Paranoid Symptoms Among Older Adults

Muzumel A. Chaudhary, MD; Kiran Rabheru, MD, CCFP, FRCP, ABPN


Geriatrics and Aging. 2008;11(3):143-149. 

In This Article

Alzheimer's and Related Dementias

For cognitively impaired individuals with paranoia, pharmacological management is usually initiated secondary to behavioural disturbance. There is increasing evidence that cognitive enhancer therapy (cholinesterase inhibitors and memantine) results in some beneficial effects on cognition and symptoms of suspiciousness and delusions in cases of mild to moderate AD with mild behavioural and psychological symptoms of dementia (BPSD).[26] However, there remains a paucity of evidence demonstrating convincing efficacy of these medications in presentations of more severe cognitive impairment with greater paranoid symptoms and disruptive behaviours.

When severe BPSD leads to concerns regarding an individual's safety and the safety of others in the immediate environment, consideration should be made for the use of atypical antipsychotic treatment.[26] Growing evidence exists for the efficacy of atypical antipsychotics in the treatment of BPSD.[26] The more controversial question, however, remains that of treatment safety. Between 2002 and 2005, Health Canada released three separate warnings about the association between atypical antipsychotic use and increased morbidity (cerebrovascular adverse events) and mortality among persons with dementia.[26] The relative risks and benefits of treatment need to be considered on a case-by-case basis, and patients or their substitute decision-makers must be fully informed prior to treatment initiation. Again, efficacy and adverse effects must be closely monitored and consideration made for tapering and withdrawal after a period of behavioural stability, unless its usefulness is clearly demonstrated in that individual.


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