Delusions in Dementia
People with dementia are sometimes affected by delusions. What is a delusion? It’s a fixed, unjustifiable, false belief that is contrary to culture. There are some fixed false beliefs that could be better described as wishes.
Your uncle might think that his comb over really does cover his bald patch, but loads of uncles think that. Your aunt might believe in ghosts, or fairies, or the power of throwing salt over your shoulder to ward off the devil, but superstition and traditions are not the same as delusions even if they are not justifiable.
What is a delusion?
A delusion is when there is no evidence for the belief. A person with dementia might think that the care workers are stealing from her. Of course, this might be true, and you need to check it out. But if there is no evidence, you might consider whether this is a delusion. Sometimes it is very clearly a delusion. They tell you that the Queen was here. It’s highly unlikely that something like that could happen without everyone knowing, and in any case, sadly, Her Majesty died more than a year ago. You can imagine why this might be in the forefront of the person’s mind. Maybe they’ve been watching a documentary on TV about the royal family. It has become mixed up in their head. It’s defined as a delusion when they can’t be shaken from the belief by logic.
So does logic work?
Logic is a useful tool. If you are disagreeing with someone, logic seems to work well. You say to your husband there were five cakes here and now there are four and we are alone. You must have eaten one! You might say to the children, please do your homework now because you’ll be too tired after football. You are giving a good reason to change their idea about what to do next. You are giving your husband a reason why he can’t deny he succumbed to temptation. But logic only works if the other person can reason and work things out. That’s not the case in dementia.
“Why do we try to argue with the person with dementia? We may always have done that, all our lives, and it is hard to break the habit. We may be willing them to still be able to reason and follow logical trains of thought, and it is heart-breaking for us if they can’t.”
You may be tempted to use logic when the person with dementia has a delusion. You might argue that the care worker can’t have taken you purse because they were not in the day it was lost. The problem with that rational approach is that the person is so fixed in their belief that they will reply that the care worker must have crept in when no one was looking. Nothing you can say will remove their belief. Worse than that, it might make them think you are siding with the thief, and it can undermine their faith in you. Even after they can’t remember what you were arguing about, they may be left with a hangover of bad feelings about you.
Why do we try to argue with the person with dementia? We may always have done that, all our lives, and it is hard to break the habit. We may be willing them to still be able to reason and follow logical trains of thought, and it is heart-breaking for us if they can’t. This is even though we know that the person with dementia gradually loses the capacity to work things out or use reasoning. Reduced short term memory and working memory make this impossible over time. We are tired and so are they, and the alternative to arguing (which is distraction or ignoring the issue) sometimes seems like too much effort. But with delusions, it is actually storing up trouble if you don’t make the effort to avoid an argument. It builds up bad feelings and stress that can come out in other ways over the day. Understanding that it is a symptom of whatever disease is causing the dementia is the first step to preserve your energy and your sanity.
If you want to know more about delusions and how to manage stressed behaviours in dementia, try my audiobook or information that is freely available on my website.
