Dementia or Mental Illness?

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Dad has always had a little confusion, been diagnosed with mild vascular dementia. Month ago I was home and witnessed what I thought was a bad case of sundowners. A very specific delusion that he obsesses on, and I spent the night exploring the house to keep him calm by helping explore problems that he was imagining in the functioning and safety of the house. The next couple days he was fine, I asked him at some point if he still believed the delusion and he sheepishly said no. Apparently he has been picking up the delusion more and more each day and two days ago he has become extremely agitated and upset about it. Mostly he is upset that he can't convince us it's true. When we find holes in his logic (the doctor offered to check ... and you said no) then he changes the story. I don't think he is imagining anything that will cause us harm except perhaps accidentally, but he persists in thinking he is somewhere else (in a hospital) in a dangerous environment and forces anyone he sees to sit and experience it with him, getting more and more threatening when they try to leave. No one in the house can have any peace and his energy level is non-stop. He broke character just before he went to bed last night, realized he was home and thanked his caregiver. This morning he awoke worse than ever. He is taking lots of valium that helps briefly, then not. We always suspected he is bipolar and the delusion isn't as upsetting as the energy level and the strength he exhibits and we are afraid he will hurt himself somehow. He's in the ER awaiting a checkover, he seems perfectly normal there, but it's been a 4 hour wait and now they need dinner and medicine and when suggested they go home and try again tomorrow, his delusion surfaced and he insisted if he went home, the dangers would be there waiting for him. I feel that he's always had strange ideas, but it is the energy with which he forces it on others is a mania, and I am hoping they treat it as a chemical or physical problem and not just write it off to dementia. You find yourself wishing you could give him a shot to just knock him out hoping he'll get over it in a bit. Anybody know if this is normal dementia behavior? Did I mention that if you disprove his theory, he changes it? It seems he has a need to keep himself upset because he can't save the world, he needs a problem to save us from. He has PTSD and I think it might tie in with that, feelings of lack of self-worth perhaps. He hates being dependent and he is not involved in the running of the household, and I think that might be the trigger. I've decided I've found a home where they care for memory and ALZ but wonder if they will take him even if we can't calm him down. Thinking we'll get him calm and he'll have chemicals to control his problem, like many people who have a mental illness, hopefully as long as it is under control he can still find AL.

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I agree that it would be difficult to have a Memory Care facility accept him if he is threatening and acting out. I'm not sure why they thought that just giving him something to calm him down for the little while was a real answer. From what I have witnessed, it normally takes much more than that. I would seek the advice of a psychiatrist who can properly evaluate him and prescribe appropriate meds.
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ThereIsNoTry, my mother has vascular dementia and I can really relate to what you're saying. She may also have an un-diagnosed mental illness. She has had generalized anxiety all of her life.

She has delusions that are hard for her to shake. Four years ago we had extra support added under the floors. She thinks that the workers put the house on stilts and made cracks in the floor that the wind blows through. She puts blankets on the thick rug in her room to cover the imaginary cracks on the floor. She wants me to call someone to come fix things. This delusion has gone on since it began. I would pick the blankets up. She would put them back down. I finally gave up.

She also believes my neighbor turned his water drains to go in our yard. I tell her that the neighbors haven't done anything wrong, but she knows they have.

Recently she decided that going in the front yard gives her a UTI. She has both real and imaginary UTIs that drive me nuts. We went to the doctor yesterday for an imaginary one. The doctor prescribed some antibiotics. I wish she had prescribed some placebos.

Our life here is one delusion after another. I end up doing a lot of shadow boxing, acting like I'm dealing with the "problems" in her delusions. I know it is the dementia. I wonder if the brain is saying something is wrong, so they look around for something to explain it or blame it on. Failing vision certainly doesn't help. The normal lines in the floor can look like cracks, I guess. And maybe it does look like water is flowing in our yard when it rains -- all normal to good eyes and a normal brain. Damaged brains may interpret signals wrong.

The advice given to ignore or play along is normally good. However, there are times when this could do harm or be expensive. Then we have to reassure them that things are okay as often as it takes. I've found that calling in other people to check things and reassure them also helps. Our parents will often believe other people faster than they will believe a caregiving child. Big hugs working through this.
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The big mistake will be seen when you get the bills for the ER. When you refuse admittance, the cost skyrockets and insurance may not cover it.
I will repeat-- non-diagnosed aggression and paranoia are red flags. No care home is equipped to handle an unpredictable, undiagnosed patient. They will tell you get him admitted and evaluated completely.
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We didn't refuse him admittance. They fixed him up and let him go! Supposedly they did the whole nine yards. Do you think that's not possible in an evening? He saw a psychiatrist the day before too. wow, that surely put a spin on it Pam! With a chemical imbalance it can be controlled with medicines. I have a friend who is bipolar and they treat it that way, and I know two people who each died within two months of being confined in a NH for dementia. Please phrase your comments appropriately. This is scary.
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Big mistake taking him out of the ER instead of getting him admitted. Don't count on any care home wanting to take a patient whose family refuses admittance to a hospital. By blood work I mean the whole nine yards, not just infection, but a complete metabolic profile.
You are going to see increasing levels of disorientation and aggression. I just hope next time you get him admitted and properly diagnosed.
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Do you think I should call the people who we were going to asses Dad and tour the retirement facility to talk about the problem before we go? They waited nine hours in the ER, gave him all kinds of tests including a CATSCAN. They gave him medicine, he calmed down, and rather than sign him in, because at his age, they might check him into a NH and I don't know anyone who ever came out of a NH well, we didn't sign that he was a danger to himself which was the only way they would do it. So Monday he'll start new medicine and if that doesn't help, then we will sign him in. Meantime, looking for a care home for him that we can afford that is good. Thanks Jeanne and Pam. By blood work, I guess you mean for an infection? That seemed to start the ball rolling, he had sepsis 2 months ago, but blood is clear now. We did that last week when this episode started. All is calm, keep your fingers crossed!
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What you describe is totally compatible with dementia, with no other mental illnesses thrown in. But that doesn't prove that your dad does not have other mental issues, especially if you think some have been present for a long time.

But whatever the cause, let us hope that he is hospitalized for observation and some help can be found for his delusions!

As experience has shown you, there is no value in disproving the delusion because it is not at all based on logic or reason. The delusion is his reality. Your initial reaction was probably the most calming approach for him. You accepted that his concerns were real and went around inspecting the house to reassure him about them.

I hope there is a medical help for his situation, but in the meantime, perhaps you could try acknowledging his concerns (without necessarily agreeing with them) and reassuring him. Don't argue that what he believes isn't true. "It is lonely to be in a hospital by yourself, isn't it? I'm going to sit here and read magazines with you for a while, then I'm just going to a room down the hall. I'll be in the building all night with you, and if you need me I'll be nearby." And then get into the distraction of the magazine.

Good luck!
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Hopefully they will admit him for a 72 hour psych evaluation and get the medications straightened out. We found when mom was in hospital and someone else was dispensing the meds, instead of her, her behaviors would level off. In the hospital they do bloodwork as soon as you hit the ER, and that tells them a lot.
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