Dementia – an acute loss of cognitive ability – can be marked by memory loss, decreased attention span and disorientation that occurs in disorders such as Alzheimer’s disease. According to Prof. Jiska Cohen-Mansfield of Tel Aviv University’s Herczeg Institute on Aging and Sackler Faculty of Medicine, dementia sufferers are often prescribed psychotropic drugs to mitigate symptoms such as delusions. But this tactic can cause more harm than good, she says. 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, suggests Cohen-Mansfield. The study, done in collaboration with Prof. Hava Golander of the Department of Nursing and Drs. Joshua Ben-Israel and Doron Garfinkel of the Shoham Medical Center, was published in the journal Psychiatry Research.
A RATIONAL BASIS FOR DELUSION
The 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.” The participants were 74 adults in nursing homes who had received a diagnosis of dementia. Researchers discovered that a large percentage of the delusions that the caregivers described seemed to have logical explanations
“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,” explains 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.
A BETTER QUALITY OF CARE
These findings can have an impact on the way heath care providers and family members respond to dementia patients, says Cohen-Mansfield. 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.
In people with dementia, delusions do not really match the psychiatric definition of psychosis. A closer analysis of these behaviors is likely to promote empathy, understanding, and ultimately a more humane and compassionate treatment, the researchers concluded.
