Hallucinationsare a common symptom of dementia. They can be frightening for those who experience them and challenging for caregivers. If you live with or care for someone with dementia who sees or hears things that appear not to be based in reality, you probably know this all too well.
There are a number of effective ways for dealing with dementia-related hallucinations. These include knowing how best to respond to someone who is frightened or concerned about what they’re experiencing, practical ways to help prevent hallucinations, and medication.
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Hallucinations in Dementia
Hallucinations are sensory experiences that seem real but actually are created in the mind in the absence of an external source or event. Most are visual, but about half of people who see things that aren’t there also may hear nonexistent noises or voices (auditory hallucinations).Multisensory hallucinations are rare.
Hallucinations should not be confused withdelusions, which also are common in dementia. A delusion is a strongly held belief that has no supporting evidence. For example, a person with dementia may believe a loved one is having an affair or stealing their money.
For people with Alzheimer’s disease, hallucinations tend to occur during relatively brief and distinct periods of time, typically just a few weeks. For those withLewy body dementia(LBD), however, hallucinations are persistent and long-term.
A 2013 review found that 82% of people with dementia living in senior care facilities had at least one neuropsychiatric symptom.
Causes
In Lewy body dementia, impairment ofvisuospatial abilityis believed to contribute to hallucinations.Visuospatial ability refers to correctly interpreting what we see as well as the size and location of our surroundings.
Furthermore, hallucinations in LBD and Parkinson’s dementia may be linked to underlying abnormalities in the brain’s processing of alpha-synuclein, a protein in the brain believed to be compromised in people with dementia.
There are other potential causes of hallucinations in dementia, some of which can easily be managed in order to eliminate hallucinations altogether:
Management and Treatment
Seeing things that aren’t there can be unsettling and even frightening, even if what is being imagined isn’t scary. For that reason, an important aspect of helping someone with dementia who is having hallucinations is to reassure them that what is happening is not unusual and that it may stop occurring over time.
It also can be helpful to explain that hallucinations can be controlled and that there is nothing to be afraid of. Don’t argue with someone who insists that what they’re seeing or hearing is real.
Practical guidelines for helping someone deal with hallucinations include:
Medications
When hallucinations are scary or distressing for the person who has them, or they have a negative impact on quality of life, it may be necessary to turn to medication. There are several prescription drugs for treating hallucinations.
Examples of cholinesterase inhibitors include Aricept and Adlarity (donepezil), Exelon (rivastigmine), and Razadyne (galantamine).
Nuplazid (pimavanserin)is the first drug approved to treat hallucinations and delusions associated with psychosis experienced with Parkinson’s disease dementia.
Medication Precautions
Some medications have serious side effects and are associated with a higher rate of death in people with dementia; these include certain antipsychotic medications, which should be closely managed.
13 Sources
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Hallikainen I, Hongisto K, Välimäki T, et al.The progression of neuropsychiatric symptoms in alzheimer’s disease during a five-year follow-up: Kuopio alsova study.J Alzheimers Dis. 2018;61(4):1367-1376. doi:10.3233/JAD-170697
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