How I Treat Alzheimer With Agitation: Navigating Patient Delusions Case Presentation

An 80-year old woman with a longstanding history of generalized anxiety, for which she had been taking an SSRI for many years, presented to the clinic for evaluation and management of agitation in the context of dementia. She had a history of cognitive difficulties that started slowly about 2 years ago and gradually progressed over time. She had been diagnosed with dementia due to Alzheimer’s disease and had been taking a cholinesterase inhibitor. She was living independently initially but as her symptoms progressed, she started to experience difficulties managing things on her own.  She was missing bill payments and getting lost in familiar areas. She accidentally took extra medications because she forgot that she had already taken them.

She had 3 children but only her youngest son lived in the same city. So, she moved in with her son so that he could provide more supervision. Patient was advised to stop driving, so her son had to take her car keys away. Her son also started managing her finances as well as her medications. The patient then started to become verbally aggressive towards her son, who in turn felt overwhelmed and struggled to manage her behaviors. This affected his ability to provide care for her. 

During the evaluation, it was noted by the patient’s family that she was acting suspicious of the son and was accusing him of things he did not do, like stealing her belongings. The patient mentioned during the visit that her son was not really her son. She said that she did know him, but that he was just an acquaintance. When other family members reminded her of her son, she would get upset that she could not remember him. 

After discussion of treatment options, she was prescribed an atypical antipsychotic medication. This helped partially to decrease her agitation. However, the patient continued to believe that the person living with her at home was not her son, and frequently got into confrontations with him.