Expert: Mary Gordon - 8/19/2009

Question
My mother is 80 yrs. old and has in the last 3 yrs. become extremely paranoid and believes that people come into her home at night when she is sleeping and when she is not at home and steal her things. She lives alone and believes that people steal her medss, her clothes, her coffee...I mean there is no end to what she alleges they steal. Even when i find the things that she says have been stolen her answer is they brought them back. She has been tested for Alzheimer disease and I have been told that she does not have Alzheimer. I have been told that it is more mental. She has been given medication that does nothing but keep her sleep and unresponsive all day so I stopped giving it to her. I need something that is going to give her some peace and I don't what to do. It's breaking her heart and mine. Is there a name for this type behavior in aging people? Where do i go to find the answers?

Answer
Hi Cynthia, I would say.....it is time to get a new doctor. You either need a new family doctor, or a referral to a specialist - a neurologist or psychiatrist with a specialty in dementias.

There are a couple of things that can be observed from what you've told me.

First off, the kind of paranoia you describe is almost always due to short term memory loss. And yes, everyone's memory gets a little foggier as they age, but what you are describing is not normal. This is not a routine part of being 80. The alarm bells are going off in your gut and I'd listen to them. Something is wrong.

When a person's short term memory is impaired, they really have no recollection of where they have left things. As a healthy adult, her entire life experience tells her that her perceptions can be trusted because her brain is reliable and intact. So when things disappear (because she has no recollection of doing something with them), she casts around for an explanation that she can accept. If things aren't where I think I left them, and I have no recollection of having touched them....some bad person must be playing jokes on me, or trying to rob me. Someone must have been in my house, moving things around, hiding things, stealing things.

The second observation is that you know that her explanation is not based on rational logic. So, her second major symptom is that she is not self aware. She is not aware that she is impaired, and she can't see that the explanation she has come up with makes no sense.  She cannot see what is obvious to you. She can't reason out that it isn't sensible to think people are coming into her house daily to take her things, much less showing up later to bring them back.  She also can't listen to your arguments and realize you might have a point. You know that this means her judgement is poor, as is her ability to think abstractly. The emotional changes you are seeing are also a symptom. Her fixed idea that strangers are in her house can be described as a delusion. It must be deeply, deeply upsetting and frightening for her.

Most people with short term memory loss alone will be aware that they have a deficit. They will be frustrated and annoyed and even frightened at their own poor memory - they will see the results for themselves, and have appropriate concern for their own situation. If your mom was cognitively intact, she'd be saying Cynthia, I need to see the doctor, I keep losing things, I keep forgetting things, I'm missing appointments, there must be something wrong. They realize that the problem is within them, not something from the outer world.

There are many causes of cognitive impairment in the elderly - Alzheimer's is just one. She needs to be properly assessed by a specialist. Something is brewing and I know you know that. Most of the progressive dementias follow a similar pattern, as the brain becomes more and more impaired. Dr. Reisberg originally came up with the Functional Assessment Staging system or FAST to describe the stages of Alzheimer's. However, they can be applied to other causes of impairment. http://www.ec-online.net/Knowledge/Articles/alzstages.html
You will see that she likely falls into Stage 3 or 4.

The brain is very delicate. It may be that she has some cause of cognitive impairment other than Alzheimer's. There are all kinds of things that can cause confusion and memory loss, various diseases and infections, strokes, head injuries, drugs, and nutritional deficiencies and on and on. This needs to be properly checked out. A proper examination usually includes a full physical to rule out many illnesses, a review of history and medications, an MRI or other scan to look for signs of strokes, tumors, shrinkage etc. It will also include an assessment of whether she might be depressed or have other psychiatric issues. Finally, it should include a close examination of her mental abilities to look for deficits. Quite often this involves putting the person through the kind of tests you would put a child through to look for learning disabilities.

You will never forgive yourself if you find out later she had something treatable if only it had been caught early enough. Even in the case of Alzheimer's and other incurable, progressive dementias, in many people, they can be slowed down with certain drugs. It is also worth knowing exactly what you are up against so you can protect her, and yourself. You need to know what might happen next, so you can make good plans, and make sure everything you need to look after her is in place. That might include updated powers of attorney, updated wills, or checking out how medicaid and medicare work where you live.

Here is a good article that might give you some insight into how memory loss works, and what your mom might be going through.
http://www.alzheimer.guelph.org/downloads/12%20pt%20Understanding%20the%20Dement...

I hope this helps. I would insist that she be reexamined, and preferably, sent to a specialist. Hang in there. I know how upsetting and frightening this is. You don't mention what medication they had her on. If you write back with any other questions, let me know what it was, and what they told you it was for.

Mary G.