11/10/2020 |

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Seeing what’s not there: dementia and hallucinations

You are likely reading this article because you have a loved one who seems to be hallucinating. Before we get into possible connections between dementia and hallucination, you are encouraged to take this short quiz to find out how much you already know about it.

1. Which of the following is NOT a known possible cause of hallucinations?

1. Narcolepsy and other sleep disorders
2. Mental disorders (e.g. schizophrenia)
3. Grief or emotional trauma
4. Excessive exercise
5. Common cold
6. Certain medications
7. Drug or alcohol abuse and recovery
8. COVID 19

The answer is…
5. Common Cold

2. Hallucinations associated with dementia may involve which of the following senses?

1. Sight
2. Sound
3. Taste
4. Smell
5. Touch
6. All the above.

The answer is…
6. All of the above.

3. True or False. Explaining that what the person is experiencing is not real and that they should not be afraid is a helpful coping strategy for people suffering from delusions because of dementia.

The answer is…
False. Caregivers recommend that you validate the persons feelings and experiences without expressing doubt about whether they are true.

4. Hallucinations associated with dementia that begin early after diagnosis are thought to be caused by _____________.

1. Lewy body formations in the brain.
2. Medications used in treatment
3. Delusions caused by dementia-related anxiety (DRA)

The answer is . . .
1. Lewy body formations in the brain.

5. True or False. All dementia patients experience hallucinations.

The answer is . . .
False. Though it’s common for people with dementia to experience hallucinations, not all do.

Facts about hallucinations

Some of those answers may have surprised you. Some of them may have confused you. So, let’s start with the basics. Essentially, hallucinations are any sensations of anything within the conscious mind that doesn’t actually exist in reality. Hallucinations can involve one or more of the five senses, can occur in healthy adults and are common symptoms of many health conditions and illnesses, including dementia. When hallucinations cause distress and interfere with normal life it’s definitely time to consult your doctor to determine the cause. Keep in mind, that not all hallucinations are caused by disease or mental illness, and some people learn to live with them without treatment.

Types of hallucinations

Many of us think of hallucinations as simply seeing something that isn’t really there. In fact, there can be hallucinations for every one of our senses – sight, smell, taste, touch and sound. And, some of those types have multiple types too.

Visual Hallucinations

Photopsia – “Kaleidoscope migraines” that appear as a bright zig-zag kaleidoscopic image or other lights floating in midair in one or both fields of vision.
Charles Bonnet Syndrome – Newly blind people who still have some remnant of vision left, such as people who have suffered a stroke, may see “simple geometric shapes in the form of ornaments . . . [and] complex shapes of faces and human bodies” that aren’t present.
Other visual hallucinations – May be caused by certain medications, lack of sleep, depression, and a host of other conditions.

Olfactory Hallucinations

Phantosmia (detecting odors that aren’t present) and Parosmia (misinterpreting odors that are present) – Are commonly caused by sinusitis, hay fever, sinus infections, temporal lobe seizures, brain tumors, and Parkinson’s disease. Loss of the sense of smell is also a symptom of COVID 19 and many other conditions.

Gustatory Hallucinations

Hypogeusia (reduced sensitivity to taste) and ageusia (inability to taste – are commonly associated with epilepsy, sinus diseases, temporal lobe disease, and brain lesions. Loss of the ability to taste is also a symptom of COVID 19.

Tactile/Somatic Hallucinations

These are sensations related to touch such as the feeling that something is crawling under or on your skin, that a missing digit or limb is in pain (phantom limb pain). Other conditions that may cause somatic hallucinations include schizophrenia, delirium tremens, alcohol abuse and recovery, and diseases associated with dementia.

Auditory Hallucinations

Auditory verbal hallucinations – Hearing talking voices when there is no source is most often associated with psychoses, especially schizophrenia. They are also associated with dementia, mood disorders and a range of less serious causes.

When it’s not Hallucinations

Sometimes a possible hallucination isn’t a hallucination at all. Even those individuals with dementia can experience misinterpretations or illusions that aren’t hallucinations at all. For example, they might mistake a coat rack for a person or moving lights reflected across a room as a moving object.

Hallucinations and Dementia

People with dementia can experience hallucinations of all five types described above, but visual hallucinations are the most common. Most hallucinations occur in people suffering from dementia with Lewy body dementia (LBD – the type of dementia that Robin Williams suffered from) and Parkinson’s disease dementia, but Alzheimer’s disease sufferers may also have hallucinations. People with other forms of dementia will likely experience fewer visual hallucinations and could experience more hallucinations later in the disease cycle.
Beside hallucinations, people with dementia may also experience illusions (interpreting what is seen as something other than what it is) or delusions (fixed ideas about something such as that someone stole something from them or that a familiar loved one is an imposter).

What should caregivers do?

When our loved one experiences hallucinations, illusions, or delusions it can trigger so many emotions for an unsuspecting caregiver. Their fear and sadness might cause them to argue with the person or correct what they say they are experiencing. Health professionals say if it causes no harm to you or your loved ones, the best approach is to just go along with it. Arguing or trying to take steps to prove them wrong are more likely to aggravate than help. Remember that your loved one is experiencing the symptoms of a disease and not choosing his or her behavior. It is important to keep track of the number of times they occur, their nature of them and any changes in severity to discuss with their doctor later on.

Here are some practical and effective interventions to try:
• Listening to the person’s description of what happened then validating the person’s feelings and experience (not necessarily the hallucination or delusion). “Grandma, you saw a strange face in the mirror?” “Wow, that sounds scary, alright” works a lot better than arguing, “Grandma, there’s no way that could ever happen.”
• A gentle pat or a hand on the shoulder to reassure the person along with a reminder that you and other caregivers are there to help and protect them in every circumstance.
• Distracting the person’s attention from the incident by listening to music, having a different conversation, playing a favorite game, taking a walk outside, or moving to a different area where other people are gathered.
• Remove any sources that may have contributed to the illusion or hallucination such as poor lighting that causes shadows, mirrors or mirrored surfaces.
We know how difficult it is to watch someone you love develop dementia and go through this life changing experience. We want you to know that Avalon Memory Care is here to answer your questions as the disease progresses. We understand the emotions that can take place for a family.

Sources
https://www.alz.org/help-support/caregiving/stages-behaviors/hallucinations
https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01134/full
https://healthblog.uofmhealth.org/brain-health/illusions-hallucinations-and-delusions-how-to-spot-dementia-symptoms
https://www.frontiersin.org/articles/10.3389/fpsyg.2017.01134/full
https://www.healthline.com/health/kaleidoscope-vision
https://medlineplus.gov/ency/article/003258.htm
https://health.usnews.com/health-news/health-wellness/articles/2015/07/02/hearing-voices-not-always-a-sign-of-mental-illness
https://www.who.int/mental_health/neurology/chapter_3_b_neuro_disorders_public_h_challenges.pdf
https://collections.lib.utah.edu/details?id=226993
https://www.aarp.org/health/conditions-treatments/info-2020/covid-hallucinations.html
https://en.wikipedia.org/wiki/Common_cold
https://www.webmd.com/schizophrenia/what-are-hallucinations#2-5
https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/hallucinations
https://dailycaring.com/8-ways-to-deal-with-false-dementia-accusations/

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