A Streetcar Named Delusion - When Dementia Takes You For A Ride

In the ten months that I have closely observed my 88 year old mother's mental health decline with "Unspecified Dementia", few things are more heartbreaking than seeing her live with increasing episodes of delusion.  The delusions can range from harmless goofy little things to very frightful, terrifying experiences.  These episodes can carry over from one day to another and that can be serious if the delusion is a particularly scary one.  Think of having an extremely graphic nightmare that you can't wake up from, and I think that you will have some understanding of a severe negative delusion experience.

Harmless delusions are the ones that don't really matter in the overall scheme of daily living.  If someone believes that a car parked outside belongs to a family member, it may bring them comfort to think that the family member is close by.  My mother frequently thinks that my car is parked outside her assisted living apartment.  She also thinks that I am a "big shot" and have some say in the running of the assisted living community where she resides.  Other delusions include "false beliefs" like the idea that mom was going to be marrying one of her male caregivers.  This one can be harmless, but may lead to worries among the other residents that a sexual abuse situation may be developing due to mental vulnerabilty.  Quite understandably, the facility's (male) staff become very uncomfortable if rumors develop as a result of these delusions.  In the above examples, the delusions may be accompanied by happy thoughts and general contentment.  It is desirable to preserve whatever feelings of happiness and contentment that may occur, so medical intervention is usually unnecessary.

Severely negative delusions can be harmful.  My mother has had a number of death related delusions in the last six months.  These have ranged from believing that an auto accident had occurred on the grounds causing a fatality, to finding a dead person in her bed.  Some of the death delusions obviously have a hallucination component to them.  Despite having medication dosages modified or even changed, these episodes continue to develop periodically.  They are very frightening and "real" to my mother.  Paranoid delusions also have the potential for harm and raise serious safety concerns.  On one occasion, my mother was certain that she was going to be targeted for murder by the assisted living staff.  Besides taking certain prudent safety steps (removing knives, scissors, and other obvious defensive weapons from her apartment), medical intervention was essential in this and all of the examples cited in this paragraph.

Sadly, effective treatments are discovered by trial and error with varying degrees of success.  What appears to be working this week, may not be by next week.  It can be frustrating while possible solutions are being tried and time continues to pass with sometimes minimal results.  It's difficult to see your mother living with terror and fright on a daily basis, even if only for a few days at a time.  Geropsychiatric nursing has a lot of knowledge in dealing with these situations.  Individual drugs or some combinations of drugs can have promising results.  It takes time and a lot of patience while these potential solutions are tried and evaluated.  There is no "one drug fits all" solution, at this time.