Deal With Delusions and Dementia
Tips for Family Caregivers on Dealing With Delusional Behavior
This article offers a neurologist's clear, step-by-step tips on how to respond to delusions, delirium and sudden increases in strange behavior in the dementia patient.
According to the Family Caregiver Alliance, the symptoms of dementia can be so uniquely troubling they can place a much higher demand on the caregiver than other illnesses do. Delusions can be one of the most troubling symptoms of dementia.
What are Delusions?
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 from a recent talk by New York neurologist Dr. Norman Pflaster.
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. According to Pflaster, "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 the 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. Let the patient know that you are keeping him safe.
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.
This is an incomplete guide and is not a substitute for, nor is it intended to be personal medical care or advice. Always see a physician for medical advice.
