Dealing with Delusions and Dementia

People with dementia may suffer from delusions, which are defined as fixed, false beliefs. Delusions can be relatively benign (i.e. the patient believes he is at work when he is really in a nursing home), or they may have a paranoid quality to them (the patient believes that the neighbors are trying to break into the patient’s house to steal his money.) Sometimes the caregiver does not know what to expect from day to day or minute to minute. Here are some tips for handling delusions and the dementia patient.

Sudden Onset of Delusions Can Signal a Medical Problem

The onset of delusions or deterioration in the dementia patient’s functioning frequently signals a medical problem, especially if the onset is sudden. It may be as simple as a urinary tract infection, but blood clots from a fall or a stroke may be responsible. Notify the doctor, who should implement testing immediately to rule out any reversible medical causes, and note that the delirium does not necessarily mean that the person’s dementia is progressing.

How to Respond to Delusions

After a medical cause is excluded, the delusional thinking may be attributed to dementia itself. Caregivers should work with the delusion rather than try to convince the patient that the delusion is false. By definition, a delusion is a fixed false belief. Trying to make the dementia patient see reason can cause the patient agitation and distress.

Try to work around the delusion and distract the patient. If the presence of the neighbors in the next yard bothers the patient, keep the blinds closed, or tell him that he is safe because the doors are locked and they can’t get in. Here are some simple tips for general situations

• If your loved one accuses you of stealing, look for the item with him. When you find it let him know that it was where he left it, “Dad, your wallet was in the dresser.” He may feel bad if he knows he wrongly accused you. You can either laugh about it telling him no problem or let the incident pass by.
• If your loved one feels you are talking about him, find out why. It may be because he heard you whispering to a neighbor. This often occurs if you are having an interview with a caseworker for services. When I do home visits for services, I include the loved one. It makes him feel a part of the conversation. If your loved one is not allowed in an interview, he may feel that you are talking about him. Even if you know your loved one won’t speak in the interview, it will make him happy just to be there.
• If your loved one feels that someone is after him ask who is after him. He may either be having hallucinations or he may be frightened by someone or something. If there is no hallucination, he may be remembering a past incident.
• Be sympathetic to your loved one. Let him know that he is safe and you won’t let anyone hurt him.

Connection Through Art Therapy

Carers can connect with an individual with dementia through those abilities that do not diminish over time, such as appreciating art, theatre and/or performance. Even if a person loses his ability to speak fluently, it doesn’t necessarily interfere with his ability to sing and enjoy listening to music for example or participate in painting, or delight in performance.

While medication is necessary in managing many cases of dementia particularly as it advances, carers and staff who understand that people with dementia are emotionally intelligent and retain their creative abilities may help delay either increasing medication, or at the very least influence, the form treatment takes.

Reaching for the Emotional and Creative Parts of the Brain

Despite his memory loss and diminished intellectual powers, a dementing individual continues to feel emotions and continues to have a need for dignity and love. His capacity to understand the tone of voice and interpret facial expressions, his need for touch and interaction are believed to remain largely intact.

The creative and emotional parts of the brain are reachable through the arts. Tapping into these can positively improve the quality of life. Regardless of memory loss, a person with dementia is expressing a unique identity when engaged.

Dementia and Apathy

Apathy is a symptom of dementia which is more complicated and widespread than commonly believed. While it is known to link to depression, its presence tends not to bother carers or family members, as it is easily managed: having a person watch the television or stare out the window are seen as simple solutions that require little effort to set up.

Addressing the specific emotional needs and tapping into the creative abilities of an individual helps alleviate feelings of apathy and may prevent him from embarking on the path to depression. Apathy is one of the treatable causes of depression in the elderly and is very common among those with dementia. The act of carers engaging with an individual meaningfully and mindfully can lead to enriching and satisfying interactions, which is beneficial to both parties.

Further Activities for a Person With Dementia

The following activities have been known to engage individuals and stimulate both the brain and the body.

• arts and crafts – painting, drawing, cutting shapes, pasting buttons
• community outings
• exercise – walking and doing movements led by a physiotherapist
• food-oriented activities – cake-decorating and vegetable prints
• games – balloon volleyball and bowling
• gardening – creating window boxes and planting a herb garden
• grooming – having a manicure, pedicure or make-up applied
• music – naming that instrument or this tune

How to Tackle Situations in which Dementia Patients Cannot Recognize

Some dementia patients typically become unable to recognize their home, their spouse, or themselves in the mirror. Though the beliefs that the patient is not home or the spouse is a stranger are similar to delusions, what these dementia patients are really experiencing is agnosia.

How to Cope With The Dementia Symptom: “I Want to Go Home.”

The patient will say, “I want to go home,” and may repeatedly pack her bags and persistently try to convince her caregiver to drive her home. She may even slip out of the house when nobody is looking in order to try to “go home”.

Distraction and redirection are recommended. Trying to prove to dementia patients that they are home can cause too much distress. They are unable to be logical due to brain damage. Even if they believed that they were home, the fact that they don’t recognize their surroundings as home can be much more frightening than simply thinking that they are not at home.

What to do When Agnosia Causes This Dementia Symptom

First, it is important to make sure the dementia patient cannot leave the house and wonder. Many caregivers install locks that cannot be defeated by the dementia patient.

Caregivers can try telling their dementia patient that they need to stay put for a while. They can ask patients what they liked best about their old house. The dementia patient may have a particular house from the past in mind. The caregiver can utilize the patient’s response to change the subject. For example, didn’t that house have a nice flower garden? I remember you always liked to plant flowers. Would you like to plant some flowers today?

How to Handle The Dementia Symptom of “Where is my Husband/Wife?”

The dementia patient may ask his wife, have you seen my wife? Agnosia prevents the patient from matching up the visual image of the person in front of him to his memory of his wife. Again, don’t try to prove that the dementia patient is wrong. Instead, be reassuring. Assure the patient that his wife will return soon and offer to keep him company until she comes back.

Another option is to leave the room for a while and then return. Agnosia comes and goes, sometimes from moment to moment. The person with dementia may recognize his wife after she returns. In addition, it is the visual image the person with agnosia has difficulty with. Wearing a familiar perfume or article of clothing might help.

Though it can be emotionally upsetting to the caregiver, it is important to remember that the dementia patient does remember and miss “his wife.” He simply cannot make the connection to the person in front of him, due to a visual processing problem.

Dementia/Agnosia Symptom: Who is that Person in the Mirror?

Sometimes agnosia causes the dementia patient not to recognize his or her own reflection in the mirror. As a result, he or she thinks a stranger has come into the house. Removing the mirrors from the house may be necessary.

When to Call 911

Call the doctor or 911 if:

• the delusions have begun seriously interrupting day to day activities (i.e. the patient locks herself in the bathroom and won’t come out due to fear of the neighbors;)
• if the patient exhibits violent or threatening behavior toward the caregiver;
• the patient becomes so agitated or delirious as to be a danger to herself (i.e. will not comply with medical instructions like taking medication or being careful not to fall.)

In these cases, medication management of the delusions may be needed.

Medications for Delusions

If the standard medicines for dementia like Aricept, Excelon and Namenda have failed and behavioral management isn’t working, neuroleptic medications such as Risperdal or Seroquel may be effective, especially if the patient is delirious or exceptionally agitated. These medications can have very serious side effects. Sometimes the medicine is only needed temporarily to restore the sleep/wake cycle, which can relieve delusions for a time. Be sure that the doctor informs you of all of the risks and benefits.

The classic protocol is not to prescribe sedating drugs in the Valium family (benzodiazepines) because these can make the person’s cognitive abilities worse. But sometimes, the doctor and patient’s family will agree to try this if, for various reasons, there are no other alternatives.

Sometimes anti-seizure medications like Depakote are used. If drugs are prescribed, especially Valium, consider putting side rails on the patient’s bed so she cannot fall out of bed, or consider putting the patient’s mattress on the floor.

While statistics show that some of these sedating drugs are not that successful, on a case by case basis doctors often achieve very good results and so the doctor will want to consider all options to see if the patient can continue to be cared for at home. However, sometimes a nursing home is necessary.

Best Tool to Deal with Patients of Dementia

The greatest tool you can use in caring for someone affected by dementia is patience. You may have to remind your loved one on a daily basis on how to do a particular task, or explain who someone is that he should know, even is it is a family member. Yelling or growing angry at him for failing to do even something simple will not improve the situation, nor improve your relationship with him. Being patient and perhaps talking about the same thing everyday may be exactly what your loved one needs to keep him safe.