Truth Can Be A Tricky Concept

Recently, a caregiver came to me with this story, “A grandmother of a friend was discharged from one hospital to another hospital in the same town. This lady ‘lies through her teeth.’ Then, she forgets what she told her healthcare providers. The lady told me she hadn’t been offered a place in a nursing home. Then, a discharge nurse from the hospital called and told that, in fact, she had been offered a place.” Was this geriatric patient “lying,” or had she simply lost the ability to keep things straight?

The families in my practice often come to me with concerns that their elders, my patients, aren’t “telling the truth.”

In dementia care, “truth” is often a tricky concept. Many patients may not be able to help what seem like “lies” because their brains aren’t working normally. This may be due to early dementia, which could be Alzheimer’s disease. Or it may be due to other types of dementia, such as “vascular dementia” or “frontal temporal dementia” (FTD). Patients suffering from these conditions may not be able to remember what might have been said earlier. Or, if they do remember, they may remember information incorrectly. Some elders lie on purpose, but in my experience, the great majority “lie” simply because they can’t remember, or because they're embarrassed that they can't remember.

If you try to challenge this sort of patient, to correct the misremembered information, you often run into a brick wall: Elders will insist to the death that they got it right, that they don’t need a doctor, that they don’t need any help.

These patients do need help.

The most common test to determine whether an elder is competent is a “Mini Mental State Exam” (MMSE). You’ve probably heard questions from this sort of test: “What day is it? Who’s the president?”and that sort of thing. The MMSE is really inadequate when you’re trying to diagnose dementia.

If you’re having these kinds of problems with a family member, I would suggest getting this person to a Geriatrician. Or, you can start with a MoCA (Montreal Cognitive Assessment) at home. However, general psychological evaluations often do not pick up on the loss of judgment or advanced reasoning.

If the doctors say the patient is fine, but you observe that they’re still having trouble you will need a “neuropsychological” evaluation. This more detailed testing is important for a correct diagnosis.