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Imaginary Friends(1)
Posted: Monday, October 7, 2019 8:46 PM
Joined: 5/22/2019
Posts: 33

I'm friendly with a mid 80 yr neighbor, who showed no symptoms this time last year, while minor symptoms this spring.  In June he was taken to the hospital for a heart condition, while there he was dx with Alz.  Since June his decline has been rapid. 

Two weeks ago he was argumentative with his wife, stormed out of the house in the middle of the night and went to his daughter's-  about a 30 min drive.  He came home to his wife today unannounced.  She called me to come over to assist her. 

When I got there, he was very agitated,  wanted to go back to his daughter's house.   He's bent on continuing to drive and doesn't realize his condition.   I went for a mile walk with him and my dog and he calmed down.  

In conversation he was outside of reality.  He spoke of living with two guys he had worked with 20 years ago.  Told of their exploits, he gave rather detailed descriptions of his activities with his two imaginary friends.  His detailed descriptions sounded very believable. 

His wife said he calmed after I left and was all the better tonight, after a good dinner-  but he still talks of his imaginary friends. 

The wife called her Physician Assistant in the afternoon and did not get a call back. She does not know how to handle this.  This is the first time things ratcheted up so high. 

Would imaginary friends as described by symptomatic of -  hallucinations, delirium, or psychosis?  How should this condition be medicated.  Is this presentation typical of middle stage Alz? Or could this be more symptomatic of LBD?



Posted: Monday, October 7, 2019 11:10 PM
Joined: 6/11/2019
Posts: 391

I think imaginary friends could be symptomatic of all 3. They could be part of a series of hallucinations, the visual imagery associated with some delusion or else the manifestation of psychosis. Or, it could just be disease progression as the walls of the brain that separate past and present from fantasy and reality all converge.

Mom is lately (as in last few days) convinced she's been talking to some man about saving shingles from a blue and white house and some woman about having meals delivered regularly. I don't know why just going along with this insanity is so hard for me, but I forced myself tonight to just agree with all of it or else say it was canceled and she just forgot. It doesn't help that her aphasia seems to be worsening at a rapid pace, so much so that I can't even guess at what she means like I could just a few weeks ago. 

I'm guessing it's a combination of stuff she sees on TV or dreams jumbled up with legitimate memories that her brain has altered in some way.
Posted: Monday, October 7, 2019 11:38 PM
Joined: 9/8/2017
Posts: 2213

This is where the disease gets horribly worse and it's concerning for your neighbor.  Do they live alone?  He can get aggressive with his wife and it's scary.  

P lease let her know she can call the Alz helpline for guidance on what she can do.  She can describe his condition.  If it's getting abruptly worse it can be part of the disease or an infection.  

Are her children aware of what is happening in their parents' home.  They need to help her during these moments.  Help her take him to the hospital when needed.

This is very difficult.  He can even attack her if he becomes delusional.  When my father became worse, he had imaginary friends or enemies, or cops were on their way (there were no cops anywhere).  He would tell me that the cops were on their way to arrest me for killing people in a war (I have never been in the military).

One time I found him at 1:00 am arguing with his reflection of the front door that has a window.  It was awful. In another incident, he almost attacked me with a chair and was about to punch me.  But for some reason he stopped and stormed out of the house and angrily walked around the neighborhood barefoot trying to get away from me. Soon after I took him to ER and it was found that he had hyponatremia caused by an increased prescription that had a diuretic. He got better from that ER visit, although still confused.  Shortly after that, he progressed in his disease and became combative again.  By then, it was time for the antipsychotics.

This stage is really horrible and he should not be driving at all.  It seems like his wife is in a horrible situation and probably doesn't have much control of it.  Let her know about the Alz helpline and that she can call at any hour. I'm hoping her children are involved and  helping their parents.

Posted: Tuesday, October 8, 2019 10:28 AM
Joined: 5/22/2019
Posts: 33

His wife doesn't handle things well.  I've suggested he should not be driving,  she responds, what can I do, what can I do.  She thinks that gets her off the hook, he won't listen to her-  and continues to drive.  Considering the decline, I hope she now does what she has to do, to keep him from getting in the driver side of the car.  

I gave the wife info about the Alz help line.  She said yesterday she called them last week and they were not helpful, the only thing they did was say they would send her info.  I've never called them, but hear how good and supportive they are, so this surprised me.  But knowing her nature,  I'm not sure she did in fact call them.  

They have a divorced adult daughter living 25 minutes away, but she carries a lot of issues. 
The husband is very good natured, at least with me.  His wife is highly critical of him, which appears to aggravate his condition.  
This is a developed problem already, which seems will continue to worsen by degrees.  Its very sad. 


Posted: Tuesday, October 8, 2019 10:44 AM
Joined: 9/8/2017
Posts: 2213

It happens often that the person with dementia will act worse towards the caregiver(s).  My father did the same thing to me.  And, they do pick up on the caregiver's stress, so yes, that doesn't help.

Please continue to let her know she can get help or guidance.  She's in there with him alone and who knows how much she's dealing with.  It is very difficult, and if she has no time for herself to recuperate, she will not be able to provide the care.  Especially if she has health concerns of her own.

It does happen that the caregiver can get stuck in their bubble and will not go out to seek help.  For shame, or privacy, or whatever reason.  Sometimes they don't want to burden anyone else.

Also, he may have always been the one with the last word. So, changing roles will not happen.  She needs help.  To help him.  She will not be able to do this alone. This disease progresses, and sometime rapidly.  Is she ready for when he becomes bed bound, incontinent?  Hand fed, bed bathed, dressed?  All on her own? 

Remind her again that this will get worse. She needs to be prepared for what her decision will be.

Posted: Tuesday, October 8, 2019 11:29 AM
Joined: 5/22/2019
Posts: 33

Thank you.
Posted: Tuesday, October 8, 2019 12:01 PM
Joined: 12/17/2018
Posts: 267

If this came on suddenly, it does sound a lot like an infection.  This sort of behavior is often a symptom of infection in AD persons.  

My mother, in the mid stages, presented very well.  People who didn't know her well wouldn't have known she had AD.  But she had imaginary friends often.  This wasn't something distressing.  She would just tell me that so and so was there with their cat or something of that sort.  Now that she's progressed, her ability to differentiate between her thoughts and reality has increased.  As well, she can't tell the difference between what's real and what's not.  She has an artificial robot cat (Joy for All cat) that she thinks is real.  Also, she talks to the posters of her that I put up so she would know where her room is.  This is not uncommon.  But it doesn't cause her distress and it was a slow journey to this point.  

I feel for your neighbors.  My mother was that type - hands in the air "I don't know" which made a lot more work for me during my life!  It's overwhelm for them but that means someone has to pick up the slack.  

The most important thing for an AD person, in my opinion, is to treat them with kindness and respect.  If his wife is not doing this, for sure he will get agitated.  They are already confused so saying that they aren't making sense will just make them angry.  They need to be heard and validated.  Then they can relax and feel safer.  So if he's saying he met his friends go along with it, then distract and redirect.  That's the dance of the caregiver.  

You are a kind neighbor.  I'm glad he has someone with an eye out for him.

Posted: Tuesday, October 8, 2019 12:07 PM
Joined: 9/5/2019
Posts: 42

In this sad situation, a call may need to be placed to Adult Protective Services. They can check on both of them and perhaps intervene and help. His condition is not going to get better, it is only going to get worse, unfortunately...

If there is a Elder Services in your area, check with them about this situation as well....

Good Luck...

Posted: Tuesday, October 8, 2019 3:12 PM
Joined: 5/22/2019
Posts: 33

I walked with him today and he was reality based.  He said he thought he was away for years and was surprised to find he was gone only ten days.  He was aware for that period of time his mind was not sound.  I was surprised he was so cognizant.  

There is Catholic Elderly Services the wife could access, I gave the wife the information months ago.  She never called them.  

I agree with the online consensus, things will only get worse.  I have my 93 yr old father to take care of, so this is not something that I can be deeply involved with.   Thank all for the comments. 


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