This article proposes an initial nomenclature and systematic approach for the nonpharmacologic understanding and treatment of psychotic symptoms in dementia. An analysis of delusions and hallucinations must examine alternative etiologies, including misdiagnosis and misunderstanding, the misinterpretation of reality because of cognitive losses, sensory deprivation and vision loss, ambiguous sensations, and delirium and medical causes. Nonpharmacologic treatments frequently follow directly from etiology, such as improving sensory function via hearing aids or eyeglasses, providing stimulation, changing antecedents prone to misinterpretation (eg, reflections in windows), or circumventing misinterpretations (eg, ensuring that an equivalent object is available so there is no sense of loss or theft). Given the differences between psychotic symptoms in Alzheimer’s disease and those in other diseases, the term psychosisshould be abandoned for most dementia patients, and assessments of etiology should be developed. Future research should clarify what proportion of symptoms currently identified as psychotic are attributable to related etiologies.
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