Report Calls for Evidence-Based Strategies to Address Alzheimer's-Related Psychosis
“Alzheimer’s-Related Psychosis: Interdisciplinary Perspectives for Understanding and Responding to Delusions and Hallucinations” — the latest report in The Gerontological Society of America’s Insights & Implications in Gerontology series — underscores the clinical, emotional, and societal impact of psychosis in individuals living with Alzheimer’s disease and stresses the need for comprehensive, person-centered approaches to care.
Alzheimer’s affects more than seven million people in the United States and is the cause of roughly 60–80% of all cases of dementia. Symptoms of Alzheimer’s-related psychosis (ARP), such as delusions and hallucinations, are common symptoms that may occur at any stage of disease progression. These symptoms are associated with poorer outcomes, including accelerated cognitive decline, increased caregiver burden, higher rates of hospitalization, and earlier institutionalization.
“Psychosis in Alzheimer’s disease is both common and complex, yet frequently underrecognized,” said Kalisha Bonds Johnson, PhD, RN, PMHNP-BC from Emory University, who served as one of the faculty overseeing the report’s development. “These symptoms can dramatically affect quality of life for both affected persons and caregivers, making early identification and thoughtful management essential.”
Addressing ARP requires a comprehensive approach emphasizing nonpharmacologic strategies to identify triggers and tailor interventions, according to the report. Interventions should focus on symptoms that cause distress or pose safety risks. When behavioral strategies are insufficient, pharmacologic options may be considered, though currently no medications are approved for managing ARP.
“We consider persistence, severity, and distress when determining how to manage symptoms,” said Clifford Singer, MD, of Northern Light Acadia Hospital, who also served on the report’s faculty. “Medications can be effective when used appropriately, but they come with risks and must be carefully managed.”
The report notes that antipsychotic medications are commonly used off-label but are associated with safety concerns, including a risk for increased mortality in older adults with dementia. Clinical guidelines recommend cautious use, starting at low doses, with ongoing reassessment and attempts to taper when possible. Investigational pharmacologic treatment options are currently in clinical trials.
“Management of ARP must be individualized,” Singer emphasized.
The report states that caregiver support is an essential component of addressing ARP. Caring for an individual experiencing delusions and/or hallucinations can be challenging for caregivers, particularly if they involve accusations or distressing misinterpretations. Caregivers can be educated to implement strategies such as providing reassurance and redirection to help manage distressing symptoms.
The report highlights the importance of shared decision-making, interdisciplinary collaboration, and proactive care planning to improve quality of life for individuals living with dementia and their families. It also offers perspectives from clinicians with experience treating patients with ARP.
Other report faculty include Sophia Geisser, BS, of the Alabama Research Institute on Aging; George T. Grossberg, MD, of the St. Louis University School of Medicine; and Martin Morthland, PhD, ABPP, of the Tuscaloosa VA Medical Center. Support for this issue of Insights & Implications in Gerontology was provided by Bristol Meyers Squibb.
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The Gerontological Society of America (GSA), founded in 1945, is the oldest and largest interdisciplinary organization focused on aging. It serves more than 6,000 members in over 50 countries. GSA’s vision, meaningful lives as we age, is supported by its mission to foster excellence, innovation, and collaboration to advance aging research, education, practice, and policy. GSA is home to the National Academy on an Aging Society (a nonpartisan public policy institute) and the National Center to Reframe Aging.