Spotlight on Care: Alzheimer's Caregiving
Welcome to Spotlight on Care, the podcast where we share stories, experiences, tips and advice on caring for loved ones affected by Alzheimer’s and other dementias. Spotlight on Care is produced by the University of California, Irvine Institute for Memory Impairments and Neurological Disorders, UCI MIND. Please subscribe to the Spotlight on Care podcast wherever you listen. For more information, visit mind.uci.edu. What would like to hear about next? Email us at mwitbrac@uci.edu.
Spotlight on Care: Alzheimer's Caregiving
Delusions in Patients with Alzheimer's Disease with Dr. David Sultzer
In this episode of Spotlight on Care, Steve and Virginia explore the complex and often distressing experience of delusions in dementia with David Sultzer, MD, the Clinical Research Director at UCI MIND and professor of Psychiatry & Human Behavior. Dr. Sultzer explains how and when delusions, such as paranoia and misidentification, develop in individuals with dementia and the impact they have on caregivers. He discusses practical approaches for managing these false beliefs, including reassurance, environmental adjustments, and structured routines. The conversation also covers available medications that may help prevent or reduce delusions, along with its potential risks.
Resource: What Are Delusions? These false beliefs can be a symptom of delusional disorder or another condition by Amy Morin, LCSW; Medically reviewed by Steven Gans, MD
https://www.verywellmind.com/definition-of-delusion-4580458docdd
From the University of California, Irvine. This is UCI MIND's Spotlight On Care, the podcast where we share stories, experiences, tips and advice on caring for loved ones affected by Alzheimer's and other dementias.
Virginia:Welcome to Spotlight On Care. I'm Virginia Naeve, and I'm here with my wonderful cohost, Mr. Steve O'Leary. Today wehave a very interesting topic, and that is when people with dementia experience delusions. Before we learn all about that particular symptom or syndrome or disorder, Steve and I like to make a brief comment about the topic and our caregiving experience that we happen to have had with our loved ones. So Steve, did your wife Patty experience delusions?
Steve:Yeah, but it wasn't as serious as I've heard from other support group members I was in and things like that. I think the kind of comment I've heard- people coming after her, she would wake up and feel like there were people in the room, and anytime she went to a new place, she would be disoriented and think that, you know, it was scary, and I need to get out of that place. So that was it. I mean, I never had her act out towards me or those kinds of activities, or look at me and say, "Who the heck are you?" She would know who I was. But anyway, I was very fortunate. We didn't have a lot of that.
Virginia:Well I didn't know what delusions were. I didn't know what Alzheimer's was, either. But in the beginning with mom, she thought everyone was stealing from her, and she was at a facility that I put her in later, three months later, took her out because she hated it, but I found notes in her closet that said, "I've caught you. Stop stealing from me." And then I finallygot her into a community she liked, but for like, two weeks, she called me three, four times in a day and said "Someone stole my toothbrush." And I wasn't clued in at this point as to what you're supposed to do with situations like that. And I said, "Mom, no one wants your toothbrush" and she said,"They're stealing it." So I went and I tied a string onto the end of her toothbrush, and I tied that to her bathroom cup, and didn't stop the delusions. Well, I didn't know that's what it was called at the time, but in any case, and that disappeared after a couple of weeks, but it was really annoying. Anyway, let's get started with our podcast interview here. Our guest today is Dr. David Sultzer. He is a physician, a psychiatrist and a professor in the Department of Psychiatry and Human Behavior in the UCI School of Medicine. He is the Clinical Research Director for UCI MIND and leads the clinical core at the UCI Alzheimer's Disease Research Center, which is known as the ADRC. Welcome, Dr. Sultzer, we're glad you're here.
David:Great. Thanks, Virginia, it's nice to be here. Really appreciate the opportunity to speak with you guys, to hear your perspective, as well as what both of you do for UCI MIND and the community with regard to Alzheimer's disease, care and caregivers,
Virginia:Thank you. We're glad you're here. Let's start with defining what this is. What is the definition of delusions?
David:Yeah, I think both you, Virginia and Steve have highlighted what delusions are. They're defined as false beliefs, if you will. We all have eccentric thoughts now and again that others might not agree with. But delusions go deeper than that,beliefs and things that are persistent, that continue on for a period of time and are really refractory to information to the contrary, you know, they're just they're fixed, they can't really be changed. So people with Alzheimer's disease and other dementias have these persistent beliefs in different domains, you've highlighted each common ones of the kinds of topics that come up. They're false beliefs that are really difficult to change their mind and the challenge is often that they can lead to things like agitation because when you have a false belief and people are explaining to you over and over why you're wrong, it tends to get people stirred up, and sometimes people will act on those false beliefs.
Virginia:That's why I should have said- well- the director of our Assisted Living Program came in and she said, "Oh, they're stealing your toothbrush. Let's catch that thief." And I thought, "That's what I'm supposed to say?" Okay, it was what I was supposed to say.
David:Exactly. Yeah, yeah.
Virginia:Right? So there are quite a few different types of delusions. Can you tell us some of the more common ones?
David:Yeah. And again, you and Steve have highlighted the most common ones. Actually, you're describing what they are. They're usually- we think of them as two categories. One is kind of paranoia or theft, or people are doing bad things, and that sometimes comes from a sense where they don't remember, or they're confused and concerned and don't trustpeople because they have unfortunately lost the cognitive machinery to know what's safe. So there's an inappropriate wariness that kind of gets into ideas about theft. We all forget where things are. It's the human condition to blame others for that, rather than take responsibility and we all have to acknowledge that. And yet, when someone has is cognitively impaired, it's just much more difficult, and there's an easy opportunity to believe that someone is actually stealing them, which is distressing. The other category is misidentification, and you know the idea that people are in the room, you describe that people are there, you don't trust, that they're disoriented in a new place. Their house isn't their home is a pretty common one that you mentioned, and it's challenging. I mean, how do you respond to a spouse of many years who says your home of many years is not your home, and I want to go home and is pretty upset about it, so it's really challenging. Those are the kind of two categories of delusions.
Virginia:Okay and they're pretty common. How long do they last?
David:Yeah it's a good question. I mean, they it varies a lot. Sometimes they're relatively fleeting. Sometimes they'll go on for aperiod of time, you know, minutes to hours, and will wane, but then individuals will, not uncommonly, have the same kinds of delusions, come back the next day, kind of thing. That's where it becomes a challenge. It's not just a one time thing, necessarily. They tend to recur, even if they go away in the short run.
Steve:What's causing those? What's causing the length to happen, or the repeat nature of them?
David:Yeah it's a good question, Steve, because it's not clear. We know, for example, that there's a neurobiology to delusions. We've done some work. Others have that have identified kind of a cortical signature of what's going on in those who are more susceptible to have delusions versus those who don't. To get into how long and why they last for shorter or longer. Nobody really knows. You know I think it's just, it's a mix of when folks are cognitively impaired, they don't remember, `so they lack the ability to bring reality onto the table, to be part of it. And there's the insight piece, I think that's the other thing that we've often thought of is very important that we all have unusual thoughts and feelings over the course of a day, and can kind of sort them into realistic, unrealistic on a good day.
Steve:Oh yeah.
David:Folks with advanced Alzheimer's disease lack the capacity to really say- realistically, is that true? You know I mean, that's really a key part of it. So it really is difficult for them to do that sorting, and they latch on to that. It's a good question about one issue with the misidentification is people, particularly with Alzheimer's disease dementia, have a visual perceptive deficit, so their ability to interpret their surroundings is a little bit more effective than you might expect. It's not just memory, it's the recognition thing. So it's just distressing, and it's easier for them to think that their spouse has been replaced by an imposter, because their picture of your face isn't what it used to be. So they're a little confused by that other than just the memory of it. So there's some characteristic, I think that's why there are categories that are much more common than you'd expect when you think of like the breadth of delusions. Younger people with schizophrenia, for example, have delusions. Their delusional thoughts are a whole different set of categories than older adults with Alzheimer's disease, which is interesting. It's not just a generic false belief thing. There's something about the illness that begets these certain types, and the frequency in time is no one really understands.
Steve:That's interesting, because I think that's a very common thing we hear from support groups is, "Gee, she doesn't recognize me, or he doesn't recognize me, or my mother doesn't recognize me," and it's like, well, "How can that have gone? I mean, they still have history. I was a child at one point with them," or I was, you know, "Married to them for 40 years. Why have we lost that connection?" And it's very hard. And so what you're saying is, is that there's a little disorientation that's occurring, and it's part of the disease. It's not them. I mean, it's not you.
David:Exactly, it's a misperception. We develop a picture of the world through our eyes, and we assign meaning to that and familiarity. Imagine if you were looking at the world through a, you know, translucent piece of plastic, so you can't reallysee is that Steve O'Leary?
Steve:That might be a good thing.
David:Well, that's a different story, a different podcast for that. And then with the dementia, it's just hard for them to kind of rebound from that, if you will or check it out, that's the other thing that doesn't happen, and it's really distressing. I mean, that's a very common delusion, and we notice in clinical practice that when folks aren't able to recognize their loved ones anymore, it's really distressing for the families. And often what happens soon before their placed elseswhere because being a caregiver depends on having the feedback that you're doing something meaningful.
Virginia:Yes.
David:And when the person doesn't recognize you, it's very, very sad, obviously, but also loses meaning for caregivers of what's my connection to this? What's my role here? And unfortunately leads to institutionalization many times.
Virginia:I remember when mom first started really not knowing me, but she knew I was good. If I walked into the room, she couldn't look at me and say I gave birth to her, but she would look at me and know that I wasn't going to hurt her.
Steve:Yeah, there was a level of trust.
Virginia:It's the only way I knew how to describe it.
Steve:I remember that towards the end with Patty, she would start laughing at me. I know I've told you that story. She'd see me coming down the hallway. She didn't know who I was, but she'd start laughing, because to her, I was fun, and we'd hold hands for 30 seconds or a minute and a half and giggle at each other, and then it was gone. But yeah, I guess maybe that's where I'm going in your experience as the caregiver, what do you do when you face that moment where you've lost that identification with them, and they're scared, or they're afraid. What's the first step that I should take as a caregiver with them?
David:you know one is to have your finger on your own pulse and recognize that this is pretty distressing, that it's part of the illness. And then I think the next most important thing is the reassurance. You both highlight, that people, even with moderate to severe dementia, can understand affect- the expression of others beyond what they see in the person or the identity, or anything else that's really kind of part of their cognitive setup. So that when you're distressed, I don't know what your experiences were, but if you're working with someone with Alzheimer's disease who's upset, anxious, perhaps delusional, agitated, that they respond to calming influences by the people around them. The affect is much more important than the words. Sometimes people with advanced dementia don't really even understand the words that you're saying, but boy, they can pick up when you're upset and angry.
Virginia:Yep.
David:And so it's managing that affect and being reassuring is
Steve:So when you say affect, that's kind of a word I don't the short answer. understand. You're referring to my emotional reaction is what I can control exactly. The words don't mean as much as- I'm smiling, I'm okay, I'm relaxed, I'm not irritated. All of those kinds of things will actually have a calming influence on my loved ones.
David:Absolutely. And folks can pick up on that.
Virginia:I should have said,"Oh, let's catch that person who stole your toothbrush." I should have said that, but I didn't know atthe time.
David:It's hard. Part of the issue here for agitation or delusions, there's a tendency for us to kind of correct people, and we our friends and family members, have various enthusiasm for that, and we have various responses. On the other hand, there's a natural tendency to do that, to being kind, and they're confused, and you want to help them by saying what's real. Sometimes that can be helpful, but a lot of times it doesn't.
Virginia:I was trying to be helpful.
David:Exactly.
Virginia:I really was, but that's not the way to do it when somebody has Alzheimer's.
David:And we're just so trained or behaviorally ingrained to kind of respond that way. It's an unnatural thing to say "What? They're stealing your toothbrush? We'll get to the bottom of that!"
Virginia:Totally.
David:You know, which is the better response and to say, "But it's okay, we've got more toothbrushes until we catch that person." Which is, it's a creative response that we just don't usually think that way.
Virginia:Yeah.
David:And that's where, hopefully thinking about these things and having a little bit of practice with it, for good or for ill, can be helpful too.
Virginia:Do delusions tend to start in the beginning of the disease, midway through, or more toward the end?
David:They're typically every person is different, and you know, roughly 30-40% of people with Alzheimer's disease will have delusions for a period of time in their illness. It tends to peak in the mid phase, if you will, when people are substantially cognitively impaired, but not many times. There are fewer delusions in later stages of dementia, partly because, sadly, there's not the cognitive capacity to launch a delusional thought, if you will. It's just difficult to kind of interpret things that way.
Virginia:Okay, do delusions- having delusions- does that indicate other types of dementia, other than Alzheimer's or other psychiatric disorders?
David:Yeah, in general, in these cases, we're aware that someone has a cognitive disorder like Alzheimer's disease, so that is a good clue. There can be illnesses like delusional disorder, which is a psychiatric illness where, typically, older adults will develop a delusional system outside of a memory impairment. In that respect, delusions overlap, but we're talking aboutfolks who have memory difficulty, and people with delusional disorder, their memory is fine. They just have delusions. And that's a relatively unusual syndrome as well. The other things to consider is that other dementias, like dementia with Lewy bodies or Parkinson's disease with dementia, are more susceptible to visual hallucinations, visual illusions, and probably delusions as well. So when we're seeing someone early on in the clinic who's got a lot of visual changes that are hallucinations, fairly early on in their course of illness that we're thinking, Parkinson's or Lewy body dementia.
Steve:I've heard that about Lewy bodies, and that's a defining difference of Lewy bodies versus Alzheimer's. They tend to-
Virginia:Hallucinate.
Steve:-hallucinate and actually act out and much more emotional about things. Maybe that's the wrong word, but is that what characterizes the difference between or adds to it in terms of Lewy bodies?
David:Yeah, I think the hallucinations are just much more common. The illness affects the visual perception areas of the brain to a greater extent, and they just misinterpret things. Interestingly, they're very formed hallucinations usually, they're not just vague images, but they will tell you, if you've had friends or family with Parkinson's disease, for example, they see small people, and they can tell you exactly what they look like. They're very clear.
Virginia:They can tell you the color of the buttons on your shirt.
David:Exactly, exactly. So that's a characteristic aspect of Parkinson's disease, with or without dementia or dementia with Lewy bodies, both of which have the same Lewy Body pathology, just in different parts of the brain.
Steve:You've said a couple of times you're talking about these different parts of the brain. Is there a part of the brain where the delusions actually occur that's different from other parts of the brain?
David:The short answer is, nobody really knows. I mean, understanding what part of the brain controls memory is simple. There's like four parts of the brain that are involved with memory and other parts and those areas are necessary and sufficient. Delusions are like any other aspect of kind of higher order thought. It's just a transcortical it's a whole brain phenomenon. We've done some work, and some others. I've identified some. If you look at a group of people with Alzheimer's disease and sort them to those with delusions and those who don't, and then look at metabolic activity across their cortex. There are certain parts of the brain that those with delusions have more hypometabolism or reduced activity. So there's some hints like that. The answer there is, it's the right frontal region as well as some of the memory circuits and the temporal lobes as well.
Virginia:I know you touched on agitation before, but agitation, depression, anxiety, are these things all causative with delusions, or just kind of a symptom of the delusion?
David:They tend to be somewhat separate actually Virginia, that there's some people will develop anxiety, some will have depression, some will have delusions, some will have two of those. Some will have all three. It's just a bit of a mix. You know, typically anxiety, depression occur a little bit earlier. In general, this is whereas, like I mentioned, delusions are a little bit later in the course of illness. I don't think there's any evidence that people who are more anxious or more depressed or more susceptible to delusions. I hesitate there, because if you have delusional thoughts, they're kind of distressing, so they're going to be more anxious. There's not like a substantial overlap in those symptoms.
Virginia:Okay, okay, all right, let's start a part of our discussion about non-medication interventions. What can caregivers keep in mind? And are there non-medication interventions that can reduce or prevent dilutions?
David:Yeah, it's a great issue, and the field is working hard on these things- that there's some caregivers, perhaps like yourselves, who have been very successful and have learned on your own how to do it.
Virginia:Really on our own.
David:Exactly. I mean, there's been a lot of work done, and there's, I sent you some references that people have kind of looked at strategies. So it's a complicated question, but the short answer is, we've touched on some of them. One, now we're talking non-medications. One is the reassurance, you know, with delusional thought. Distraction. A key first start, as I've alluded to already, is don't argue. When you think about it, if a friend or family member has a false belief.. Okay? There's no intervention needed. Sometimes they lead towards distress, anxiety or agitated behavior, and obviously, then it's much more important, but to not argue, and that's something that as a caregiver, you're overworked and underpaid and just it's challenging, so it's easy to argue, because the sense is, if you explain it to them, they'll understand, and then it will go away. Sadly, that isn't gonna work usually.
Virginia:It doesn't happen.
Steve:Yeah, being right isn't necessarily advantageous.
David:It's overrated in general.
Steve:But I think that's an important characteristic as caregivers. And I think you're describing this pattern. You know, the good news about the disease is it evolves over time, but as it evolves over time and gets more difficult, and you need to be more adaptable. And so it's important that you're aware that these things are going to occur and I think this is an important part. What would you say- maybe there isn't a percentage- but do you have an idea of how likely Alzheimer's patients would develop delusions?
David:In broad strokes, about a third, basically, somewhere between 30%-50% are going to have delusions for a significant part of just one day or three days, but you know, a period of time of weeks to months where they have delusional thoughts. And it depends on what you mean by delusions, and who's measuring in the circumstance and those, for example, in skilled nursing facilities, it's higher than that, partly because people are there, because they have delusional thought and agitated behavior sometimes as a consequence.
Virginia:I was thinking, are there environmental modifications in the home or in a community that can be made that would help reduce delusions? I know caregiver behavior and responses are important, but are there environmental things you can do?
David:Yeah, there's a few things. I mean, one thing is familiarity, that's probably the most important thing. Steve you mentioned, when a new place fosters delusional thoughts, or may, just because the person may not really understand why they're there, or that what this place is? And when you tell them, "Oh, this is your home now," that obviously goes against everything they would expect to hear from you. So it's a challenge, keeping things familiar, not changing things more than need to be changed, making some other environmental adjustments, things like some people respond to mirrors or TV very poorly. There's a well known phenomena, people seeing their own face in the mirror and being convinced that there's a stranger.
Virginia:Scares them.
David:Exactly. So no mirrors. Take the mirrors away.
Virginia:I was told with mom, we need to take the mirrors down.
David:Yeah. Same thing with TV. For some, I won't get into detail about the horror if TV was real, if that was actually happening in your room, that would be really terrifying.
Steve:Especially today's program.
Virginia:Oh just turn on the news.
David:We won't go there. But it's like, you don't want that happening in your room. And you and I say that's on the TV. It's overthere. But folks with moderate to advanced dementia just, they see it and they just assume that it's there. It's not real common. But that's another environmental thing. If you notice that things like that are precipitating distress or delusional thoughts that obviously to kind of reduce the exposure to that when possible.
Steve:I've got a question for you about the issue of travel. We're talking about changing environments. I know how many guys in groups that I've been in say, "Well, I wanted to travel. I wanted to try and take advantage of all the good time that was left," and we've often said, "Well, there's going to be one final trip. You don't know when it's going to come, you don't know how it's going to happen, but all of a sudden that's going to be the last trip." Because even if it's to a place, in our case, it was to a place Patty's been to, dozens of times. And finally, we went to Hawaii, and we were in our condo, and she went, "Where are we?" And I went, "Are you kidding? You've been here all the-." So you said limit the amount of change that's going on in terms of environment. How do you decide when that's appropriate?
David:Yeah, it's a great question, Steve, and there is no simple answer to that. Some people enjoy new experiences. They'regoing to a place that's familiar to them, that will resonate with them, and you're having a good time too. And as we're talking about that's a good emotional experience. But in general, it's the novelty that really is challenging for folks. So I encourage folks to really be conservative in doing that, in taking trips, particularly long and tiring trips, because then everything else gets more difficult, too, and losing the sense of familiarity. I've had many- around the holidays, for example, since we're around that- people want to go to the east coast to visit lots of family for the holidays, and many times, people with moderate dementia just don't understand what that's about. It's just socially overwhelming. They don't exactly recognize everybody, and that's socially awkward for all of us, but when you have a cognitive disorder, it's even more distressing, and the idea about having all the grandkids hanging on you can be terrifying. So it's really the secret there, is have a fallback option too and we encourage folks for larger social engagements to have the person with dementia in a different room, for example, and people go in, like two or three at a time, you know-
Steve:Small group.
David:Exactly, but some of its trial and error, it may turn out that that's not needed. But just to be aware.
Virginia:That's good advice.
David:Social would be good, but it isn't necessarily, sadly.
Virginia:Right exactly. I learned with mom. There were times they had to call 911, at the assisted living facility because she fainted. There were various problems, but the hospital visit threw her completely off. It was bad in the hospital, but evenafter getting her back to her room, it took two to three weeks to get her back to what I would call okay and normal. If I'd to learned to say "No, she's not going to the hospital for that."
David:No. It's really challenging, because when you call 911, you know what's going to happen. And it's really a tough choice that you have to make as a caregiver. And gets into this realm of just trying to balance things that are inherently hard to-
Steve:Yeah I had that experience with a TAI.
Virginia:Oh, did you?
Steve:Yeah and I'll never forget that. I mean, she was, she was out of totally, totally lost, and holding, hugging, grabbing my hand because she felt so displaced. And, you know, they're putting her in an MRI tube, they're doing all of these things to try and figure out what stroke happened. And she eventually came totally back. I mean, amazingly, but that happens,
David:You know, it's really distressing.
Virginia:Sure it does. All right, well, let's talk about medications. We've talked a lot about non-medication interventions. Are there any? Tell us about that David.
David:Yeah, it's a challenge there. In general, there aren't good medicines for managing delusions. I mean, there just aren't great medicines for that. Physicians will sometimes, after a careful discussion and attempts using non-medication strategies, that's always important to happen first, to consider a trial of an atypical antipsychotic such as Seroquel, Quetiapine, Risperidone, Risperdal.
Virginia:That's the one they put mom on.
David:Right, right. And there's a long history, and a lot of studies have looked at that in controlled ways. And the bottom line isthat, on average, there will be modest benefit at best. You know, they don't, they're not curing the delusions, they're not solving the behavioral disturbances unfortunately. On average, there's benefit, but the magnitude sometimes, both physicians and families think that this is going to solve everything, and they generally don't. Everybody's different, so some people don't respond at all, and some people will get a great response, and you don't necessarily know until you try. So it may be worth the trial. But again, the magnitude of benefit in general, and what was your experience? Did it help?
Virginia:I had them take her off of was it Seroquel? Is that how you pronounce it? Oh, Risperidone. Not good at pronouncing those things. After a while, I'm thinking, "Well, they've already got her on an antidepressant. She's got this and that." And I thought, "I don't think we need another drug." And I wasn't noticing a big benefit.
David:Yeah, that's commonly what people say. Sometimes there's greater benefit, fortunately, but sometimes there isn't much benefit at all, and many times it's worth a trial. But to assume, I think that's the challenge in the field, is just to assume that these medicines are going to be the answer. They really aren't. And the side effects also are something notable we can talk about that. But all of these medicines, the antipsychotics, have side effects that can make things worse, including cognition. So we want to be gentle in using psychotropic meds for sure.
Virginia:Okay, okay.
Steve:We've heard wives discuss the whole idea of their husbands acting out, or fathers acting out, this fear that occurs with the caregiver, and then they got to do something. They've got to put them on some drug to manage them, as are terms I hear. Is this related to the difference between size and issues like that, or is it something more significant that exists in men in terms of their behaviors?
David:Yeah, I think it's a great question. Across the medical literature and my own experience, it's an equal opportunity. Delusions are occurring about the same. It may be what you do with the delusions that are a little bit more over represented in men versus women. And a colleague back in my fellowship training, did a study of people's life history of aggressive behaviors like well before dementia, and when people who had those histories became demented, they weremore likely to be agitated and aggressive. So we become more like ourselves in a way, you know. So I can make an analogy to the men versus women piece there, but it's hard to know. And there's not an obvious, overwhelmingly men versus women. And I think we could mobilize a hypothesis for that, but I'm being creative here.
Steve:So you'd probably go back to your same recommendation if, as a wife or a daughter taking care of a male, be cautious in terms of the use of medications. Try things, see if they work, but don't expect them to necessarily be the be all and end all.
David:Exactly with regard to the medicines and they're many times, they're worth the trial. And you have to, every person's different, and each physician needs to understand the circumstances. You know, if it's a safety issue, then we need to bemore aggressive with management, including medication in the thinking that any benefit would be helpful compare andthe risk is worth it. So it depends on the circumstances.
Steve:Yeah, I'll never forget Patty, who was totally non-aggressive personality, swung and hit someone.
Virginia:Yeah, my mom did too.
Steve:Yeah. It was as if they had to do something. It was a one and only time. And after that, it went away. But it was sure scary for a moment to think that somebody that would have never raised a hand to anybody.
Virginia:Hardly raising her voice.
Steve:Yeah, yeah.
Virginia:I know it. Well, we're pretty much getting ready to wrap up here. Dr. Sultzer, is there anything that you think we haven't covered, or anything you want to add?
David:I think we've covered most of it. I'll mention while we're on medication. I mean, the field is really moving towards better meds, and there are half a dozen or more medications that are currently in trials for these kinds of behaviors that as you're aware, there's an explosion of new information about treating Alzheimer's disease with monoclonal antibodies, etc. And many of us have felt that this area has been under developed and under studied. That's changing. I mean, there are trials going on that work through medications that have a different mechanism than the anti psychotics. So the goal is to raise the benefit but fewer side effects, basically. And so we'll be seeing better options down the road. They're just not here yet, unfortunately.
Virginia:Okay, they take a while. Okay, anything else you want to add Steve?
Steve:Well, I have to tell you, it's just amazing to listen to you talk about it. And I thought of this whole category and like,"Well, you know, I don't really remember a lot of hallucinations." But when we get into it, on a day to day basis, there were a lot of things that went on that I just didn't understand what was happening. And I think this has been so valuableto understand that these acting out, these emotional periods that they're going through, are reality, and you need to be prepared that they're going to happen and tone it down- don't overreact.
Virginia:That's right, yeah.
David:And they're just fundamental expressions of the illness. It's not the person sadly who's doing this. And you have to kind of step away from that for good or for ill. And it highlights the challenge of doing that. You use the term disoriented by what you're trying to respond to. That exemplifies why caregiving is so challenging.
Virginia:Yeah, exactly true. It feels really odd to go along with something and you're thinking, "What the heck?"
David:Exactly.
Virginia:Anyway, thank you so much, Dr. Sultzer for joining us today.
Steve:Keep up the good work, man.
Virginia:No kidding.
David:And you guys.
Virginia:Aw thank you. I know that you do have some resources that you like, and we'll put those in the show notes. For our listeners, thank you for joining us today and join us again soon for another episode of Spotlight on Care.
Steve:Spotlight on Care is produced by the University of California Irvine, Institute on Memory Impairments and
Neurological Disorders:UCI MIND. Interviews focus on personal caregiving journeys and may not represent the views of UCI MIND. Individuals concerned about cognitive disorders, prevention, or treatment should seek expert diagnosis and care. Pleasesubscribe to the Spotlight on Care podcast wherever you listen. For more information, visit mind.uci.edu.
