Scary and depressing delusions - how to respond?

EvaBee · April 18

My mother is in stage 4 of dementia. She's been anxious for over a year. Since she hates meds, I haven't felt it's severe enough to push for anxiety medication. I've been increasingly aware she is having delusions that cause more anxiety. I know the general advice is to accept their reality and not argue with how they are remembering things. But, the delusions she is having all twist reality into a scary and depressing place. I think they might start with nightmares. But then in the morning she starts to think they are real, and the thoughts keep recurring for days. Then maybe they go away for a while, and then weeks later they pop up again. For example: Six weeks after the news broke about the Guthrie kidnapping, she spent a couple of days convinced someone was going to come to her apartment and kidnap her. She begged not to be left alone for a minute. Most commonly, she "remembers" my brother and me saying abusive and threatening things to her, things we would never say in a million years. I'm not aware of any actual abuse in her past at all, beyond some schoolyard bullying more than 85 years ago.

When she talks about this, I try to assure her that her family loves her, that she's safe. I tell her I think she must have been dreaming, that these things didn't happen.

I know I'm not supposed to argue with her when her thoughts are distorted. But it's not helpful to let her just think things like her loving son is a mean person who is plotting against her. Deflecting doesn't seem like enough since the negative ideas keep getting mentioned repeatedly. Fortunately, at this point we can still discuss her false memories calmly, but it doesn't push the scary and depressing delusions out of her head. What else can I do to respond to her distorted thoughts?

I am assuming that this is going to keep getting worse and that at some time medication will be needed to help manage this. Does anyone want to share how they knew it was time? What medication was used? Did it help? Were there side effects?

sandwichone123 · April 18

I'll let others answer about medications, but to me it sounds like she's watching TV and then thinking that what she saw relates to her. You might want to see if you can limit what she sees as a way to decrease her delusions.

Quilting brings calm · April 18

If she’s been anxious for a year and is now having delusions …. It’s time for medication. Talk therapy isn’t going to help because she won’t remember the discussion five minutes after the appointment now will she be able to do any ‘affirmation, validation, etc’ between appointments. There is no reason to allow her to suffer anxiety when medication will help. There’s no reason for you to suffer dealing with her anxiety either. There’s enough other things to deal with.

SDianeL · April 19

a Geriatric Psychiatrist is the best type of doctor to prescribe and manage medications for dementia. Get an appointment with one. If the delusions are causing anxiety it’s time. Agree she should not be watching the news or shows that might trigger her delusions. Music videos might be better.

H1235 · April 19

I agree. I will just add that the right medication and dose will not turn her into a zombie.

harshedbuzz · April 19

It sounds like your mom needs medication. I prefer a geriatric psychiatrist for psychoactive medications as they are the subspecialists in this area. But some neuros and PCP do prescribe.

Given that she is having actual delusions, an SSRI might not be enough. We found it took an antipsychotic necessary to tamp down this sort of thing. Dad's geripsych had him on a cocktail of 3 different meds at low doses which provided relief without sedation. With meds on board, dad was able to respond positively to strategies like redirection and validation.

My dad was stuck of 2 delusions. The first was that mom was cheating on him. And I stole $360K from him. If mom defended herself, he became angrier because now she was lying, too. I was able to convince him she adored him because he was so awesome, but it wasn't practical to drop everything to calm him down nightly when this started. That said, people here suggested that I apologize. I fought this for a long time. I mean, I didn't do it and I feared admitting might make things worse. But one day when I purposely goaded him to make a video to send to his geripsych so he could see what things were like at home, I gave it a try. It took all the wind out of his sails, He accepted the apology and I found the accusation came up a lot less often. Validating how he felt being robbed soothed him. Go figure.

TV was a real trigger for dad. It used to amaze me that the man who couldn't recall his lunch could report the plot of last night's Law and Order: SVU. I used the cable remote to block channels with content that triggered agitation. News and weather were a problem. You may find mom does better on a TV diet of old movies or sitcoms from years ago.

HB

EvaBee · April 23

On TV: My mother actually is barely able figure out how to use the TV remote anymore, and she was never a big TV watcher except for the news. I quit turning on the news a few months ago because it was making her anxious and she couldn't really follow most of it anyway. But she heard about the Guthrie case through other people in her AL, and specifically asked to watch the news to find out about that. Clearly, it was a mistake to let her watch the evening news for a couple of nights for that story. Lesson learned.

Alzheimer stage 4 has been a learning experience for me on the impact on entertainment - first she stopped being able to follow a plot, so dramas are out. Game shows lost interest. Then the news gave her anxiety. Then even many of the Winter Olympic events gave her anxiety - what if someone got hurt? They were moving so fast. Now even the reality shows with performance talent contests are starting to be overstimulating. We are down to mostly PBS shows with no plots, news, or long discussions! "Antiques Roadshow" is calming. Travel shows are good. An hour a day is enough. I keep her DVR loaded with options.

EvaBee · April 23

Thank you for the recommendations to talk to a geriatric psychiatrist. I will follow up. And thank you, HarshedBuzz, for providing real-world examples and experiences.

H1235 · April 23

https://alzconnected.org/discussion/comment/270998#Comment_270998

My mom loved to sew and craft before dementia. She spends a lot of time on YouTube watching these kinds of videos. She also watches some music videos. I set up an account for her and started pulling up things I knew she would like to get the algorithm going in the right direction. I don’t think she knows how to search. This has worked well for her. I hope you can find something that helps.

EvaBee · April 23

https://alzconnected.org/discussion/comment/271008#Comment_271008

Thank you for that suggestion. My mother was also a sewer and crafter, as well as a painter. It is painful that in the last year she's lost the ability to do creative planning. She is even losing interest in going to the art and craft classes at her AL that try to be very supportive. She might enjoy art videos. YouTube would also have plenty of dance and music she would enjoy.

JPJardinel · May 12

It really sounds like you’re doing everything you can to respond to your mom with patience and reassurance, and honestly, the fact that you’re thinking this carefully about how to help her already says a lot about how much you love her.

From what you described, I think it may be time to involve her doctor more directly because this seems less like ordinary confusion and more like ongoing fear and emotional distress that’s affecting her quality of life. One thing that sometimes helps is focusing less on correcting the details and more on comforting the feeling underneath it, like reassuring her that she’s safe, loved, and not alone instead of trying too hard to prove the memories didn’t happen.

Also, here's a post that hopefully will help you out.

https://hopebridge.care/the-connection-between-mental-health-and-dementia-in-later-life/

Scary and depressing delusions - how to respond?

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