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Fluctuating cognitive levels and paranoid behavior can be common with some types of dementia. Paranoia can also be a symptom of a mental health disorder. I'd see if she could get a referral to a neurologist to have her further evaluated.
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Yes, you need to have her evaluated.
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Yes, it' fairly common. Have you had her evaluated by her family doctor? It's an easy process and usually one visit is enough for an evaluation.

My Mother's paranoia reached the place that she started calling 911 two or three times a week. Needless to say, she could not stay alone any more and came to live with me and my husband. At first, she was extremely paranoid and easily frightened. For the first year or so, we would have to reassure her nightly. She imagined that "unfamiliar" sounds were people under/behind her bed and even outside her window. I'm very thankful to say that she's comfortable now and the paranoia seems to be behind her. A loving, reassuring environment makes all the difference. Good luck to you and your loved one.
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