Husband's dementia has gotten significantly worse and he's increasingly agitated and paranoid. Any advice is appreciated.

So far I haven't heard any positive stories about Nuplazid. I know several caregivers whose doctors prescribed it for their loved ones with psychosis, and after a few months and $12,000 lighter in their wallets, went back to the doctor, were taken off the drug and prescribed an old tricyclic in lowest dose. I think the drug is imipramine and it's been around long enough that it's cheap.

Sundowners? My 83 year old husband has Pseudo Parkinsonism, dementia, heart issues among other things. He saw people in the yard at night (no people). Went and sat in the car at midnight to "catch em". Using Seroquel and Aricept have helped but now it looks like "daytimers" (my term) may be there to. Will check out the Nuplazid, thank you.
I give him his pills in teh morning. Put the new one in the mix and say "here ya go" "Thank you- we're off on a roll for the day " has worked for me
Good luck and bless you

After so many years of shared decision making it must be difficult to suddenly be placed into a situation where you must make decisions, and keep your husband in the dark about those decisions. However, given his dementia, it is the best thing going forward. You have the authority, and you must use it to keep both of you safe.

For long term options, you might want to consider contacting a SW with your local Area Agency on Aging (AAA). The SW was able to help me a lot when I was searching care options for a neighbor, not only providing a list of every LTC facility (and highlighting the ones she thought most met senior's needs and the ones we should avoid) but identifying what programs might be available to help with payment.

Has he been checked for a urinary tract infection?

This could be the problem as it is escalating with time.

It sounds like you are at a place where you need to make decisions for the future. You can not care for him if he doesn't allow you to. What are the plans for the time that you can not do anything and he is failing?

I'm hoping at this point in his prognosis that you have medical and durable power of attorney for him. With those in place you can freely talk to his Dr's either in person, on phone or the patient portal. You don't need to ask your husband for permission or even let him you know that you are talking to them if it will save you from his outbursts. Sadly paranoia is common with Parkinson's, but I know there are medications available to help with that, and you need to make sure that he's trying and taking whatever he needs to, even if it means you are crushing them up and putting them in his food unbeknownst to him. I also put my husbands medications in applesauce as he has some trouble swallowing, so you could try that too. (or pudding or ice cream) And I will say, don't share with him everything that you're doing with his Dr's , if that seems to upset him. Just do what needs to be done to get him the help he needs, and hopefully your household will be more peaceful. Best wishes.

Has the PCP or neurologist discussed hospitalization and treatment by a geriatric psychiatrist? Your husband would likely spend 1-3 weeks in the hospital while they find a medication that works and stabilizes his condition. My understanding is seeing people that are not really there is a common symptom of Parkinson's Disease, particularly when mixed with other dementia types.

I suggest asking for a geriatric psychiatrist recommendation and call him/her to arrange hospitalization.