Understanding the Burden of Dementia-related Psychosis

Health care professionals and a caregiver discuss the overall burden of hallucinations and delusions associated with dementia-related psychosis, explore unmet needs in diagnosis and management of these symptoms, and discuss the need for increased dialogue between clinicians and caregivers.

Dementia-related psychosis has a prevalence of 10% to 75% across various dementia types.1 Hallucinations and delusions associated with dementia-related psychosis are closely linked with increased caregiver burden and increased risk of nursing home placement.2-4

Awareness of hallucinations and delusions associated with dementia-related psychosis, including how to recognize and report them to the health care team, is an important role for health care professionals (HCPs) and caregivers, as collaboration among providers and caregivers is key to earlier identification, diagnosis, and potential management.5-8

To increase disease awareness and dialogue among HCPs, patients, and caregivers, NeurologyLive presented a special broadcast, “More Than Cognition: Understanding the Impact and Consequences of Hallucinations and Delusions Associated With Dementia-related Psychosis,” featuring perspectives from neurologist Alireza Atri, MD, PhD; geriatric psychiatrist Davangere P. Devanand, MBBS, MD; and caregiver Linda Gregory.

Ms. Gregory’s mother was diagnosed with Alzheimer’s dementia and subsequent related psychosis. Ms. Gregory shared her family’s experience of her mother progressing from showing classic symptoms of dementia, including memory loss and confusion, to exhibiting concerning behavior related to hallucinations and delusions. These instances evolved from what originally seemed to Ms. Gregory and her family as harmless memory lapses to fear and paranoia. Concern about her mother’s safety ultimately led Ms. Gregory and her family to pursue full-time care for her mother in a memory care unit.

Ms. Gregory noted that she and her family felt a great deal of confusion and guilt due to their lack of understanding of what exactly dementia-related hallucinations and delusions were, and that a clearer explanation of these symptoms from an HCP would be helpful as caregivers navigate the different symptoms with their family member. Ms. Gregory’s account of the challenges that she and her family faced, including increasingly aggressive behavior from her mother, provided a sobering real-world look at the deep-seated impact that dementia-related psychosis can have on the family unit.2,9-11

Ms. Gregory’s experience also demonstrates a key point in the care process: Caregivers are often not provided with the full scope of information and expectations to best prepare for handling a loved one’s progressive disease. As Dr. Atri noted, HCPs need to do a better job at communicating information and directing caregivers to appropriate resources so that they feel fully supported and informed.

Dr. Devanand shared that a study in older people with Alzheimer's disease dementia showed that a 10% increase in neuropsychiatric symptoms was associated with a 30% increase in odds of nursing home placement.3 Having this information may help caregivers be more proactive in planning future care for their loved ones and adjusting overall expectations for themselves in terms of their own ability to adequately care for the patient and manage the patient’s symptoms.

Overall, management of dementia-related psychosis remains a large unmet need, as no antipsychotic medications are currently approved for the treatment of the disorder, and all antipsychotics carry a Boxed Warning indicating that elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.12 Available antipsychotics also have adverse effects and little documented efficacy to support their use in this vulnerable population.13

All told, more open communication between HCPs and caregivers—including conversations about the range of symptoms, signs of progression, and access to educational and supportive resources—is key to helping ease the burden of this disease.

To view a recording of the full presentation, click here.

This nonaccredited presentation is sponsored by Acadia Pharmaceuticals Inc.

1. Data on file (200). Acadia Pharmaceuticals Inc.
2. Mohamed S, Rosenheck R, Lyketsos CG, Schneider LS. Caregiver burden in Alzheimer disease: cross-sectional and longitudinal patient correlates. Am J Geriatr Psychiatry. 2010;18(10):917-927.
3. Porter CN, Miller MC, Lane M, Cornman C, Sarsour K, Kahle-Wrobleski K. The influence of caregivers and behavioral and psychological symptoms on nursing home placement of persons with Alzheimer’s disease: a matched case–control study. SAGE Open Medicine. 2016;4:1-9.
4. Scarmeas N, Brandt J, Albert M, et al. Delusions and hallucinations are associated with worse outcome in Alzheimer Disease. Arch Neurol. 2005;62(10):1601-1608.
5. Jost BC, Grossberg GT. The evolution of psychiatric symptoms in Alzheimer’s disease: a natural history study. J Am Geriatr Soc. 1996;44(9):1078-1081.
6. Alzheimer’s Association. Challenging Behaviors. https://www.alz.org/national/documents/statements_antipsychotics.pdf. September 2011. Accessed November 4, 2020.
7. American Psychiatric Association. The American Psychiatric Association practice guideline on the use of antipsychotics to treat agitation or psychosis in patients with dementia. https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890426807. Published May 1, 2016.
8. Jeste DV, Finkel SI. Psychosis of Alzheimer’s disease and related dementias. Am J Geriatr Psychiatry. 2000;8(1):29-34.
9. Gilley DW, Wilson RS, Beckett LA, Evans DA. Psychotic symptoms and physically aggressive behavior in Alzheimer’s disease. J Am Geriatr Soc. 1997;45(9):1074-1079.
10. Leonard R, Tinetti ME, Allore HG, Drickamer MA. Potentially modifiable resident characteristics that are associated with physical or verbal aggression among nursing home residents with dementia. Arch Intern Med. 2006;166(12):1295-1300.
11. Lopez OL, Becker JT, Sweet RA, et al. Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. J Neuropsychiatry Clin Neurosci. 2003;15(3):346-353.
12. US Food and Drug Administration. FDA Public Health Advisory: Deaths with Antipsychotics in Elderly Patients with Behavioral Disturbances. Silver Spring, MD: US Food and Drug Administration; April 11, 2005.
13. Schneider LS, Tario PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patient with Alzheimer’s disease. N Engl J Med. 2006;355(15):1525-1538.
Related Videos
View All
Related Content
© 2023 MJH Life Sciences

All rights reserved.