Experts on the AARP Caregiving Advisory Panel answer reader questions and offer helpful advice. Below, clinical psychologist and family therapist Dr. Barry Jacobs responds to two queries about caring for parents with dementia.
Q. My mother has been diagnosed with vascular dementia. She suffers from paranoia — for example, she thinks her phone is tapped and that people come into her apartment and take things — and takes medication to treat it. She wants me to be with her all of the time, yet she suspects even me. Do you think that cognitive therapy will help at this stage?
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A. It hurts when the person you are striving to help accuses you of malevolent intent and hostile acts. It's what makes paranoia — an irrational fear of others that's a common delusional symptom of dementia — so exasperating and often stymieing for family caregivers. Try to win over your loved one with sweetness and reassurance and she may regard you with greater suspicion. Confront her, however gently, about her unwarranted mistrustfulness and she's likely to feel threatened, convinced that you're allied with the swarms of enemies who mean her harm.
How might cognitive therapy help your mom? This popular, evidence-based form of psychotherapy (often part of a broader approach called cognitive-behavioral therapy) helps people become more aware of and better able to correct the irrational distortions in their thinking in order to decrease responses of depression and anxiety. There is some research (primarily conducted in England) that suggests that cognitive therapy techniques can be effective in decreasing paranoid distortions. In my clinical judgment, however, such techniques are most likely to work when paranoid delusions are relatively mild — not the severe and myriad distortions your mother has been experiencing. If she won't talk on the phone for fear it is tapped, she is likely to clam up and hunker down in the office of a mind-probing psychotherapist — if you could even persuade her to go.
So how should you deal with your mother's paranoia? Allow the medications enough time to decrease her delusions and make her thinking more reality-based. Once the quality of her thinking substantially improves, ask her primary care physician to refer her to a psychotherapist for a trial of cognitive therapy to help her better recognize and correct whatever distortions in her thinking remain. She won't ever be the cogent and perhaps appreciative person she once was; her dementia, unfortunately, precludes that. But at least, if her fear is reduced, you will suffer less heartache.