3 Things in Dementia That Look Like Lying (But Aren't)

0:00A man with dementia drove his car through the front of a building and afterward he still

0:07Kimberly Williams: insisted he was perfectly safe to drive. If you're his family, what does that look like to you? Is that denial, stubbornness, an outright lie? What if his brain was actually telling him that he's a safe driver? Because there are several symptoms that happen in dementia that from the outside, absolutely can look like lying to you and me. But from the inside, when we understand the symptom that we're seeing, we understand they are not intentionally trying to deceive us or ignore reality. And in this video, I'm going to show you three of the biggest ones. Because on the outside, while it can look very similar, they're outright lying or in denial.

0:54Kimberly Williams: Underneath, it's actually something completely different. Careblazer, real quick, if you learn better by watching things, then you can hop on over to my YouTube channel where I post these podcasts in video format, sometimes have different visuals to help people learn even better. You can just type in Careblazers into YouTube and I will pop up. All right, let's get back to today's podcast. And here's what I want you to keep in mind through this entire video. A lie requires somebody to know what is true and intentionally tell you something different. And in these three situations, that is not what is happening at all.

1:34And once you understand that, it can change how you start

1:38Kimberly Williams: to respond. Hi, I'm Dr. Natalie Edmonds, a board certified geropsychologist. If you are new here, welcome. This is a place where we talk about everything dementia. All right, let's start with one that comes with some of the biggest safety battles in dementia, and that is analcygnosis. This is when someone is not aware of their limitations or difficulties or even condition. So this is where your loved one genuinely believes they are still safe to drive. They can still handle the finances. They can still manage living alone safely, even though there's so much evidence that none of those things are true.

2:21Kimberly Williams: You're looking at everything that's happened thinking, how can they think they are fine? They've been scammed out of thousands of dollars. They've almost set the house on fire. They drove their car through the front of a building. And yes, this was a real life patient that I worked with when I was at the hospital. This is why anosognosia can look so much like lying, but this is different than somebody knowing they have difficulty and just not wanting to admit it. With anosognosia, the brain changes literally prevent the person from understanding and recognizing that they have problems, that they have impairment.

2:59Kimberly Williams: So when we try to do something and it turns out we can't do it well or we can't do it at all, our brain is able to recognize, oh, I guess I don't have the training or skill for that like I thought I did. But with anosognosia, that reflection, that accuracy is not happening at all. It's not that the person isn't looking at all of the evidence that you're looking at. It's that with anosognosia, their brain is literally not even showing them that evidence. Literally not even looking at the same picture you're looking at. The second symptom that can look a lot like lying but is not is something called confabulation.

3:37Kimberly Williams: This one is more about memory instead of awareness So here's the simplest way I can describe it. The brain doesn't like a blank. It doesn't like a gap of knowing what happened. So when the brain reaches for a memory that it cannot remember, the brain sometimes fills that empty space with an answer that is completely false and not based in reality at all. Instead of them purposely thinking in their head, wow, I have no idea what happened. I can't remember what happened. I'll just make something up. That's not what their brain is doing. Instead, in this situation, their brain is making up a story to fill in the blank, and they have no idea that the story they've made up is inaccurate.

4:19Kimberly Williams: That is why your loved one can look you dead in the eye, full seriousness, and say, the neighbor came over yesterday and dropped off flowers, but you know nobody came. You know there's not even any flowers. So from your perspective, that didn't happen. from their perspective, it's just as real as any other memory. She is not intentionally making up a story. Her brain is remembering a false story. That's why in the beginning, I said, remember, lying requires somebody to know the truth and intentionally give you something different. That's not what's happening here. The person doesn't know the truth.

5:00Kimberly Williams: Now, one important caveat here because it is very easy in dementia care to over pathologize everything, meaning we always every mess up or thing that isn't perfect, we blame it on the dementia. People with dementia can get facts wrong, just like you and I can get facts wrong. Sometimes that does happen. Okay. And the third thing that can look like a lie is a delusion. There are many different types of delusion, but a delusion is when a person believes something so strongly, even though there is no evidence to support what they believe. And it is not true. It's not based in reality. Now you might be thinking, wait a minute, isn't that confabulation?

5:38Kimberly Williams: But no, confabulation is literally about their memory. They're trying to fill in gaps in their memory and they're filling it in with things that are not true. A delusion is more about a belief. Often those beliefs center around certain themes. A person is stealing from them. A spouse is cheating on them. Somebody's trying to harm them. Somebody's trying to get rid of them. This is not really my home. And those beliefs tend to come up in the same way over and over again. So it's kind of like a repeat false belief versus a confabulation can just be a one-time thing that they said that isn't true.

6:18Kimberly Williams: And then you may never hear that again. Okay. So this is where things get tricky. We just talked about anosognosia, confabulation, delusion, three symptoms that are very common in dementia that look like lying, but are not lying. And I know, and you know, real life is not so clear cut. Real life, it's not so easy to hear and see what a person is doing, especially we're in the middle of being stressed and fatigued and overwhelmed and to know, oh, that's confabulation. Oh, that's anosognosia. Oh, that's a delusion. It's not that simple. I don't want you to get caught up and knowing and feeling like you have to know exactly what the symptom is that your loved one is doing.

6:59Kimberly Williams: But I really do hope what this video can do is instead of you asking yourself, why is my loved one lying to me? I would love for you to start asking yourself, what could be happening in their brain that makes this thing feel true to them? And if you were to step inside of a world where the things that they are saying and believing they actually do believe is their reality, it is not an intentional, deliberate lie to make your life difficult. So not why are they lying to me, but what could their brain be trying to communicate to them? What could be happening in their brain that is making them feel that this is true?

7:39Kimberly Williams: Then, based on that answer, we can ask ourselves what type of response might actually help here. Because in all three of those symptoms, the one response that does not work the majority of time is telling them they're wrong, telling them they're incorrect, providing them the evidence of all the things that are true. None of that typically works. It actually makes things worse. Remember, you can still respond to the behavior without agreeing with whatever they believe, without having to say that what they are believing is true. Careblazer, I hope this helps you. I know this is really hard, complicated stuff, and you might be left wondering like, okay, but what do I do?

8:21Kimberly Williams: I think my loved one has one of these symptoms. I still have not found a way to respond. Number one, my biggest recommendation is just to resist that urge to correct them. Resist that urge to bring them to your reality. You will frustrate yourself and you will frustrate them. Number two, if you haven't grabbed my book, The Dementia Care Toolkit, there's filled with strategies that you can try in situations just like this. Number three, if you're looking for even more personalized help and support, check out our Care Collective program. All of that you can learn more about online at www.careblazers.com.

8:57Kimberly Williams: I will be back next week, as always, with a new video. Careblazer, keep up the amazing work. I know it doesn't feel great, but you are doing amazing. And thank you for what you are doing for your loved one with dementia. Sending you love. Bye.