A GP working in an aged care home asked:
“One of my patients, who is 85 years old, continues to show signs of psychosis (delusions and hallucinations). She strongly believes staff are entering her room at times when she is not there and stealing her possessions, and also reports seeing cats in her room at times. She has Lewy Body Dementia.
Lewy Body Dementia (LBD) is closely related to Parkinson’s Disease Dementia (PDD), but an important difference is that LBD patients only receive motor benefits from Parkinson’s medications in about 50% of cases.
Visual hallucinations occur in around 50% of LBD patients (and often take the form of small children/animals). My approach to these symptoms in terms of treatment comes down to whether the hallucinations are distressing to the patient or not. If your patient is worried about seeing cats in her room, then medication may be a valid option. Dementia Support Australia could provide a medication review in this case.
A final important point about her ‘delusions.’ Not all delusions are mediated by psychosis in someone living with dementia. ‘Delusions of theft’ are often described in dementia, but tend to arise not from psychosis, but from artefacts of poor memory. I suspect it is likely that she is simply forgetting where she has put things and then, when she can’t find them, quite reasonably (from her perspective) assumes that ‘someone must have taken them.’ It is unlikely that an antipsychotic will help moderate such beliefs, which are not psychotically mediated in this setting.
Have non-pharmacological strategies tried in an attempt to decrease the impact of her delusions?
If not, consider a formal referral to Dementia Support Australia in order to explore these further.
Dementia Support Australia also offers a new dedicated GP Advice Service where you can provide further information and you can access clinical advice from our medical specialists.
A/Prof Steve Macfarlane is the Head of Clinical Services at DSA. He is a geriatric psychiatrist and spent 11 years working as the Director of two metropolitan public-aged psychiatry services in Melbourne, prior to helping establish the Severe Behaviour Response Team in 2015.