Confabulation, anxiety, depression

Maru · May 10

Moving on into the reality of DH's ALZ. For upwards of a month DH has seemed to be normal and, admittedly, I allowed myself to become somewhat lulled (is that a word?)into my own denial. What I failed to see was that his constant itch was most likely anxiety, that his calling hid brother more often was his attempt to a ease his depression, which he was finally able to express in way I could understand. He seems to have lost the ability to be able to express what he is feeling. Then, it finally dawned on me that all these far-fetched opinions that he has been telling me were confabulations about different sources of worry. For example: "I wish grandson X was a better father. He is too harsh like his dad was." My immediate reaction (since he was "now normal" according to my denial) was to ask why on earth would he say such a thing, as we haven't seen our grandson in almost 2 years and there was no reason to assume this. DH just made this up, probably influenced by his own depression and anxiety.

I have to re-adjust my thinking and my responses, obviously. I am just surprised at how subtle some of the changes have been. Loss of memory and loss of words and wrong word usage are far easier to see.

We will see his Primary doc in two weeks and will talk to her about what meds to take for both the anxiety and depression.

SDianeL · May 11

denial is common so don’t feel bad. It’s like not seeing the forest for the trees. Confabulations and delusions are common. They aren’t necessarily due to anxiety or depression. It’s more likely his brain isn’t working properly due to disease. The “facts” he retrieves get jumbled and he believes they are real and true. He can no longer reason. As someone posted here, his reasoner is broken. Medication may help anxiety & depression but it may not help confabulations or delusions. Best to get in his reality and agree with him and then redirect. Read the book “The 36 Hour Day” and search for Tam Cummings videos online. They will help you help him. I found that doctors aren’t much help other than prescribing medications. Caregiver training helps more along with this online community. 💜

harshedbuzz · May 11

@Maru

I think it's pretty common for those closest to a PWD to slip easily into denial. IMO, it's a combination of loving eyes and seeking to avoid the reality of losing their LO.

I think it's a great idea to consider meds. If your PCP isn't proactive around this, I would ask for a referral to a geripsych for meds management. They're the experts in managing psychoactive medications.

My dad had mixed dementia— Alzheimer's and WKS. While many people with dementia do seem to have conflated memories in the middle and late stages, it is a hallmark of WKS and is seen even in early stages. He'd been treated for depression for years; his geripsych thought he actually had bi-polar disorder. He was already on Prozac when we decided to add meds to the mix.

It's critical when discussing with the doctor to differentiate between delusions (false beliefs with no basis of fact), hallucinations (actually seeing, hearing, smelling something) and confabulations (real memories distorted by details that are forgotten and backfilled with random thoughts).

For dad, the confabulations started well before the other issues and seemed like a rewrite of family history. He often ascribed all manner of ghastly deeds committed by his sister or mine to me. For instance, he told my then middle school son that I'd gone to a bar and left with some random man to have sex/drugs and "left the kids at the bar". It did happen, but it wasn't me. This was a decade before he was diagnosed albeit late in the game. Not all confabulations were unpleasant— some were recounts of fun times where the who, what, where and how ended up garbled. He once described a drive on a date night with my mom that happened in 1960— but set it a vacation area he visited in the 1970s driving a car he didn't own until 2006. If you didn't know the real story, it would seem perfectly plausible.

If his musings about his grandson are a conflated memory, it's because he witnessed or experienced a someone who was victim of a harsh parent. Perhaps a friend or cousin or even himself. One thing we noticed as dad progressed into later stages, was that he often conflated things he saw on TV. His mind made him the victim of crimes, accidents and dangerous weather. Watch for this— you may need to install parental controls. Once when I asked how he was doing, he told me he was kidnapped by bad men, driven somewhere and murdered. That was the plot of mom's crime drama from the night before. Why he could recall that but not whether he'd eaten is another mystery.

Dad's delusions were mostly very negative. I don't believe they were at all related to depression or anxiety. His geripsych added an atypical antipsychotic for this symptom. It wasn't enough to eliminate them entirely, but it made it easier to redirect the topic.

Oddly, most of his hallucinations were pleasant for him. The ones that weren't, were irksome at worst.

HB

Maru · May 11

https://alzconnected.org/discussion/comment/242799#Comment_242799

Luckily for us, our primary doc is quite sympathetic to dementia and how it affects the caretakers, as well. She is not pill happy, but is willing to give things a try to see if they help. I have found my best advice right here on this site from those in the trenches. Hope that you are holding up in your trials.

Confabulation, anxiety, depression

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