Magento 1 - Stop Spam Accounts from being created
Honey Spam adds a hidden field in the account creation page.
https://github.com/magento-hackathon/HoneySpam
Credits to Fabian Blechschmidt and contributors.
There's a built-in CAPTCHA in Magento 1: Configuration - Customer configuraiton - CAPTCHA This should help stop the fake account creation. At least it worked for me. For other types of form spam you'll indeed need an extension.
This one works well: https://fishpig.co.uk/magento/extensions/block-robots-stop-spam/