Minding Our Elders: Increasing paranoia in older adult needs investigating

Dear Carol: My 71-year-old mother is slender, a non-smoker, socially active and gets a decent amount of exercise. She takes three medications that I know of. While she has an occasional “gap out” with a word here and there, that seems like normal aging.

What troubles me is that she’s increasingly paranoid about other people doing things to her. When she forgets where she put something, she’s sure someone moved it or took it. If she has a car problem, she insists that someone sabotaged it. I try to ease her mind by joking about her suspicions, but she won’t budge. She insists that someone “did” something. I don’t see other signs of dementia. What could it be? — GC.

Dear GC: Your concern that something isn’t right with your mom makes sense. Because of the publicity that surrounds dementia, particularly of the Alzheimer’s type, adult children and even older adults themselves can easily jump to the conclusion that personality changes, paranoia, and/or memory issues signal dementia.

While many people live quite well with dementia if they have the right type of support, this is not a diagnosis that most people would take lightly. There are a number of reversible situations that can cause dementia-like symptoms, so these need to be looked at first.

Medications would top the list. Everyone reacts differently to drugs and their side effects, both prescribed and over the counter. Some of these side effects can include cognitive issues, more often memory issues and confusion though other issues such as paranoia do occur. A partial list of drugs that can have a negative effect on the brain are those for bladder control, anxiety, sleep, pain (OTC drugs, too), allergies and some medications for autoimmune disease, antifungals and antibiotics, as well as those for mental health.

Long as this list is, it’s not even close to being complete, but remember that medications save lives and can improve quality of life for many people, so look for the possible problems without negating the positive effects a drug may be having. If the doctor determines that a medication that your mother could benefit from also has negative effects for her, there might be an alternative form that she can take with fewer issues.

There are a number of other reversible health issues, such as infections, that can cause this type of personality change, particularly in older adults, as well as mental illnesses where paranoia can be a symptom. Therefore, a need for complete physical, mental and cognitive health checkups seems evident.

Yes, it’s possible that your mom is developing some type of dementia such as Alzheimer’s, frontotemporal dementia (FTD) or Lewy body dementia (LBD), but not necessarily. If nothing is uncovered in her physical exam and medication review, seeing a neurologist or dementia specialist may be the next step.

The important thing is to find the root cause with the hope that it’s reversible. If she’s found to have dementia, your next step will be to learn how to help her live well with her disease.