individual, but keep it simple. Don't overwhelm your loved one with lengthy explanations or reasons.
    • Switch the focus to another activity.
      Engage the individual in an activity, or ask for help with a chore.
    • Duplicate any lost items.
      If the person is often searching for a specific item, have several available. For example, if the person is always looking for his or her wallet, purchase two of the same kind.
    • Change the environment
      For example, if your loved one repeatedly sees something in the home as threatening remove it from view. If the person believes that someone is peering in the window, keep the blinds lowered.
    See the Doctor

    If your loved one is having severe delusions and there is a fear of self harm or caregiver harm, or if the delusion is extremely troubling to the person, it's important to have a medical evaluation to diagnose the cause (i.e. infection, side effects of medication, etc.), prescribe treatments and determine if medication is needed. The first line of treatment for these behavioral symptoms is non-drug approaches (such as the ones above), but if these strategies fail and symptoms are severe, medications may be appropriate. While antipsychotic medications can be effective in some situations, they are associated with an increased risk of stroke and death in older adults and must be used carefully. Work with the doctor to learn both the risks and benefits of medication before making a decision.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: