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Do I tell mom what’s really happening? Trying to navigate where she’s not thinking someone is out to get her and not let her think she’s losing her mind. Never knew this was going to be so hard.

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Looking back at my own experience: My mother (who has always been difficult) has dementia and it did not start with memory loss. Stopped socializing but shadowed me, demanding I fill her social needs. Exaggerated every slight as a huge personal attack. Became combative that everything was a scam with a fanciful conspiracy. Couldn’t find anything in her house because everything she wanted to use had been “stolen”, even as I stood there and watched her hide items.

Paranoia was one of the first hints of her dementia. Paranoia is not a symptom of aging.
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If this isn't dementia then you are looking at some mental issues that need to be addressed. Sadly the only way to do this is to speak with your Mom about her reality right now, and about the need for a good baseline exam. This will start with her own MD and a good bloodwork and urine panel. Then a visit. And a referral on to a neuro-psyc MD for the rest of the exam. Explain that this is a baseline to reassure her where she's at, and for the future, and really quite a normal thing to be done at her age.

You need answers as to WHY this is happening before you can guess at how to address it.
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These are signs of Dementia. Mom needs a good physical with labs. Labs will show what her Thyroid level is, her kidney levels, potassium levels if out of wack can cause cognitive problems. If nothing is found wrong, then as Alva says, she needs to see a Neurologist.
Have you had her checked for a UTI, makes the wonky.
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As other responders have stated, and I agree: paranoia is not "normal" to "just age"... she either has the beginnings of dementia or has a mental health issue. So, an accurate diagnosis is what will help you to help her. You will need to learn how to engage with her more productively and peacefully so that you don't get burned out.

Teepa Snow videos on YouTube are quite helpful. She is an expert on caregiving people with dementia. If you continue to react to your Mom as if she is simply and older version of herself, you will make life unnecessarily hard for the both of you. Get your head out of the sand and educate yourself and take her to the doctor for a diagnosis, then you can work on solutions. She could have a UTI, a thyroid problem, a vitamin deficiency, dehydration, and other treatable problems that all have similar symptoms to dementia. These need to be discounted by her doctor. Then you can move forward with getting her the best help possible. If it's dementia, then it is a marathon, not a sprint. So remember to take care of yourself!
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There are ways to acknowledge how someone feels, and then redirect them to something else.
There's a video channel on YouTube called Care Blazer that has great tips
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Paranoia is one of the first signs of dementia.

You can't change her mind. She's most likely incapable of understanding what you're telling her. She is going to believe someone is out to get her, and that's that.

I've seen this same thing with two family members and also a close friend. Each time the family was in denial that it was dementia. Here are examples of what happened with these people. Person One thought that her soon-to-be ex-husband was trailing her around town spying on her, but he was several states away embarked on a new romance and he wasn't anywhere near her. She'd get angry if anyone tried to tell her he wasn't watching her. Person Two believed that his car was about to be repossessed and that cops were looking for him. It wasn't true, there was no warrant and he was current on his car payments. Person Three believed that her daughter was coming into her house and stealing her clothes. She expanded this to her friends stealing her clothes and other items, including thinking that a neighbor was trying to steal her husband in addition to wine from the basement. None of it true.

You wouldn't believe how people will cling to the idea that such behavior is NOT dementia. Maybe it isn't in the case of your mom, but dementia is definitely a possibility, so you need to check it out.
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Is this fixation/panania behavioir new?

I would book a Doctor appointment & discuss. A full checkup, bloods etc may rule out causes. Hopefully help diagnose correctly & find the right direction. It may take several attempts.

The well known symptom of Dementia are memory loss BUT Dementia can present with many other symptoms first. Eg Vascular Dementia can show up as understanding & planning skills problems first. FTD can have personality changes & Lewy's Bodies can have delusions & hallucinations.

Start researching & be observant of changes in your Mom. Look for problem areas & ways to increase her safety. Eg Have good lighting for bathroom including sensor lights at night. Low lighting + sight issues can = increased fear & falls.
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