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

The Dementias

General paranoid symptoms are common in many psychiatric disorders and as such are nonspecific. However, the detailed description, specific nature, and quality of the paranoid theme(s) may be supportive of a specific group of disorders, such as depression, mania, dementia, schizophrenia, or delusional disorder.

Paranoid symptoms in late life may arise secondary to AD or other dementias. Approximately 40-60% of persons with AD manifest psychotic symptoms, typically in the middle stages of the illness.[18,19,20] The most common symptoms manifested are delusions, which tend to be paranoid, concrete, simple, and nonbizarre.[21] Frequently encountered delusional themes include persecution, infidelity, abandonment, and misidentification. Individuals may be convinced that they are victims of theft, have unfaithful spouses, or believe that others are conspiring to admit them to long-term care. Some become convinced that an imposter is impersonating a family member, or that their house is not their home.[17]

The diagnosis of dementia requires a documented decline in cognitive function that includes memory impairment and at least one of aphasia, apraxia, agnosia, or a disturbance in executive functioning. The cognitive deficits are associated with impairment in occupational or social functioning and represent a decline from a previously higher level of functioning.[15]

A screening cognitive assessment is performed using the Standardized Folstein Mini-Mental State Examination. The scale has a maximum score of 30 points, with scores <24 suggesting significant cognitive dysfunction. Day-to-day functioning is determined by documenting activities of daily living (ADLs) and instrumental activities of daily living (IADLs). In the presence of cognitive deficits with functional impairment, further neuropsychological testing and neuroimaging may be warranted to better determine the etiology and subsequently prognosis.


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