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Living With Alzheimer's >> Behavior Basics | 04.24.15

Delusions: when fantasy becomes reality

Among the more troubling symptoms of dementia are delusions that cause the person to treat real situations as the truth.

Some of the more common delusional beliefs of those with dementia:

  • Claiming that people are stealing from them or hiding personal items.
  • Believing people close to them are imposters or guilty of unfaithfulness.
  • An inability to distinguish fantasy from reality, such as believing characters on TV are real or stating they have had direct conversations with God.
  • Paranoid thinking that others are plotting against them, spying on them, or threatening them.
  • Believing that caregivers are plotting to abandon them or put them in an institution.
  • Claiming they have a serious physical illness when they are not sick.

As a caregiver, it can be difficult to take seriously the claims of a delusional person, even in those cases when they could be reporting an actual experience. (For example, if a person’s money was actually stolen, their claim might be unfairly dismissed as fantasy.)

Try to understand what the delusional person is feeling.

Delusions may appear strange, but to the person experiencing them, they are very real. The person is not “lying” or “making things up”—instead they are expressing how they truly feel. Try to be understanding and see if there are elements of truth in the claims of the person.

The more outrageous the delusions—for example, if the person continues to insist on the truth of things that are clearly impossible—signal it’s time to seek help from your doctor. Your physician or specialist will be able to recommend some next steps in the face of serious delusions, which could be caused by various physical illnesses.

Of course, if delusional behavior leads you to believe a person may hurt themselves or someone else, you should immediately call your doctor or 911.

How should you respond?

In the face of hurtful delusional behavior, such as accusations of theft, betrayal or infidelity, remember to not take these attacks personally. Keep in mind, to the person with dementia, this is their reality. Try to be sympathetic and always respond with a calm and forgiving nature. Your attitude might help convince them that you have their best interests at heart.

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