Among the many unfortunate side-effects or symptoms of Alzheimer’s (and other forms of dementia) is the susceptibility of the afflicted individual to false beliefs and inaccurate perceptions. This was made painfully evident to our family in dealing with my dad, Jim. I mention a few specific illustrations of this further on. For more detailed accounts, read “Jim’s Story.”
But, Jim was hardly unique in this regard. So, as I have said numerous times in this weblog: what follows is the resource that I wish I had had when I was managing occurrences of paranoia in my dad’s house. I hope that it can help you and your family dealing with what is an extremely difficult aspect of the disease.
Definitions
Hallucinations
Medically, a hallucination is defined as follows. “The apparent, often strong subjective perception of an external object or event when no such stimulus or situation is present; may be visual, auditory, olfactory, gustatory, or tactile.”[1] So, an Alzheimer’s-afflicted person may perceive insects, pests or the like of that, where there in fact are none. (But check the claims out first! See Tip # 3.)
Delusions
Similarly, a “delusion” is “[a] false belief or wrong judgment, sometimes associated with hallucinations, held with conviction despite evidence to the contrary.”[2] Delusions are far more common than hallucinations. There are many relevant sorts of delusion. As recounted elsewhere, Jim falsely believed that my children (then around the ages of 6 and 8) were stealing from him and leaving their toys in his personal space. Now, there’s no question that kids leave toys around. And my kids were no exceptions. But my mom used to teach kindergarten-age children. And what my dad falsely believed were my kids’ toys, were actually learning games (and so on) that my mom was storing at home.
Tips
- Remain calm. You will only worsen the situation by loosing your cool. Additionally, Alzheimer’s sufferers (among others) pick up on – and feed off – your own emotional state. So, try to keep your reactions in check. It’s easier said than done, I realize. But it’s importance cannot be understated. It is a key point.
- Draw near to your loved one. There is something to be said for just “being there.” Sometimes maintaining proximity can by itself defuse the situation. It’s said that people’s three favorite words are “please,” “thanks,” and our own names. On the assumption that this bit of psychology is not rendered worthless by the Alzheimer’s, try trading on it. If they don’t respond to the usual forms of address (“it’s okay, mom”; “I’m here, grandpa”; etc.), then see if their given name will snap them out of it.
- Investigate the claims. Sure, your loved one’s cognition is “off.” We know this is true. It is not uncommon for a cognitively impaired individual to experience perceptual difficulties. However, as the saying goes: Even a blind rooster picks up some corn. The fact that mom or grandpa is prone to false beliefs does not mean that every utterance is false. So, before you just assume that there really is no spider on the bed, it’s probably best to check to make sure.
- Express concern, empathy, reassurance, understanding. For dementia patients, it’s not always what you say, but how you say it. You may have to modify your approach depending on the person’s level of function. But, some suggestions include statements such as: “I’m so sorry that you are having such a [bad, painful, scary] experience,” “I can’t imagine what you are feeling right now,” or “I cannot fully relate to what you are experiencing, but you should know that I am here for you.” While you’re investigating – or while you are following any course of action – say encouraging or comforting things.
- Distract/redirect. After you have investigated and decided that the relevant claim (whatever it was) is baseless, then you can put some energy into trying to help your loved one get the uncomfortable thought out of his or head. There are several tacks that you could try. Maybe it’s close to time for a meal – or at least for a glass of water. You could also try turning on some music. (See “Can Music Calm an Alzheimer’s Patient?”) Along similar lines, you could try switching on the television. Or perhaps you could draw his or her attention to some old photographs, read out of a book or newspaper article, or take him or her on a walk.
- Turn off background noise. Of course, the previous suggestions assume that the radio or television are not already on. If dad’s delusions or grandma’s paranoia arouse amidst some level of background din, then consider quieting things down. Lower volume controls or power off electronic devices entirely.
- Take your loved one to the doctor for a checkup. Granted that Alzheimer’s can issue in delusory beliefs and hallucinatory perceptions, it is a fact that other conditions may cause similar symptoms. For example, a urinary-tract infection (or any ailment that makes a person feverish) can derail a person’s belief-forming mechanisms. The bottom line is this: Just to be sure about the etiology, have your loved one evaluated by a medical profession. Prescriptions may be another factor. If there has recently been a dosage or script change, these alterations could be relevant to the behaviors that you are dealing with.
- Don’t take any negative reactions personally. The fact that an Alzheimer’s sufferer has a proclivity to react badly needs to be kept clearly in mind. Take it in stride. My dad owned a baseball encyclopedia that he purchased in 1969, when he was around 39 years old. When I was about 13, he bought an updated version for me. I had in in my possession for decades. At one point, when we were all dealing with his dementia, he took the updated book off my shelf and claimed that it was his. He insisted that I return it. Truthfully, it hurt my feelings because his giving it to me had been a special memory. I felt that it must not have been important to him. But this reaction, while understandable, was unfair. His brain was being ravaged by a disease that was, to put it somewhat artfully, “deleting” memories from his hard drive. Yes, he had confused his book and mine. But he did not do this spitefully. His own book had meant something to him, and this memory (crossed up as it was) had been what he acted upon.
- Keep to the daily routine (as much as possible). If your loved one is anxious or scared, familiar behaviors or objects can be a great comfort. When paranoia strikes, try to steer your charge back to the usual activities. If it’s time for dinner, then set the place settings as you normally would. Leverage the schedule to help “reset” things and calm everyone down.
- Note patterns. If grandpa becomes agitated or confused after morning coffee, then try switching to decaf.[3] If mom gets skittish in the evening hours, then you might be contending with an ancillary condition known as “sundowners.” Perhaps grandma is set off when the postal truck passes by the window. Or it might be that dad’s episodes begin after visits from one particular nurse. Perhaps events occur during the grogginess that lingers after an afternoon nap; or maybe they happen following a sleepless night.[4] Any of this information could help you to understand, anticipate, and deal with the relevant delusions. Plus, it will give you further detail to disclose to medical professionals.
- Let them take their time. You want the delusional or hallucinatory experience to conclude. Toot sweet. And I get it. But, don’t rush them. It’s irritating, scary or uncomfortable for you loved ones as well. It’s important to “de-stress” the circumstance, not inflame matters. Placing them under time constraints – whether explicit or implicit – will therefore be counterproductive. The ramp up in pressure typically will not go unnoticed. It will merely increase the felt frustration by all parties and prolong the event.
Of course, these suggestions are not magical. The paranoid incident will pass with time. The best that you can do sometimes is simply to be present and loving. But also bear in mind that persistent or recurring delusions/hallucinations may require pharmaceutical (or other) interventions. So, your loved one’s physician should be kept in the loop. (See, again, Tip #7.)
Notes:
[1] “Hallucination,” MediLexicon, <https://www.medilexicon.com/dictionary/39105>.
[2] “Delusion,” MediLexicon, <https://www.medilexicon.com/dictionary/23469>.
[3] Probably, you want to decrease or eliminate caffeine in your loved one’s diet. But, consult with his or her doctor. For other, possibly beneficial, dietary changes see two other articles on this website: “Alzheimer’s-Proof Your Diet: Vitamin D and Other Nutrients” and “Alzheimer’s-Proofing Your Diet: Carbs, Fats and ‘Exotics’.”
[4] For more on Alzheimer’s and sleep, see the following posts: “Alzheimer’s and Sleep: Too Little, Too Much and Just Right” and “Alzheimer’s and Sleep: Herbs, Spices, and Other Supplements.”