Question: How do I respond to my mother with Alzheimer’s disease who keeps accusing me of stealing her money?
Answer: Your mother is experiencing a delusion. Delusions are false, fixed beliefs that cannot be explained on the basis of one’s culture or religious background. In dementia, delusions occur frequently, with up to 30 per cent of individuals experiencing delusional ideas at some point in their illness.
Delusions in dementia are most frequently paranoid or persecutory in nature, and typically involve themes of people stealing from them, or people trying to harm them (e.g. poisoning). Depending on the theme of the delusion, the person with dementia may become anxious, fearful, depressed, or even aggressive.
When delusions arise suddenly, it is always important to rule out a medical condition, like an infection, that could be causing the new symptoms. In these cases, treating the underlying medical problem, or stopping a new medication, might reduce or eliminate the delusion.
If the doctor confirms that the person is medically stable, this might be another new symptom of the illness, and suggests that the underlying dementia is getting worse. Delusions in dementia however, are not necessarily a permanent symptom of the illness, and may wax and wane throughout the course of the disease.
Dealing with delusions
The first step in dealing with a relative with delusions is to remember that the delusion is part of the illness. It is therefore crucial not to take the accusations personally or blame yourself for this behaviour. Do not become defensive or react in an angry manner. In fact, attempting to directly address the accusation and contradicting your relative, is probably the worst thing you can do, as this will only serve to focus the person’s worries even more and lead to further anger.
I typically suggest that the caregiver attempt to “derail” the person by changing the subject completely and/or distracting them with pleasurable activities, music and food. It may be necessary to try several diversions before the person will calm down. At times, asking another relative or friend to get involved, and utilize these same techniques may be helpful.
In most cases, delusions can be handled in this manner. More rarely, the delusions will be so distressing for the person, or might result in dangerous aggressive behaviours. In these cases, discussion with the person’s doctor might be necessary as medications to treat the delusions may need to be prescribed.
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