Understanding Dementia
What Is Dementia?
Dementia is a syndrome characterized by a general decline in cognitive abilities that disrupts an individual’s daily living.
The term dementia is general for cognitive decline, including memory, language, problem-solving, and personality. It is a group of neurodegenerative disorders, most commonly Alzheimer’s, resulting from damaged brain cells that impair mental and physical functioning.
Is Dementia a Disorder or Disease?
Dementia isn’t a specific disease; instead, it is a syndrome caused by multiple underlying brain disorders.
Does Dementia Only Develop in Senior Adults?
No, dementia and psychotic symptoms can present in younger adults as well as older adults.
When dementia is diagnosed in younger adults, those under 65, it is called young-onset or early-onset dementia. Since dementia can be diagnosed in younger adults, it is important to understand and recognize the symptoms of dementia, especially if a family member was diagnosed in their 60s or younger.
What Is the Average Age of Onset of Dementia?
The average age of diagnosis of dementia is 65 or older.
Most individuals are diagnosed at the age of 65 or older. Despite the average age, there is a risk of being diagnosed with a form of dementia at an earlier age based on genetics, lifestyle, and the type of dementia.
Additionally, as individuals age into their 70s and 80s, the risk of diagnosis significantly increases.
Can Dementia Look Like a Psychotic Disorder?
Yes, dementia can closely mimic a primary psychotic disorder.
Both can produce hallucinations, delusions, paranoid ideas, confused or disorganized speech, misperceptions, suspiciousness, and agitation. In older adults, new-onset hallucinations or delusions are frequently first noticed and labeled “psychosis,” even when those symptoms are driven by underlying cognitive decline.
The pace of onset and the pattern of cognitive changes (memory, language, daily functioning) help clinicians distinguish dementia from a primary psychotic illness.
Signs & Symptoms of Dementia
What Are Some Signs of Dementia?
Several types of dementia can impair memory, thinking, and decision-making in an individual’s daily life.
As you age, you may notice slight changes in your memory, muscle and bone weakness, and cardiovascular issues. These changes are normal signs of aging and can be expected. Individuals with dementia can also have the same or similar signs of aging.
However, they can also have difficulties with:
- Communication
- Memory
- Attention
- Judgment, reasoning, and solving problems
- Vision issues like recognizing objects, processing visual stimuli, and depth perception
Other symptoms can indicate a loved one has dementia, including:
- The use of unusual words to describe familiar objects
- Memory lapses, especially of old memories
- Getting lost in their own or a familiar neighborhood
- Forgetting the names of close family members or friends
- The inability to complete tasks
Make an appointment to see your healthcare provider or a loved one’s if you notice any of these symptoms.
If you notice severe personality changes that indicate an acute psychiatric crisis, reach out to Ocean View Psychiatric Health Facility. Our professionally trained mental health and recreational therapy team members can help stabilize the extreme symptoms of dementia, such as psychotic symptoms.
What Is a Common Symptom of Early-Stage Dementia?
Early-stage dementia’s most common early symptom is memory loss.
Often, during the early stages of dementia, individuals will find it challenging to remember important dates or things they recently learned. This happens because the brain’s cells are slowly degenerating, making it difficult to maintain cognitive functions such as memory.
Other signs of dementia are noticeable in the early stages of dementia, including:
- Finding it difficult to complete daily or familiar tasks
- Confusion about place or time
- Difficulty following conversations or finding the right words
- Increased anxiety or depression
The symptoms of early dementia can be subtle, making them difficult to notice. Symptoms also vary from one individual to another, meaning they may not be recognized initially. This means mild cognitive impairment can go unnoticed until the dementia progresses into late-stage dementia.
What Is It Like to Live With Dementia?
Individuals who live with dementia can find that the symptoms cause constant challenges with completing their daily tasks.
Those with dementia face unique challenges that can disrupt their behaviors and daily experiences. They can have good and bad days that can affect their emotions and cognitive function. Sometimes, they experience behavioral changes that can include following caregivers closely and repeatedly asking questions.
What Are the Signs of Dementia Progressing?
The more common signs that indicate the progression of dementia include challenges in completing tasks, memory loss, confusion about place and time, and troubles with communication.
Since dementia is progressive, its symptoms can be difficult to notice at first; however, as the symptoms worsen, they become increasingly noticeable.
Do Symptoms of Dementia and Psychotic Disorders Overlap?
Yes, there is significant overlap between psychosis and dementia, with 30% to 70% of people with dementia experiencing psychotic symptoms.
Because symptoms can look similar, careful assessment is essential: when symptoms began, how rapidly they progressed, and whether medical issues, medications, or stressors might be contributing. Accurate diagnosis guides appropriate treatment and supports for the person and their family.
Diagnosis: Identifying the Difference Between Dementia & Psychosis
How Do I Tell the Difference Between Dementia & Psychosis?
Dementia-related psychosis involves cognitive decline (memory loss, confusion) combined with psychotic symptoms, usually appearing in moderate-to-advanced dementia.
In contrast, pure psychosis involves detachment from reality without necessarily having dementia’s memory loss. Delusions in dementia are often paranoid (theft/imposter), while hallucinations are usually visual.
Telling psychosis apart from dementia is a key early step in ensuring the person receives appropriate care.
How Does Dementia Typically Present?
Clues that point to dementia-related psychosis include:
- Gradual decline in memory, language, or executive skills preceding or accompanying psychotic symptoms
- Disorientation to time/place or fluctuating attention
- Visual hallucinations are more common in some dementias (e.g., Lewy body dementia)
- Symptoms often worsen with illness, sleep disruption, or medication changes
What Can Indicate a Primary Psychotic Disorder?
Clues that point to a primary psychotic disorder or other causes include:
- Abrupt onset of psychosis without significant prior cognitive decline
- Prominent persecutory delusions or formal thought disorder in someone with long-standing, stable cognition
- Younger age at onset
- Always consider and rule out medical, medication, or substance causes that can mimic either condition (infections, metabolic disturbances, withdrawal, adverse drug effects)
What Are the Criteria for a Diagnosis of Dementia?
Doctors perform a comprehensive exam to diagnose dementia that includes:
- An assessment to determine if an individual has a potentially treatable underlying condition that can affect cognitive functions
- A physical exam to check for cardiovascular issues like high blood pressure, as well as checking for other illnesses
- A review of the individual’s medical and family history
What Determines a Diagnosis for a Primary Psychotic Disorder?
According to DSM-5, it requires ruling out secondary causes, such as substance use, medications, or medical conditions, through psychiatric assessment, toxicology screens, and lab tests.
When Should I Seek a Healthcare Provider?
If you notice you or a loved one is having difficulty with their cognitive skills or other psychotic symptoms associated with dementia or a psychotic disorder, you should make an appointment as soon as possible.
Early detection of dementia can help manage symptoms.
Treatment for Dementia and Presenting Psychotic Symptoms & Disorders
How Do Treatments Differ Between Dementia and Psychosis?
Treatments differentiate between dementia and psychosis by first determining whether the symptoms are caused by a neurodegenerative process (dementia) or a primary psychiatric disorder.
If psychotic symptoms arise from progressive cognitive decline (dementia), care focuses first on nonpharmacologic supports – routine, environmental changes, reorientation, caregiver strategies – and disease‑directed medications that may improve cognition and reduce behaviors over time.
If psychosis appears to be a primary psychiatric disorder, antipsychotic medication plus psychotherapy and psychosocial supports are the mainstay, with “start low, go slow” dosing in older patients and ongoing psychiatric follow‑up.
Always rule out delirium or reversible medical causes first. Treating infections, metabolic problems, or offending medications can often resolve psychotic symptoms regardless of the underlying diagnosis.
Clinicians stress the importance of a thorough psychiatric assessment — knowing the symptom onset, pace of change, and any medical or emotional triggers helps determine appropriate treatment and support.
While we don’t treat dementia directly at Ocean View Health Facility, we do help older adults diagnosed with dementia manage their psychotic symptoms.
What Medications Help Treat Dementia?
Doctors may prescribe medications such as cholinesterase inhibitors and memantine, which have been proven to temporarily alleviate symptoms such as cognitive decline.
Antipsychotics are a last resort in dementia, and are used only for severe danger or distress, at the lowest effective dose for the shortest time, with informed consent and close monitoring because of increased risk in older adults (falls, sedation, stroke, mortality).
What Medications Help Treat a Psychotic Disorder?
Antipsychotics are used to treat psychotic disorders.
Medication is highly effective in treating psychotic disorders, primarily by reducing symptoms. Antipsychotic medications work by balancing brain chemicals, specifically by blocking dopamine activity. While they often do not cure the underlying condition, they are crucial for managing acute episodes and preventing relapses.
Can Treatment Help Slow the Progression of Dementia?
Treatments can help manage psychotic symptoms in dementia and may modestly slow functional decline by addressing reversible contributors (e.g., infections, metabolic problems) and optimizing vascular and medical risk factors.
Cholinesterase inhibitors or memantine sometimes improve cognition and behavior, but they do not reliably stop underlying neurodegeneration. Antipsychotics can reduce severe psychosis but carry significant risks (sedation, falls, increased mortality) and should be used sparingly after nonpharmacologic approaches.
Overall, treatment can improve quality of life and function but is unlikely to fully halt disease progression.
How Does Treatment Help With Individuals Presenting With Psychotic Symptoms?
Treatment for psychotic symptoms – including antipsychotic medication and therapies like CBT – works by reducing brain chemical imbalances (dopamine), lessening the intensity of hallucinations and delusions, and building coping skills to manage distress.
These approaches improve daily functioning and prevent relapse.
Does Dementia Require 24/7 Support?
Dementia does not usually require 24/7 support in the early stages, though moderately severe dementia may, and late-stage dementia typically does require round-the-clock care.
When psychotic symptoms occur, families should increase supervision and make the home safer by removing hazards, reducing clutter and loud noises, and keeping daily routines predictable while using calm, reassuring language.
Start with non-drug approaches – distraction, validation, familiar activities, and identifying and avoiding triggers – and seek a dementia or psychiatric specialist if symptoms become severe or dangerous, since short-term medications may sometimes be needed with careful monitoring.
Prioritize caregiver support by getting training, arranging respite, and keeping a clear emergency/crisis plan with important contacts.
When Does a Dementia Patient Need Hospice?
Dementia patients need hospice care once their life expectancy reaches 6 months or less.
Once the symptoms of dementia become severe, they significantly impact an individual and may indicate that it’s time for end-of-life care.
A few examples of the significant impacts of dementia include:
- Unable to perform daily activities without assistance
- Severe cognitive impairment
- Decline in health
- Weight loss
- Recurrent infections
Treating psychotic symptoms can improve safety, behavior, and day‑to‑day function, and may temporarily delay the need for hospice by stabilizing symptoms, but it does not typically change the underlying trajectory.
How Can I Choose the Best Care Option?
Deciding on the best level of care for an individual with dementia depends on the severity of their symptoms, specific needs, and preferences.
Research facilities, visit in person, and confirm staff training and certifications.
For psychotic symptoms, options include:
- Enhanced in‑home care with caregivers trained in dementia behavior strategies
- Medication management
- Adult day programs with behavioral support
- Specialized memory-care or secured dementia units staffed for challenging behaviors
- Inpatient psychiatric or crisis stabilization for severe or dangerous symptoms
Ensure any setting can provide 24/7 supervision if needed, individualized behavioral plans, safe environments, and timely access to psychiatric consultation; also plan for caregiver respite, costs, and advance care/legal planning.
FAQs
Dementia can be challenging to cope with, especially when accompanied by psychotic symptoms. At Ocean View, our mental health and medical professionals are trained to address your acute psychiatric needs. Our admissions team is here to help you. You can contact us at (844) 562-1212 or outreach@ovphf.com.