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People who have dementia often accuse the people closest to them of theft, injury, or other horrible things. While abuse can be real, it's important to remember that most accusations are a symptom of disease. Here are 10 ways to deal with them.

"You stole my purse!"

"You are keeping me prisoner here!"

"You are trying to kill me!"

(To a spouse or partner) "You are cheating on me!"

There's nothing unusual about false accusations from people who have dementia. A false accusation of harm from someone you are working hard to help is hard to take. In the United States, there may be even be legal issues that arise from false claims that have to be dismissed by a social worker or a prosecutor's office. It is important to keep your cool, and to realize that false accusations are almost always manifestations of a diseased brain. Here are 10 approaches to false accusations from people who suffer major neurocognitive disorders that may help. Let's start with five situations many caregivers encounter.

False accusations tend to take different forms in different types of dementia. People who have Alzheimer's disease are more likely to make false claims of persecution earlier in their disease, and false claims that misidentify people later in their disease. False claims by people who have Parkinsonian dementia tend to have a visual component. They may hallucinate a vivid "movie" of an event that never took place. People who have Lewy body dementia may display Capgas syndrome, belief that a family member or caregiver has been replaced by an impostor. Delusional jealousy, belief that a spouse is cheating on the patient sexually, is more common in Lewy body dementia than in other major neurocognitive disorders. People who have other forms of dementia complicated by a sleep disorder may suffer delusions, hallucinations, or illogical thinking caused by deprivation of REM sleep. And there are people who get "stuck" in the intermediate state between wakefulness and sleep, suffering hypnogogic (falling asleep) and hypnopompic (waking up) events that they internalize as real.

"You stole my money!"

People who have dementia have to give up control over their finances. Their remaining financial authority may be limited to a little cash in a wallet or a limited balance on a debit card. When the concern is over a small amount of currency and coin, a useful response is to look for it with them. Then it helps go over recent events where the money may have been spent. 

When the accusation concerns larger amounts of money, it helps to keep records. Even if the person you are caring for can no longer completely follow, say, balancing a checkbook, it helps to be able to show that you have taken care to keep track of income and expenses. Of course, the expenses of people who have dementia usually vastly exceeds their income. If you are caring for someone on government assistance, you may have to remind them that they no longer can access their assets as the price of keeping them in care. 

Logic usually isn't particularly helpful in discussions of finance with people who have dementia. Your demeanor makes the difference. At the earliest opportunity, help the person you care for engage in a different activity.

"You're poisoning me!"

Someone who has dementia may suffer the delusion that a family member or a caregiver who cooks for them is trying to poison them. This is most likely to occur when the patient is served unfamiliar foods or foods prepared in an unaccustomed way. The solution? Provide familiar foods. Allow the patient to observe their preparation, or even to "help" in the kitchen. Take a bite of the food with your own fork or spoon to assure the patient it is safe.

Food served in nursing homes is bland for a reason. People who tend to "connect the wrong dots" may interpret unfamiliar seasonings as an attempt to sabotage their health or poison them. There is usually no problem with bringing them their own condiments to give their food a familiar taste.

"You stole my wallet/glasses/dentures/remote control!" (and so on)

When someone who has dementia can't remember where something is, they may conclude that someone had to have stolen it. It is easier for them to blame someone else for the missing item than to accept that they cannot remember what they did with it. 

How do you respond?

  • "Let's look for (the missing item) together."
  • "I am sorry (the object) is missing. Can I look for it one more time?"
  • "Maybe it was moved when we were cleaning. Let's take a look."
For frequently "lost" objects, either buy duplicates, or have a hiding place where you place the object for safekeeping. But make sure other family members or nursing staff know where you stash these problem items when you are not available to provide them.

"You're keeping me prisoner!"

A formerly independent adult who now is restricted to the home may feel like he or she is in prison. Sometimes it is enough simply to talk about going to favorite places. Or it may be possible to "get ready" for an outing but redirect the patient's attention as time passes. Other times it is possible to go on a "field trip" outside the home or nursing facility for a change of pace. 

Be sure you have authority to take the patient outside the home. Sometimes legal liability attaches for doing a good deed if the patient is hurt or wanders away.

In addition to dealing with these four common situations, there are six principles to keep in mind when dealing with false accusations from someone who has dementia:

  • Remember that you can't win an argument with someone who has dementia. You will only make them more upset.
  • Keep answers to questions short and simple. 
  • Keep calm, and stay positive. Use affirming body language.
  • Make sure the home environment is calm. Don't let the TV blare. As much as possible, insulate patients from upset and upsetting people.
  • Validate, then distract. Treat the patient's concern as legitimate, even if their analysis is faulty. Then move to another activity as quickly as possible.

Finally, don't take accusations personally. Remember that your loved one with dementia is trying to make sense of their reality — the only way they know how. Focus on showing that you care.

What do you when your spouse with dementia accuses you of adultery? Answer simply, yes or no. Then redirect the conversation to shared memories of some special event. Or share a favorite activity. If you need your own time out, take it, but not for so long that the patient feels abandoned. 

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  • Iroka N, Jehangir W, Ii JL, Pattan V, Yousif A, Mishra AK. Paranoid personality masking an atypical case of frontotemporal dementia.J Clin Med Res. 2015 May..7(5):364-6. doi: 10.14740/jocmr2099w. Epub 2015 Mar 1. PMID: 25780487.
  • Weintraub D, Hurtig HI. Presentation and management of psychosis in Parkinson's disease and dementia with Lewy bodies.Am J Psychiatry. 2007 Oct. 164(10):1491-8. Review. PMID: 17898337 .
  • Photo courtesy of SteadyHealth

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