What should I do about delusions in late stage Alzheimer's?

Hallucinations occur when the patient sees or hears something or someone whom you, the caregiver, cannot see or hear. Most of the time, these sensations are relatively benign and do not disturb the patient, although they may be upsetting to you. At other times, the patient may become severely frightened in response to these hallucinations, feeling they are in danger or that they are being attacked.

When this occurs, you will need to consult with the treating physician to see if additional medication, or a tranquilizer, may be indicated to help the patient get over this. More often, however, hallucinations are merely interesting to the patient rather than frightening. One of my patients used to see children coming into his living room, and his interpretation was that they were coming into this room because it was the only room in the house that was air-conditioned.

Still more troublesome can be delusions. One patient of mine regularly accused her caregiver husband of stealing her clothes from her closet. She would become very angry, go to complain about her husband to the neighbors or sometimes even call the police.

This caregiver husband was one of the most caring, loving and gentle persons you could imagine, but when his wife could not find something that she had misplaced, the accusations began. This situation required her doctor to prescribe increasing doses of a major tranquilizer. After several increases in the dose of the medication, the delusions disappeared, and she once again began to sing the praises of her husband whom she described as “the best caregiver ever.

As the caregiver, you may notice the patient experiencing either depression or apathy. Spontaneous activities will grind to a halt; the patient will not eat, get dressed or participate in any activities. Trying to distract the patient or offering tender loving care may help, but sometimes medications will be needed.

Bring this to the doctor’s attention. At this stage of the disease you may have to be in frequent contact with your patient’s doctor, or consult with members of your support group who may have developed some skill or technique for dealing with one of the many behavioral problems which can occur.

Verbal communications in the late stage of the disease will have become quite limited. “Yes” and “no” may be the only words the person can form regularly, and they may develop a kind of short-hand to express themselves. For instance, one patient used just the single word “McDonald’s” to indicate that he wanted to be taken to McDonalds for a hamburger.

As the caregiver, you will have to learn to guess or interpret what the patient is trying to tell you. If the patient can’t find a word when trying to tell you something, supply the missing word to the patient, if you can guess it, so the conversation can continue. Nothing is gained by insisting that the patient try to come up with the missing word.

You would only have created additional frustration.

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