When focusing on hospital admissions/stays the word delusions pops up a lot, especially when describing our elderly population. What is the difference between delusions and dementia? Here’s an explanation.
Dementia is a decline in your mental ability such that it affects your activities of daily living or ADL’s. These ADL’s are: grooming, toileting, eating, taking medications, decision making, loss of reasoning skills, and reduced visual perception. Unless the dementia is caused by depression, low B12 levels, or thyroid insufficiency dementia is not reversible at this time. There are many diseases that have dementia as a symptom of the disease such as Alzheimer’s Disease, Vascular Disease, Lewy-body Dementia, Fronto-temporal Dementia, Posterior-cortical Dementia, Parkinsons Disease, Multiple Sclerosis, AIDS, Korsakoff’s Syndrome (Alcoholism), brain trauma, and others.
Delusions are beliefs that are held by a person despite evidence to the contrary (faulty judgement), in other words against reality. An example would be someone thinking that their spouse is unfaithful when there is no real evidence that this is true. The person cannot separate what is real versus what is imagined. People with this disorder usually can still function normally as part of society with the exception of their delusion.
Delusions can occur in middle to later life although it is not a common occurrence out in the community. It is more likely associated with a hospital stay due to surgery, a long hospital stay for disease management where infection, pain killers, sleeping pills, sedatives are used or where the conditions of dehydration, poor nutrition, sleep deprivation, isolation, and medication changes are involved (In these cases especially surgery, delusions can appear quite suddenly). It can also occur in those patients diagnosed with dementia or in those patients who already have a frail constitution.
Once the triggers are found and addressed, it can take weeks to months to fully recover from them. It was found in a look-back study by The Center For Advancing Health in a November 8, 2011 article (www.cfah.org/delusions) that elderly hospital patients with delirium are more likely to die within the year following their delusion diagnoses!
The first signs of delusional thinking are confusion, disorientation, impairment of language skills either understanding or speaking (dysphasia), slurred speech (dyarthria-due to muscle weakness), tremors, hallucinations (seeing or hearing something that isn’t there), and short term memory loss.
Delusions can occur as part of substance abuse, psychoses, and schizophrenia as well. The delusions are divided into the following categories:
Jealous – beliefs that a mate/partner is unfaithful.
Erotomanic – beliefs that someone famous is in love with them (leads to stalking behavior)
Grandiose – having an overly-inflated self worth, identity, sense of power, or that they are more knowledgeable than those around them.
Persecutory – the belief that they or someone they know is being harmed or mistreated, or someone is planning to do this in the future as evidenced by repeated complaints to the police.
Somatic – the belief that they have an unsubstantiated disease or condition.
Mixed – more than one of the above.
The Cause Of Delusions: They are divided into genetic, biological, and environmental. There can be a genetic tendency to suffer from delusions. This is many times noted in their family history. In biological there are certain abnormalities in the brain that cause the brain’s neurotransmitters to malfunction. These are the chemicals responsible for relaying messages from one neuron to the next. The messages become interrupted and thoughts become skewed. In environmental the delusions may be triggered by stress, alcohol abuse, or drug abuse. Some examples are : immigrants isolated by lack of 2ndary language skills, people with poor eyesight, folks with poor hearing, etc. Isolation sometimes causes the brain to create stimulation when there is none from the surroundings.
Other symptoms of delusions include increased anger, lower mood, increased irritability, or the presence of hallucinations.
Because the hospital setting can trigger the onset of delusions due to isolation from their normal world, medication changes, lack of sleep, etc., it is no wonder that hospital personnel want patients to bring their glasses and hearing aids, get them up increasing their activity physically and mentally, and have the shortest stay possible so that they stay in touch with their world.
Thank you to the Cleveland Clinic for increasing my knowledge about delusions! https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder