Expert: Mary Gordon - 4/20/2009

Question
QUESTION: My friend is 75 yrs. old. She cannot remember things from yesterday, yet she remembers things from 40 yrs. ago. She realizes something is wrong. She also has very delusional thoughts about things that just happen(She changes what people say to make her story sound good.)She blames the forgetfulness on being depressed. She is a wonderful person,but I am worried about her.

ANSWER: Francine, you have very good reason to be worried about your friend. What she is displaying are textbook perfect symptoms of a progressive dementia. She really needs to see a doctor and get properly assessed and diagnosed. There are many causes of dementia besides Alzheimer's, and some of them are treatable and even reversable. Even the ones that can't be cured can be slowed down in many people, to give them more independence and a better quality of life longer.

It's also important to know what is wrong with her so she and her family can make good plans. If she has an incurable dementia that is going to progress, she needs to get her affairs in order, and get things set up so someone trusted can look out for her interests when she can no longer make her own decisions. A visit to a good lawyer can also help the family make sure her money is preserved for her care, and help everyone understand the insurance rules where she lives. She may also want to make sure her wishes and preferences are known, to help her loved ones make sure she is cared for the way she wants to be.

If your friend is not able to help herself, or can't see her own challenges, I would strongly urge you to call her family, and express your concern. This is about your friend's health and safety, and that is far more important than anything else. In very short order, she may be in real trouble trying to look after herself, and may even be in danger from her own appliances, medications, driving, strangers who might try to take advantage etc. etc.  Quite often people with a brewing dementia really can't understand that there is anything wrong with them, even when those around them are really alarmed.

I don't mean to scare you, but this is really serious, and if you love your friend, you will both encourage her to see a doctor (perhaps you could volunteer to go with her if she might have trouble explaining to him what's going on), and make sure someone in her family is alerted. Quite often, if a family does not see the person very frequently, and the person can carry on a good social conversation on the phone and seem like themselves, the family may not realize that anything is wrong until they get a call from the doctor, from a neighbor, from the police, or from a dear friend like you.  You'd hate to say nothing, and find out later she might have been helped with an earlier diagnosis, or worse, have her experience something awful, like a serious kitchen fire because she forgot to turn the stove off, getting lost on her way to the store, or even a drug overdose (the last one happened to my mother in law!!).

Hope this helps- she's lucky to have a friend like you paying attention!

Mary G.



---------- FOLLOW-UP ----------

QUESTION: Why is she so delusional? Example; Makes up what people say to her. She says praying to god (she is very religious)will bring back her keen mind> She refuses to tell anyone. She blames everything of depression. She moved in her deceased brothers home and away from her roots. She hates his house but said she promised him on his death bed she would move in his house. I really don't believe he said to move in his house. I know its not true.

Answer
Francine, if she has a dementia, her brain is being damaged. Delusions are very common in dementia A delusion is just a wrong interpretation of real things - as opposed to an hallucination, which is seeing or hearing something that isn't there.

If your whole life you could rely on your memory and your perceptions, you continue to do so. If your money disappears from your purse, and you have no memory at all of spending it, you think someone has taken it. If you are repeatedly losing things, you think someone is playing tricks on you, or taking your things. Your mind is desperate for explanations.

They can get wrong ideas about ordinary things. For example, my mother in law became convinced that people on TV could see her and talk to her. She wouldn't wear her pajamas in front of the TV because she was modest and thought strangers could see her. She forgot how to turn the TV off and actually put a sheet over the TV so they couldn't watch her. She became totally convinced that the host of a children's show was visiting with her and talking to her through the TV. No amount of arguing would convince her otherwise.  

My mother in law would report conversations that couldn't have taken place - for example, she would tell us that a neighbor was saying very mean things about her family. However, the things she said the neighbor brought up were impossible - because they involved intimate information about her past that no one knew but her (for example, would a neighbor who barely knew her be able to criticize in great detail something my mother in law's long dead sister had done 60 years earlier ?)

She would tell us about things that just couldn't possibly have happened, like nice visits from friends and relatives who had passed away. At one point, she lived in a place that was an end unit. She became upset there were people living on one side of her, who were having loud fights, and even tell us what she thought they were saying. Showing her the window on that side so she could see there was no apartment on that side didn't convince her. We were actually with her once when she thought she could hear them, and we couldn't hear what she thought she could hear (and she was extremely deaf).

At one point, she became terribly angry at us, thinking we had excluded her from a family event she had attended. She had no memory of being involved in the planning, of attending, of having a lovely time - and no amount of convincing would make her believe us that she had been there. She even made up hurtful ideas about why we hadn't invited her (and I swear to you, she was there !!).

Brain damage is a funny thing. When a person's brain isn't working right, everything gets confused, and they try very hard to make sense of everything. Most people who are getting a dementia cannot see that there is anything wrong with them. It isn't that they are in denial. Their brains really don't allow them to realize that the problems are with them - they just can't see what is obvious to you.  No amount of arguing, reasoning, convincing, persuading, cajoling is going to get through to the person - their ability to see and understand their own situation is going, and they can't reason through to a sensible conclusion.  It is very, very upsetting and stressful to the person. They are doing their very best. Your friend isn't doing this on purpose, and she may well be depressed. It must be very scary when things start to make no sense.

Here is a long article, but a really good one, and I think it will help you to understand what is probably starting to happen to your friend.

http://www.alzheimer.guelph.org/downloads/12%20pt%20Understanding%20the%20Dement

Hope this helps.

Mary G.