A delusion is about to be smacked by reality. What do I do?

EvaBee · August 18

My mother is in an assisted living and has moderate dementia. About once every month or two, she'll have a new delusion. They are quite persistent. The same story will come up for more than a week, sometimes the story will slowly shift over time. They often feature themes of rejection and loss. She recently has been telling me that a particular person who leads a weekly activity called her and told her he was cutting all ties and had moved away to do something very important. That he wanted her to destroy all evidence they had ever known each other - books he gave her, etc. This is someone she has known a long time and considers a good friend. She has been sleeping poorly thinking about it. She is mourning losing this friend, wondering how others will react to his sudden departure and whether he arranged for a someone to fill his role. She is utterly convinced she will never see this person again.

I fully expect she's going to walk into her activity this week and he will be there as always. I will go with her. I'm concerned how she's going to react and whether she is going cause herself embarrassment. I'm also wondering whether to let the activity leader know what's going on in advance, because she may try to have a very strange conversation with him.

How do deluded people react when physical evidence disagrees? And what is worse, me telling her friend in advance that she is having a delusion, or me letting her embarrass herself?

JulietteBee · August 18

Sadly, I do not have an answer for you. Lke you, Idk if it is better to tell my mom's friends of her Alzheimers diagnosis or have her embarrass herself as she is losing more and more words. I think both our moms would be mortified if they thought we ratted them out and trust may forever be lost.😢

H1235 · August 18

I doubt the physical proof will allow her to understand it’s a delusion or that she was wrong in any way. I would guess her mind alters the delusion in some way to fit with the evidence. There will probably be some kind of excuse that makes perfect sense to her. I think I might tell this person about this delusion. I don’t think there is a right answer here. I would try not to worry about her embarrassing herself. She has dementia. While this friend may be confused and at a loss for how to handle things, I hope they would be aware that strange behaviors sometimes happen with dementia.

pamu · August 18

I have no real advice but can share my experience. My mom (88YO) is in MC. She has delusions and fixations about staff often. The latest one is that her charge nurse is pregnant and that her husband doesn't want the baby so she is going to give the baby to one of the other nurses. Ugh. It's really difficult not to comment or let her know this is false. Because she is one of my mom's main caregivers I don't want mom to have negative feelings toward her. I just said, "oh wow, that must be difficult" and I also said, "she's so nice and a good nurse". Mom agrees with that and I think it made her have supportive feelings toward her instead of something unpleasant for her to focus on. All of the staff know that she has delusions so we are not embarrassed anymore. During a visit last week mom was having a difficult afternoon and yelled to me in the hallway, "I know you're having trouble with your husband but don't take it out on me!". One of the nurses passing by said to me "don't take it personally". I wasn't embarrassed for her but all I could think of is that I wanted to say to everyone who witnessed it…"I don't have a problem with my husband!". LOL.

ARIL · August 18

It’s great that you can be there with her to help her through this, whatever happens. But I think it’s unlikely she’ll have a realization that she was mistaken; it’s more likely she will fold the moment into her own reality. He’s back. He changed his mind. That’s not him. Or even have no reaction at all.

I would tell the friend in advance, but briefly: Mom has been imagining that you have moved away, and she has been upset about that. So if she says something to you, that’s what it’s about.

Nothing about this disease is easy. Your mom is lucky to have you.

Maru · August 18

When a person with dementia has delusions, that is their reality. You are living in a different world than hers. Trying to get her to see reality through facts, proofs, etc., will only lead to agitation for your mother, possibly anger and arguments. If she is having delusions, your mother's friends may already have recognized that something is "off". If she is living in AL, undoubtedly she is not the only one there with dementia.

EvaBee · August 20

Thank you so much for the responses. They were very helpful to me in planning for how it might go today. I appreciated Pamu's story about her mother's delusions about staff and the "unwanted baby". It opened my eyes on how vivid and persistent and odd these delusions can be - it's a whole soap opera in the mind sometimes. I'm realizing some of my mother's frustrating behaviors in the past months are also flavored by other delusional thoughts, more than I had been aware of.

I wanted to follow up to let you know how it actually played out. My mother spent the week tying herself up in knots and losing sleep, thinking about how shocked people would be when they found out the activity leader had suddenly left, and wondering about various strange details - it was like a bad novel. Her best friend also goes to the activity. I let her know that my mother was having the delusion and the recommendations for how to respond. They had dinner together and my mother told her friend a whole lot of her delusional thoughts. Her friend tried logic to talk her out of it and found that didn't work at all. So, then she fell back to the recommendations on how to respond empathetically. Her friend was really glad I had given her a heads-up! I made sure that my mother didn't start rumors that would get back to the staff and have them worried that the activity leader had quit.

This morning, the activity leader walked in as usual. My mother cried out, "I'm shocked!" But then we all got on with the exercise activity. Afterwards, she and her best friend and I left the room together and started talking about it. The activity leader said hello on the way out, my mother asked him a question about, "What was all that about?" and I was able to quickly explain that she'd had a dream that he'd told her he had quit and left town. He reassured her he wasn't quitting or cutting contact.

So, my mother accepted that her thinking was not correct and that it was a dream or delusion. She finds it disturbing that she can't trust her mind. We were able to talk about it. Maybe tomorrow she will forget the reality of today and go back into the delusional thoughts. She still has plenty of the delusional "memories" related to this which she perceives as facts.

If my mother were 70 years younger, she would probably be in training to be a doctor. She always wants to understand her diagnosis. And then she forgets most of it. She has been open with her friends that there is something wrong with her brain. She is an unusual person. But, at least in her case, at Stage 4 of dementia, when the delusion got smacked hard by reality, she was able to understand it was not real.

Arrowhead · August 22

It's called Anosognosia, a condition there the person doesn't realize there is something wrong with them and will not believe those who tell them that there is. Their hallucinations are real to them. Their reasoner is broken. No matter what evidence you have they will not accept it. They are in their own world, and they will live in it no matter what you say. Arguments will not convince them, only anger them. The best thing for you to do is to try to see things their way and to live in their world as much as possible.

A delusion is about to be smacked by reality. What do I do?

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