False Beliefs and Delusions in Dementia

What are False Beliefs and Delusions?

Delusions and firmly held false beliefs are common and challenging symptoms experienced by individuals with dementia. Unlike regular personal beliefs, which can be influenced by life experiences and subject to some level of control, individuals with dementia are unable to rationalise these false beliefs. Consequently, these delusions significantly impact their emotions and behaviours.

The effects of these false beliefs can be distressing and overwhelming, leading to various emotional states such as anxiety, paranoia, fear, distress, and panic. Despite being entirely imaginary, these delusions feel incredibly real to the person with dementia. Examples of such false beliefs include thinking that someone is trying to harm, steal, or follow them or believing that their own home is not their actual residence.

Managing these situations can be incredibly challenging for individuals with dementia and their family members. The need for compassionate support is paramount in improving the overall quality of life for those affected by dementia.

Causes of False Beliefs and Delusions

False beliefs and delusions are among the challenges that may arise, which can be attributed to various factors. One potential cause is sensory changes, where variations in perception can lead to misunderstandings. Additionally, certain medications may have side effects that contribute to the development of false beliefs. Physical health challenges, such as infections, fever, pain, or dehydration, can also play a role in generating delusional thoughts.

Environmental factors can intensify false beliefs and delusions in individuals with dementia. Being in unfamiliar or unrecognisable surroundings or encountering a new caregiver can trigger such experiences. Disruptions to daily routines and the removal of familiar items can further contribute to feelings of confusion and disorientation. Additionally, factors like high levels of stress and significant life events can impact the manifestation of false beliefs.

It is essential to understand that each person’s experience with dementia is unique, and there can be various combinations of contributing factors. Although it may not be possible to prevent false beliefs and delusions entirely, identifying and avoiding triggers can be beneficial in managing the condition. Treatment approaches can involve a combination of methods tailored to the individual’s specific needs. These may include medication, psychotherapy, and supportive interventions aimed at improving the person’s overall well-being and quality of life.

Delirium

Delirium is an acute medical challenge characterised by disturbances in attention, awareness, thinking, and cognition. Delirium often occurs in people with dementia. Even though delirium and dementia have similar symptoms like confusion, agitation and delusions, they are different.

The main difference is that delirium starts suddenly, over a day or two, and symptoms vary over the day. In comparison, dementia happens slowly, over months or years. One exception is dementia with Lewy bodies. This type of dementia has many of the same symptoms as delirium, and they can vary a lot over the day.

Common symptoms of delirium include:

Confusion
Disorientation
Difficulty focusing or sustaining attention
Difficulty understanding and following conversations or instructions
Difficulty organising the thoughts
Challenges with sleeping patterns
Hyperactivity and restlessness
Mood swings, anxiety, and irritability

Appropriate management of delirium is essential for better outcomes and preventing complications. Managing delirium involves supportive, personalised care, such as ensuring a calm and familiar environment, maintaining a regular sleep schedule, and minimising disruptions. In some cases, medication may be prescribed to manage symptoms.

Hallucinations and Delusions

Hallucinations and delusions are distinct yet interconnected phenomena. Delusions refer to false beliefs that lack evidence or factual basis, while hallucinations involve false perceptions that seem real to the individual experiencing them.

In the context of dementia, hallucinations typically engage the person’s senses, leading to vivid experiences that feel real to them. For example, individuals may visually perceive things that do not exist, such as bugs crawling over the bed in a room. Similarly, auditory hallucinations may manifest, causing people to hear noises or voices that are not present in reality but appear genuine to the person with dementia. Understanding these nuances is crucial in providing appropriate care and support for individuals dealing with dementia-related hallucinations and delusions.

When a person with dementia experiences delusions, the false beliefs may be categorised under one of the following types of delusions:

Grandiose Delusions – Beliefs around superiority. For example, a person believes they are better than others, have a great talent or have made an important discovery
Jealous Delusions - Beliefs around being the victim of an affair. For example, a person is suspicious that a loved one is unfaithful
Erotomanic Delusions – Believing that an important and famous person is in love with them. In this case, stalking behaviour may be developed
Somatic Delusions – Beliefs that a person is suffering from a medical condition
Persecutory Delusions – Believing that a person is mistreated, someone is being spied on, or someone is trying and planning to harm the person
Mixed Delusions –A person has two or more of the types of delusions mentioned above

Compassionate care and understanding are crucial in providing effective care to individuals experiencing delusions, helping improve their quality of life and mental well-being.

Signs of False Beliefs and Delusions

False beliefs and delusions can lead to significant emotional challenges, social isolation, and withdrawal from various domains of life, including work, relationships, and self-care.

Some of the early signs related to false beliefs and delusions are the following:

Feelings of being exploited
Preoccupation with trustworthiness
Hiding possessions
Readiness to respond and react to perceived slights
Mistaking people's identities
Reliving past events

Support workers, caregivers, and health professionals must adequately assess the signs of false beliefs and delusions. That will enable appropriate intervention and person-centred support for individuals experiencing challenges.

Confabulations

Confabulation is the creation of false memories without intentions of deception. People that experience conditions that affect memory, like dementia, amnesia, and Alzheimer’s disease, are more likely to confabulate.

People that have confabulations have gaps in their memory. In those gaps, they unconsciously place distorted information or experiences at the wrong time or place. Confabulation is linked with brain injury and mental health challenges, but they are noted in healthy people without mental health challenges or brain changes.

Delusions and confabulations are both false beliefs, but there is a difference. Delusions influence people’s behavioural choices and appear across an array of situations. But, if a false belief is related to the recall of memories, individuals are probably experiencing confabulation.

By gaining a comprehensive understanding of the causes and triggers of confabulation, healthcare professionals can develop person-centred interventions and strategies to support individuals experiencing confabulation.

What Triggers Confabulations?

Confabulations can arise from various triggering factors, each contributing to the construction of false narratives or inaccurate details. One such factor is overlearning and over-generalisation, where existing knowledge or schemas unconsciously fill in missing information, even if it leads to an erroneous storyline. Additionally, challenges with encoding information can result in incomplete memory formation, leading to potential forgetting or misremembering of events.

Emotional factors also play a significant role in confabulations. Strong emotions like stress, anxiety, or frustration can increase the likelihood of fabricating false memories. Furthermore, the difficulty in discerning between real memories, imagined events, and information acquired from others can create false memories in individuals. Memory loss and gaps caused by brain injuries, neurodegenerative conditions, or other memory-affecting challenges can further contribute to the generation of confabulations.

The leading cause for confabulation is often brain changes. However, there are other conditions and challenges associated with confabulation, including:

There are strategies and methods for people with confabulation to manage situations and events without consequence for them and their surroundings. Getting support is among the essential steps to cope with confabulation. Working with healthcare professionals, such as neurologists, psychiatrists, or neuropsychologists, can help identify specific triggers and develop strategies to manage confabulation episodes.

How to Get Help With Leaf Complex Care

Leaf Complex Care provide person-centred and proactive support, customising care plans to the unique needs and preferences of the people we serve, and imprinting kindness and compassion on everything we do.

Leaf Complex Care has many years of experience working with people that face false beliefs and delusions. Our dedicated support workers deliver care at home and help individuals become empowered members of their communities.

Our offices are located in Bristol, Midlands, Slough and Somerset. Contact us today to learn more about how we can help you, or your loved one through our humanised support.