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Published on: March 28, 2012
by Rich Nauert PhD for Psych Central
Emerging research suggests the primary method of treatment used today — prescription drugs — for the delusions experienced by individuals with dementia may be doing more harm than good.
Dementia is characterized by an acute loss of cognitive ability and is often associated with memory loss, decreased attention span, and disorientation.
In a new study, researchers investigate the practice of prescribing psychotropic drugs to mitigate symptoms such as delusions.
According to Jiska Cohen-Mansfield, Ph.D., many of the delusions experienced by dementia patients may have a rational basis and could be more effectively treated through behavioral therapy than by medications.
The study is published in the journal Psychiatry Research.
Researchers examined six common categories of delusion, including fears of abandonment, suspicions that patients’ possessions were being stolen, and feelings that they were not “at home.”
Study participants consisted of 74 adults from nine nursing homes in Israel who had received a diagnosis of dementia. The research team questioned caretakers, including registered nurses and nursing home staff, who had daily interactions with the patients.
Researchers assessed elements including the patient’s mental state, behavioral pathology, and incidents of past trauma. Caretakers were asked to describe not only the patient’s delusions, but to explain the circumstances under which they emerged.
From the information garnered, researchers discovered that a large percentage of the delusions that the caregivers described seemed to have logical explanations. Some were even the result of the patient re-experiencing traumas they had suffered earlier in their lives.
“If you begin to think about these delusions from the point of view of the dementia patient, you begin to understand that their delusions are explainable reflections of the reality they live in,” said Cohen-Mansfield.
For example, for patients who felt that they were not at “home,” the nursing home did not satisfy their definition of home. Anxiety often accompanied separation from the outside environment or from their loved ones — a rational response.
An understanding of these ‘logical’ perceptions can impact the way heath care providers and family members respond to dementia patients, Cohen-Mansfield said.
Characterizing their delusions as “psychotic” puts them in the category of severe mental illness, which is frequently inappropriate. Instead, caretakers can devise methods to work with patients that take context into account.
Cohen-Mansfield also noted that participants in the study were highly medicated, with 47 percent on antidepressants, a third taking sedatives/hypnotics, and 13.5 percent on antipsychotic medications.
“If you can ascertain why the patient is experiencing these ‘delusions,’ you can create another treatment plan that addresses issues of orientation,” she said.
In sum, labeling a person with dementia as suffering from delusion may be incorrect or off-base. A closer analysis of the behaviors is likely to promote empathy, understanding, and ultimately a more humane and compassionate treatment.
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