Behavioural and psychological symptoms of dementia (BPSD)
Although it is widely understood that dementia affects memory and the ability to perform everyday tasks, fewer people appreciate that many of those living with dementia can also develop some strange thoughts and ideas such as false beliefs, delusions or hallucinations (seeing or hearing things that aren’t actually there).
These delusions and hallucinations are part of the behavioural and psychological symptoms of dementia, or BPSD for short. Some scientists refer to them as neuropsychiatric symptoms.
It’s thought that at least 9 out of 10 people with dementia will experience BPSD to some degree but the nature of their symptoms will depend on their individual characteristics, the type of dementia, the part(s) of the brain which are affected and the stage or extent of disease. BPSD symptoms can occur at any stage of the disease process.
Hallucinations
Hallucinations involve seeing, hearing, feeling or smelling things that are not actually there. Hallucinations in dementia can be pleasant or scary and distressing. For example, the affected person might enjoy a conversation with a deceased friend or relative or hear people yelling at them, see people coming after them or feel bugs crawling on their skin. Visual hallucinations – seeing things – are particularly common in Dementia with Lewy bodies (DLB). They tend to be very well formed and detailed, recurrent, and consist of people or animals.
Delusions, abnormal thoughts and beliefs
Delusions are unshakeable false ideas which are features of dementia and other mental illnesses. In dementia, delusions are typically suspicious and paranoid in nature and they can often lead to false accusations.
Paranoid and suspicious beliefs
It is common for people living with dementia to believe that others are trying to harm them in some way. These beliefs can include fears of being targeted, watched, talked about, or stolen from. This can lead to unpleasant feelings of fear and anxiety, they might quickly leap to all sorts of conclusions, and become wary or suspicious of anyone they encounter. They might accuse or suspect strangers, tradespeople or even friends and family of all sorts of wrongdoing including infidelity or criminal activity. Capgras delusions are specific beliefs about a partner being unfaithful.
This video explains a little more about delusions (especially at the 2 minute mark)
Delusions can be distressing for all concerned
Delusions can be distressing for everyone involved. The person experiencing these thoughts will be suffering all sorts of angst and those that are unjustly suspected or accused will feel wounded and hurt.
Challenging false beliefs
It is unlikely that you will be able to convince someone experiencing a delusion that they are mistaken and their beliefs are not true. A common feature of delusions is that they are fixed and unshakeable.
If you are wrongly accused you will naturally want to straighten things out, but arguing is unlikely to help. Nor is logic or reason. These are all more likely to add to the confusion and distress of the person who is experiencing the delusion and living in a very different reality.
Helping someone with delusions
As with other BPSD symptoms, although not easy, it is important to recognise that these false beliefs are not deliberately intended to harm or hurt you. They are part of a disease process which is damaging the brain and causing the person affected to interpret and experience things differently.
Please note that any confrontation or argument about false beliefs is more likely to fuel matters and make things worse.
Most emotions such as anger or fear are short lived unless they are repeatedly triggered and so shifting the conversation topic or activity can be very helpful. Similarly connecting positively and sympathetically on an emotional level can be more effective, particularly using feelings based communication.
If possessions are mislaid or difficult to find then that can perpetuate beliefs of theft. Tracking things down and consistently storing them in the same place can help.
Keep an open mind
Bad things happen and bad people do exist and so just because someone with dementia makes an accusation doesn’t necessarily mean it is false. Keep an open mind and don’t make automatic assumptions. Anything is possible so do consider and explore what is actually going on.
Sometimes accusations reflect real and current circumstances. Sometimes they stem from events that happened in the past but were previously forgotten or even hidden.
Medication for delusions
Various medicines known as “antipsychotics” can be used to try and ease these particular dementia symptoms but they are not always effective and can increase the risks of other serious conditions such as strokes. Medical experts recommend that they should only be used for certain patients with dementia when the benefits outweigh any risks.
