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MIL with assumed LBD (so limited hallucination and delusional medication options) believes the MC is infested with bugs that are constantly biting her. It is her latest attempt to prove that she MUST go home --not a past home...the one she knows is across town...forgotten complicated ownership...not returning -- which IS NOT happening. And while we know it is a delusion (yes, we've investigated and there are no bugs), she is picking at her skin until it bleeds. She is also scratching and destroying the walls trying to kill the bugs.



The UTI connection is already known so that has already been addressed and does not pertain to why I'm asking the question. She is also being given a spray bottle to "kill the bugs". Hopefully, that will at least stop the wall problem.



What options do we have to keep her from making her skin bleed?

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This sort of super sensitivity to perceived rashes/bug bites that results in obsessive scratching until skin is truly damaged does occur fairly often with advancing dementia disorders. A different approach might be to have a consult with palliative care - balancing risks and benefits of very low doses of risky medications with her poor quality of life now, and the risk that her behavior may lead to issues with the memory care facility as well.
Topical creams can be helpful, as well as a good moisturizer (such as Cetaphil or Eucerin cream) but I'd check to see how often memory care med techs actually apply them, and to what areas of her body.
Hospice may be a good resource, as the focus here is on her comfort and quality of living, but not necessarily extending the length of her life - if you feel that is what she would choose for herself if she understood her situation.
Will be thinking of you - this is such a hard place to be.
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VERY important with Lewy Body to what medicine she is taking or given!!!
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I would have her seen by a geriatric specialist to see if some mild medication may relieve these thoughts before she gets a really bad skin infection.
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If she can still read, I would print a label that says something like "miracle bug killer and itch alleviator cream!!"

Then put that label on a big lotion bottle and tell her to us as needed. This might give her a different obsession but, at least it will not be potentially dangerous to her health.

This disease just sucks.
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My father had Lewy Body Dementia. He had the same complaint. He called the type of bug "no see ums". His care facility had an exterminator come in and treat his room. That seemed to work.
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AinSeattle Jun 2022
We tried the exterminator/room treatment idea and she now claims they came and did the whole building BUT her room. Since she wasn't the person that actually physically treated the room and she wasn't standing in the room watching (not that she would remember anyway), she says "[insert nasty word]" that the room was sprayed.
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Please seek out a Geriatric Psychiatrist so that she can get medication.

Google this: geriatric psychiatry in seattle wa
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AinSeattle Jun 2022
She is in memory care in a different rural state.
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I am truly sorry that you and your MIL are having to suffer through this. My mother was diagnosed with dementia 5 years ago and started with the bug bites last year and threatened to call the ambulance to be taken to the hospital. I took her to a dermatologist, primary care, urgent care and her neurologist. We tried itching creams, sprays and allergy medications but they did not help. Her neurologist increased her seroquel from 25 mg to 50 mg and that eased the daily complaints, however, she still has episodes of bugs biting her and thinks she has bugs biting her occasionally instead of daily.
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Thanks for posting this question. I don't have an answer for you, but hope more people post suggestions. My mother who has dementia is doing the same thing. She lives with us and does go outside a lot. She does get bit by bugs sometimes (we live in the country), but often she tells me she has bug bites when she doesn't. I've bought her tons of bug spray and anti-itch ointments/sprays, but rarely uses them. I also tell her she should cover up when she goes out, but that's not working either. She complains all the time and it's frustrating! She hasn't scratched the walls, but has ruined the paint and screens in her room with a fly swatter. I've had to buy her another fly swatter because she demolished the first one. She will pick and itch her arms and legs until they are bleeding. She tells me she has to pick them to get the "infection" out. Twice I've had to take her to the doctor because she has picked and scratched until they truly do become infected. Her doctor talked to her about this, but that hasn't worked either.
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DILKimba Jun 2022
If she has dementia talking to her will do no good. You may need to get a lotion based bug repellent and just put it on her arms and legs any time she goes out.
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Has her vision been checked lately. Some eye problems can cause you to see floaters that can look like bugs. As a result anything you look at can appear to have bugs on them.

What causes floaters?

Eye infections.
Eye injuries.
Uveitis (inflammation in the eye)
Bleeding in the eye.
Vitreous detachment (when the vitreous pulls away from the retina)
Retinal tear (when vitreous detachment tears a hole in the retina)
Retinal detachment (when the retina gets pulled away from the back of the eye)

https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/floaters
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my2cents Jun 2022
Absolutely - floaters can be blobs floating in your vision and can also be very small black dots/lines that honestly look like a bug walked by. I have had floaters all my life, but every once in a while I see one for a split second that catches my peripheral vision with appearance of a large bug or little mouse.

I would say that if you think you see some bugs on the wall or the sheet and don't know it's a floater, your brain would go to 'now my skin is itching'. Just like if someone talks about lice and then my own head itches.

I had a PVD issue (similar to retinal tear, but it's really just a small blob of the vitreous that pulled away). Each blink makes the darn thing flap. Told by several eye drs that you just learn to live with it. Then found out that some people get them after cataract surgery and dr goes back and repairs it. So will be scheduling cataract surgery with a doctor who repaired the PVD for someone I know.

If this lady can sit for a good eye exam, it may be quite helpful to her.
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You can get MIL some mittens here:

https://www.amazon.com/s?k=alzheimers+mittens&crid=3G0E2H132M3F7&sprefix=alzheimers+mittens%2Caps%2C116&ref=nb_sb_ss_retrain-deeppltr_1_18

IF she will keep them on her hands, that will prevent bleeding skin. Keep her nails very short also.

My aunt with advanced Alz would pick at her scalp until there was no hair left in certain areas. It's a sign of agitation in a person with dementia. Have you spoken to MILs doctor about medication to calm her down? While you say there are 'limited hallucination and delusional medication options', I'm quite sure there are calming medications available to her that WOULD address the agitation she is experiencing. Ativan worked quite well for my mother during the advanced stages of dementia when she was very agitated and insisting things were happening that weren't.

Also, at mom's Memory Care, the caregivers would come get her dressed and out of her room every morning by 10 am. They'd bring her into the activity room to keep her occupied and engaged with the other residents doing a puzzle, eating, or an arts and crafts project of some sort. Such a thing may help MIL keep her mind OFF of these bugs she's obsessing about in her room. Have you spoken to the staff about what THEIR plan is to prevent her from decimating the walls and herself?

Wishing you the best of luck with a very difficult situation.
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AinSeattle Jun 2022
She is on anti-anxiety and anti-depression meds. Adjustments will be discussed at her next appointment. Thanks for the suggestions.
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Unfortunately, somatic delusions are difficult to treat. Counseling or any type of talking therapy is useless. The only alternative is antipsychotic medicines, like Seroquel, Haldol, Olanzapine, Risperidone and others. Even antipsychotics may fail, but they are worth a trial. Talk with her doctor.
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AinSeattle Jun 2022
Her doctors won't put her on anti-psychotics due to their use causing increased mortality in the elderly while not getting enough benefit in LBD patients. They've been asked.
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Let the MC handle it. They're being paid well to take care of such situations.
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