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10 February, 2012

The work I did during the last several years of my career yielded observations of a psychotic disorder in the elderly to which few if any are paying attention.  Professionals who may have noticed it are glossing it over with, in my humble opinion, the misdiagnosis of dementia.  The disorder appears to strike almost exclusively females in their late sixties to mid-seventies, the mode being early seventies.

The onset is rather sudden (over less than three months).  The clinical manifestations are the development of persecutory delusions and, usually, delusion-congruent auditory, visual and even olfactory hallucinations.  Professionals I tried to talk to about this odd disorder were prone to pass it off as dementia or medication effects, but neither proved to be the case.  While psychosis can develop in persons with dementia, it is clear that these women did not have that disorder.  There are over 100 causes of dementia* in the elderly including such things as multiple, small strokes, Parkinson’s, medication effects and the like but I could not pin this particular one on any of the usual causes.  Further, with the exception of Pick’s disease, psychosis seldom develops until the later stages of rather obvious dementia.

(*Alzheimer’s is altogether too often diagnosed as being the problem, accounting for only about 2/3rds of dementia cases, and correct diagnosis is critical when it comes to planning for the future as well as treatment.)

Dementia is defined as having (1) memory impairment and (2) at least one of the following signs and symptoms:

  • Apraxia, the inability to carry out normal motor tasks like buttoning a blouse
  • Agnosia, the inability to name common objects
  • Aphasia, difficulty with either or both verbal expression or receptive aphasia in which the words of others sound like nonsense; or, finally
  • Disturbance in executive functioning (calculation, judgment, reasoning, etc.).

NONE of the women observed as having the odd psychosis exhibited any of these signs and symptoms of dementia.  It was common for them to be fully competent in self care, to manage their finances just fine.  Their grooming and homes may be immaculate and, outside of the effects of the psychosis, they functioned just fine in every way.  Neither were medications problems associated with what I observed.  Many who came to my attention took no medications whatsoever.  These women often came to the attention of law enforcement, either through the proclivity to call 911 about some imagined intrusion or persecution, or through calls from neighbors or family.  Often the victim worked their family members into delusions and would isolate themselves from family, making it difficult for family to intervene.  They came to the attention as well of Adult Protective Services agencies because of their behavior.

The nature of my later work as a supervisor was such that I wasn’t able to delve deeper into the problem.  However, because I reviewed and assigned all referrals, and read the subsequent reports, I was aware of enough cases involving this psychosis to know that it can persist for at least 3 years without the development of any significant signs or symptoms of dementia.  It appears for all the world to be a stand-alone psychosis.  I might add that no mood disturbances were observed, ruling out psychotic depression, and there were no prior histories of psychotic disorders.  It’s intriguing to ponder what the heck this is all about.

How long has this been going on?   Has it forever been glossed over as simply dementia or is it a relatively new problem?  If it is relatively new, why is it showing up now?  Is it simply a matter of longevity (as has been the case with the increase in the incidence of dementia); is it environmental; is the psychosis even treatable?  I have my doubts about treatment as delusional disorders usually don’t respond well to medications, other than reducing the anxiety associated with the delusions.*

Why does it strike almost exclusively females?  I doubt anyone of note or influence is likely to read this, but I’m hoping somebody, somewhere will think “whoa — there’s something going on here”, just as they eventually did with the association of migraine headaches with sexual abuse PTSD.  I’ve been all over the internet hoping to find some other description of this anomalous psychosis without even a hint that it’s been noticed.

Have you seen this?  Share your story in a comment.


* This fact, by the way, is the best way to approach trying to convince sufferers to consider medication.  Rather than challenging the delusions, it is best to suggest that experience has shown that the troubles seem never to go away, and to suggest sympathetically that medications might at least help relieve the fear and anxiety with which she is living.


From → Social Work

  1. Rachel Castellano permalink

    My Mother is exhibiting this behavior and I am floored. It happens only when she is confronted with handling paperwork and being questioned on the phone. Simple tasks that don’t require much thought. Her home is very clean and she is a Jehovah’s Witness so when she studies, she writes the answers down on the literature and they are well thought formulated answers.

    • Thank you for your comment, Rachel.

      Lacking further information*, I’m not entirely sure that your mother has this disorder. The delusions are persistent at all times, not episodic. It may be that she is in the early stages. Alternatively, she may be experiencing some early symptoms of dementia. The task of handling paperwork, or that of answering questions, may force her to be aware of some loss of memory and reasoning function and thus lead to some irritability. Having time to read a familiar subject, think about questions in an unhurried manner, and write them down without any pressure might not be a fair comparison to being questioned in real time on the phone. My mother never developed any significant dementia but did suffer some memory loss. She spent some time doing crossword puzzles and liked to go over a very old geometry text she had as a way of exercising her mind and found those activities pleasurable. On the other hand, she would get frustrated during real time conversations when trying to remember names and events. Whatever the case, do keep an eye open for any worsening of signs and symptoms of dementia.

      * Much depends on how old she is (you didn’t say), what medical conditions she may have and what medications she may be taking.

  2. Reblogged this on The Curmudgeon and commented:

    I wanted to push this post up higher in the list and so am re-blogging it. Hope springs eternal.

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