In this episode of the Truth, Lies Alzheimer's podcast, host Lisa Skinner draws on her 30+ years of dementia caregiving experience to explain why people with Alzheimer’s and related dementias often exhibit hallucinations, delusions, and paranoia. She opens with statistics from the Alzheimer’s Association—about one‑third of Alzheimer’s patients develop paranoia and 90% display behavioral impulses—then shares a vivid personal story from her book, “Truth, Lies, and Alzheimer’s: Its Secret Faces.” The story, titled “Birds in the Mattress,” recounts how her grandmother, Mrs. Walker, reported birds living in her mattress, rats on the walls, and men planning to break in and kill her. The granddaughter’s attempts to investigate the claim reveal how individuals with dementia can craft convincing explanations for their false beliefs. The episode highlights how impaired reasoning, memory, language, and perception in dementia lead to misinterpretation of reality, resulting in false sensory perceptions and paranoid delusions. Skinner explains that reasoning alone cannot dispel delusions; instead, caregivers should acknowledge concerns, validate emotions, and gently redirect attention. She notes that behavioral management therapies are first‑line, but severe psychotic symptoms may require medication and close coordination with a physician. Throughout, she emphasizes the importance of consistent communication with healthcare providers and offers practical resources, directing listeners to her website mindingdementia.com and a Facebook support group for caregivers. The episode concludes with encouragement for caregivers to seek community support and reassurance that they are not alone in navigating these challenging behaviors.
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Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.
Hello, hello, hello. Are you ready for another new episode of the Truth, Lies Alzheimer's Show? I hope so, because I've got one prepared for you today. And I'm Lisa Skinner, your host. So before we get started, I just want to mention, if you want to check out my website at mindingdementia.com, I have resources and other information available on that website for you to hopefully utilize. So don't forget to check that out, mindingdementia.com. Com. So according to the Alzheimer's Association, approximately 1 out of 3 people who are living with Alzheimer's disease will develop paranoia or suspiciousness, and approximately 90% of people living with dementia will display behavioral impulses. Why is that? Well, it's because people living with brain diseases like Alzheimer's eventually lose just about all of their thinking powers, their judgment, their memory, language capabilities, abstraction, their organizational abilities, the ability to reason things out, and their perception, as well as their ability to pay attention to the world around them. Because all of these things work harmoniously and in concert for a person to be able to operate effectively in this world. We rely on these skills to maintain control and keep confusion away. And they work together to define a world that a healthy person understands. But once these abilities are damaged by a brain disease, those people are no longer capable of that understanding. Therefore, because people with brain disease suffer from impaired reasoning, they may easily misinterpret others' intentions and have difficulty understanding what is being communicated to them. Their ability to separate fact from fiction can also become impaired. I'm going to share with you a story that's taken from my book, Truth, Lies, and Alzheimer's: Its Secret Faces. And this story and scenario illustrates some of the behaviors that we commonly see with Alzheimer's disease and related dementia, and it is called Birds in the Mattress. Mrs. Walker only lived a few miles from her family, so they visited her often. When her eldest granddaughter got her driver's license, she immediately drove over to see her grandma to show off her brand new license. Her nana was very, very special to her, and they enjoyed spending time together. Well, during this particular visit, she encountered some very peculiar behaviors by her grandma that she was not expecting. They were sitting in the living room having a nice conversation when Nana started telling her about these birds that actually lived in her mattress. And came out at night to peck on her face, that she saw rats running along her walls, and that they were planning to invade her house. And then she went on to describe these men who were constantly trying to break into her house because they were stealing her possessions, including her jewelry, and that they were eventually going to do away with her and take her life over. Well, I was the granddaughter listening to these tales, and I did not know what to think about them. I was completely blindsided by these far-fetched stories that I was listening to. They sounded so impossible to believe. But I adored my Nana and desperately wanted to believe what she was telling me. So the first thing I did was led her into her bedroom one day, or bedroom that day, and told her that we should check her mattress to see if we could tell exactly how these birds were getting in and out of it. I pushed her mattress up to see underneath it and looked through the blankets off and the sheets, I didn't see any evidence of holes or anything that would substantiate her story of birds living in that mattress. So I said to her, "Danna, can you help me out?" Do you know? Can you show me where these birds are getting in and out of your mattress so I can help you? So you can sleep at night again and not be so frightened? Well, she just looked me straight in the eyes and said, "Oh, Lisa, they are definitely there. They're just very, very clever." Well, as it turns out, later on I found out when I chose this to be my professional career path, that it actually was a brilliant response for her to explain the birds away to me. And I later learned that people living with a brain disease that causes dementia and they're having hallucinations or they're having false beliefs, they become masterful at explaining away their beliefs, like my grandma did by saying, "Oh, they're just very, very clever." Well, unbeknownst to our family, while she was alone, it turns out she was calling the police to report these intruders 2, 3, 4 times a day sometimes. They initially did send out a patrol officer to her house to check things out, but of course they found no evidence of anything that she was claiming, although she did continue to call them day in and day out. So one day there was a knock on knocking on my family's door. It was the police chief, and he was there to talk to my mom about my grandma's relentless calls to the police station. And he said to my mom, "You need to do something with her. We cannot continue to take these calls. We don't have the time or the resources to deal with this." 'Your mother is a nutcase.' Well, I was standing there listening to this conversation and could not believe that the chief of police just called my grandmother a nutcase. He showed no concern for her safety or any consideration that maybe, just maybe, there was something wrong with her. He rushed to a judgment that she was a nut. I was absolutely mortified, and I have never forgotten that day. It stays with me always. Now, at that time, I didn't know exactly what was wrong with my grandmother. I only knew that she was changing right before our very eyes. Soon after that, my mother did tell me that my grandmother had been diagnosed with what was called back then senile dementia, which is synonymous with today's Alzheimer's disease. And that was the beginning of our 20-year journey of watching my grandmother decline until her death. So my further thoughts for you about that story are, as was evident in the story, Mrs. Walker was experiencing delusions, hallucinations, paranoia, and suspiciousness, which are all common behaviors with dementia. You can see them displayed individually or separately, as you did in my story. Now, her belief that there were birds living in her mattress and that they came out at night and pecked on her face is an example of a delusion or a false belief. And that is a false sensory perception that usually manifests as hearing voices or seeing things that aren't there. Now, believing that men were going to do away with her is an example of paranoia and suspiciousness, which is also a false belief. Mrs. Walker's belief would also qualify as a paranoid delusion because she believed someone was going to harm her. Now, unfortunately, there are— there's absolutely no amount of reasoning that can talk a person experiencing a delusion out of their belief. Often the most effective solution is to attempt to redirect their attention to something else after you acknowledge their Concern and validate them. Finally, paranoia is often seen in those suffering from dementia. According to the Alzheimer's Association, approximately 1 out of 3 Alzheimer's disease sufferers will develop paranoia or suspiciousness, and many times a person with dementia will misplace a belonging and then accuse someone else of taking it. That becomes their truth. They 100% believe that it's been stolen from them. And this is because people with brain disease suffer from, again, this impaired reasoning. They may easily misinterpret others' intentions and have difficulty understanding what is being communicated to them. And once again, their ability to separate fact from fiction may become severely impaired. Hallucinations, paranoia, and delusions can sometimes be managed with behavioral management therapies. However, in extreme psychotic symptoms, Medication management may be required. So you wanna make sure you have a, a really established relationship with your loved one's doctor and make sure the doctor is provided with consistent updates on your loved one's condition. One of the key functions that our brains perform is that of perception. In a person living with dementia, the ability to perceive things the same way those of us with healthy brains will and do diminish and will affect the person's judgment, both visually and conceptually. Their level of confusion will increase over time because they are losing their ability to make sense of what their senses take in. Consequently, this can produce several adverse reactions such as fright and/or combative behavior. Additionally, problems with memory and misperception can generate suspiciousness and paranoid thoughts, just like you heard in the Birds in the Mattress story, where Mrs. Walker believed that people wanted to harm her. So hopefully that'll give you a really comprehensive understanding of what you are witnessing if your loved one or the person you care for starts having these false beliefs, delusions, hallucinations, acting suspicious, accusing you or others of stealing things. This is what it can look like in the real world. So that concludes today's episode of the Truth, Lies Alzheimer's Show. Once again, I'm Lisa Skinner, your host, and I will be back next week for another new episode. Don't forget to check out my website. There's lots of resources on there for you, mindingdementia.com. I wish you all a very happy and healthy week ahead, and I'll be back next week. Hope to see you then. Bye for now.
Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.
