The Accusers in Dementia

The purpose of this retrospective study of 116 dementia patients with and without accusatory behavior was to determine its frequency and evaluate its relationship to individual characteristics, behavioral and psychological symptoms, and certain dementia-related domains, namely, cognitive impairment, stage of disease, language difficulties, and functional disability. Little more than one third (38%) of the patients studied had accusatory behavior. The average age of the patients with accusatory behavior was 74 years, and the male to female ratio was 2.6:1. Accusatory behavior was more prevalent in the higher stages of dementia by 2- to 3-fold and was positively associated with hallucinations. Three patients with accusatory behavior had delusions of infidelity. There were no significant associations between accusatory behavior and other categories studied. This study raises a caveat of issues and, more important, whether the different themes relating to accusatory behaviors are true delusions, persecutory ideation, misidentification, nondelusional suspiciousness, or other. It is suggested that it would be more useful to relate them as symptoms.