Hallucinations And Delusions Signal Alzheimers Associated Cognitive Dysfunction More Strongly Compared To Other Neuropsychiatric Symptoms
Data used in preparation of this article were obtained from the Alzheimers Disease Neuroimaging Initiative database . As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. A complete listing of ADNI investigators can be found at:
The Journals of Gerontology: Series B
Possible Causes Of Hallucinations In Alzheimer’s
Delusions and hallucinations in Alzheimer’s disease are quite common, affecting up to half of all Alzheimer’s patients, usually in the middle stages of the disease. While they can occur in all five senses, seeing things is the most common type. But, what causes them to occur?
While chances are reasonably good that if your loved one is seeing people in her home who are not there, it is a symptom of her dementia, it’s important to realize that there are other possible causes as well. Hallucinations can occur for a variety of reasons in later life, with one large study in Sweden finding that almost 7% of all 85-year-old individuals without dementia were experiencing hallucinations.
Treatment Of Hallucinations & Delusions
Be sure to consult with a doctor in order to best understand why your loved one is hallucinating or having delusions and whether medication is indicated. For both delusions and hallucinations, medications called antipsychotics are sometimes prescribed. Antipsychotics, also called neuroleptics, are prescribed for health conditions including schizophrenia, and have been shown to help people with dementia who struggle with these symptoms.
Doctors may prescribe any of a number of antipsychotics after evaluating your loved one, but the drug most often used to help dementia-related hallucinations and delusions is Risperidone, which has been shown to alleviate symptoms in the short term. The side effects of risperidone and other antipsychotics can be severe including muscle tremors, weight gain, fatigue, and dizziness and non-drug treatments are typically preferred. A doctor may, however, conclude that medication is necessary.
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Tips For Caregivers On Dealing With Hallucinations & Delusions
Consult a physician if your loved one is having delusions or hallucinations, to rule out other causes unrelated to dementia. Mental illness and medical conditions such as migraines, brain tumors, epilepsy, urinary tract infections, and dehydration can all be causes.
Resist the need to stop or control difficult behaviors. Think carefully about whether or not your loved one is causing a problem. If the answer is no, try letting it be. This is not to say that you have to lie to or humor your loved one you can be honest while also showing respect. For example, you might say, I dont hear or see anyone outside the window, but I know you do, and you seem worried.
Consider the situation. Investigate why a hallucination or delusion is occurring in that particular moment. Beyond mental and medical causes, there can also be environmental and social causes as well.
Keep a journal to record when, where, and how your loved one experiences delusions or hallucinations. Record how your loved one is behaving, and what sorts of events have happened recently.
Control the environment. Make sure there is sufficient lighting in the room and not too many distractions. A radio or TV, for example, might cause your loved one to hear voices and not understand that whats coming from the speakers is not actually in the room. Also, pulling curtains or shades can provide comfort for someone afraid of being watched.
How Can You Tell If Someone Is Hallucinating
Sometimes the person may appear to be hallucinating, but there is another cause . The following tips can help to identify hallucinations:
- Hallucinations differ from misperceptions or misidentifications. Listen to what the person is describing, and check if anything could be causing what they are experiencing. For example, if they describe a swarm of insects, and there is a busy pattern on a carpet, it may be a misperception. By changing or covering the carpet, the misperception may stop.
- If the person seems to be having auditory hallucinations , arrange to have their hearing checked. If the person wears a hearing aid, check that it is working properly at the right setting, and encourage them to wear it. The person may be having problems with their hearing, rather than hallucinating.
- If the person seems to be having gustatory hallucinations , make sure they are getting regular dental check-ups to rule out other causes such as tooth decay or denture cream. For more information see Dental care and oral health.
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The Difference Between Hallucinations And Delusions
- Hallucinations are defined as false perceptions. They are very real to the person experiencing them. One example is seeing bugs crawling on the floor, though they are not there. Nothing you say to the person having that experience will convince him/her otherwise.
- Delusions, per the National Institute of Health, are strongly held fixed beliefs or opinions not based on evidence. These false beliefs and opinions can be about people or things. They can also be about the person with dementia. Some common types of delusions include stealing, believing there is an intruder, and infidelity. Paranoia is a form of delusion.
Coping With Hallucinations In Elderly Dementia Patients
When it comes to handling a seniors hallucinations, Marion Somers, Ph.D., author of Elder Care Made Easier: Doctor Marions 10 Steps to Help You Care for an Aging Loved One, suggests joining them in their version of reality. Ask the dementia patient about what they are experiencing as if it is real so you can more effectively defuse the situation. Refrain from trying to explain that what they are seeing or hearing is all in their head. Otherwise, youre going to aggravate them, and you dont want to increase the level of agitation, Somers advises.
Reassure them by validating their feelings. Say something like, I see that youre upset. I would be upset if I saw those things, too. Tell them that they are safe with you and you will do everything in your power to help them feel secure.
A comforting touch, such as gently patting their back, may help the person turn their attention to you and reduce the hallucination, according to the Alzheimers Association. You also can suggest that they move to a different room or take a walk to get away from whatever may have triggered the experience.
Hallucinations arent just a symptom of Alzheimers disease, either they are also very common in seniors with Lewy body dementia. Furthermore, poor eyesight, hearing loss, certain medications, dehydration and urinary tract infections can all contribute to hallucinations.
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Give Them Kind Reassurance
If your loved one with dementia is experiencing hallucinations, you can offer them kind reassurance. For example, you can let them know you will check on them often. Or you can say something like “Don’t worry. I am here to protect you.” And if your loved one is in a care facility, inform their caregivers of their hallucinations and how it impacts them.
What Is A Hallucination
A hallucination can involve your loved one smelling, hearing, seeing, tasting, or feeling something that isn’t there. Your loved one may see the face of a deceased loved one in the distance or see bugs crawling on their hand. In some instances, your loved one could hear an old friend talking and may even engage in a conversation with the imagined individual.
Hallucinations are triggered by changes in the brain that typically happen during the later or middles stages of the dementia journey. Certain types of dementia are more commonly associated with hallucinations. For example, hallucinations are more common with Parkinson’s dementia and dementia with Lewy bodies, but can also be experienced by those with Alzheimer’s disease.
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Alzheimer’s And Hallucinations Delusions And Paranoia
Due to complex changes occurring in the brain, people with Alzheimer’s disease may see or hear things that have no basis in reality.
- Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. For example, a person with Alzheimer’s may see children playing in the living room when no children exist.
- Delusions are false beliefs that the person thinks are real. For example, the person may think his or her spouse is in love with someone else.
- Paranoia is a type of delusion in which a person may believewithout a good reasonthat others are mean, lying, unfair, or out to get me. He or she may become suspicious, fearful, or jealous of people.
If a person with Alzheimers has ongoing disturbing hallucinations or delusions, seek medical help. An illness or medication may cause these behaviors. Medicines are available to treat these behaviors but must be used with caution. The following tips may also help you cope with these behaviors.
Relation Between Nps And The Dat Cognitive Dysfunction: Factor Analysis And Irt
The bifactor model showed excellent fit = 116.29 , p< .05 TLI = .98 CFI = .99). Among the cognitive variables, factor loadings with the main dimension were between .60 and .95, reflecting the main dimension indexing cognitive variance among participants. NPI-Q Hallucinations and Delusions had the highest loadings of NPI-Q factors at .57 and .59, respectively, reflecting a strong association between these two symptoms and DAT-associated cognitive dysfunction. provides a representation of the factor loadings of the NPS and the cognitive variables onto the continuum of DAT-associated cognitive dysfunction.
Results from the IRT analysis dovetailed nicely with the results from the bifactor model. Specifically, findings from the IRT analysis likewise indicated that NPS varied in the strength of their relationship to the latent continuum of DAT-associated cognitive dysfunction. The strength of the relations, captured in the variables a parameters, ranged from 0.20 to 1.52. Again, the two strongest indicators of the DAT continuum were Hallucinations and Delusions . An analysis of the IRT information functions reveals the relative strength of the relations between these two symptoms and the continuum of DAT-associated cognitive dysfunction . The strength of association of Hallucinations and Delusions was greatest in the relatively high/more severe levels of DAT-associated cognitive dysfunction, as indicated by the variables b values .
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Auditory Hallucinations And Alzheimer’s
These occur when the person hears voices or noises although nothing is there. As with visual hallucinations, it is important to rule out physical causes such as physical illness and the side-effects of medication. It is also worth checking the person’s hearing and make sure that their hearing aid is working properly if they wear one.
One indication that the person may be experiencing auditory hallucinations is when they talk to themselves and pause, as though waiting for someone else to finish speaking before continuing. However, talking to oneself is very common – not everyone who does this is having an hallucination.
Shouting at people who are not there also suggests the possibility of hallucinations.
People are less likely to hear voices when they are talking to someone real, so company can help.
- Jacqueline Marcell, Hallucinations and Delusions: How to Help Loved Ones Cope, July 2006.
- Alzheimer’s Society – UK – Carer’s Advice Sheet 520, Jan. 2000
Is It Really A Hallucination
First make sure that what youre dealing with is a hallucination caused by dementia and not simply the result of:
Eye sight problems
Dementia can affect sight and vision in many different ways. For example, a person with dementia might mistake a reflection in the mirror for an intruder or think people on TV are in the room with them. They could also have problems recognising familiar faces or become wary of familiar environments, for example, a shiny floor might look wet, a shadow in a corner might look like a hole.So before assuming theyre having a hallucination, arrange a sight test with an optician and make sure each room in the home is well lit and dementia friendly.
Other health issues
A kidney or bladder infection, alcohol, and certain medications can also cause confusion and lead to hallucinations.
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What Are Delusions
Hallucinations are false feelings delusions are false beliefs. For example, a person with dementia might believe that workers in a nursing home are poisoning meals or stealing. Delusions can be frustrating and difficult to deal with because they affect how someone with dementia relates to others.
More generally, delusions take the form of paranoia, a general sense in someone that people are lying, acting in bad faith, or conspiring. Paranoia can come without any logical reasoning, and worsens as someones memory deteriorates.
About 15 percent of people with Alzheimers disease will experience Capgras syndrome, which is a specific type of delusional misidentification syndrome that causes someone to believe that a friend or loved one has been replaced by an identical imposter. Capgras syndrome is most common in Lewy body dementia . People with a history of anxiety are particularly vulnerable to capgras syndrome if they have dementia. These delusions can be so strong that theyll lead to violence, particularly from men, so it is advised that the caregivers of people who have experienced Capgras take steps like announcing themselves before entering a room, because the syndrome seems triggered primarily by seeing a persons face.
What You Can Do
First, its important to help your loved one manage the hallucination. Rather than argue, try to change the subject or offer a distraction instead. Call your loved ones physician in the case of frequent hallucinationsrelief may be provided through non-drug therapies such as meditation. Antipsychotic medications can work in the most severe cases, but theres also an increased risk of stroke with these drugs.
While dementia can cause hallucinations, its important to be aware that other senior health concerns can cause them as well. Examples include Parkinsons disease and dehydration.
Caring for a loved one with dementia is a challenging task for anyone. The responsibilities can sometimes feel overwhelming, but help is available. Seniors can face a variety of age-related challenges. Though some families choose to take on the caregiving duties, there may come a time when they need a trusted senior care provider. Families sometimes need respite from their duties so they can focus on their other responsibilities, and some seniors need around-the-clock assistance that their families are not able to provide. Home Care Assistance is here to help. We will work with you to customize a care plan thats just right for your loved ones needs. Call us today at 573-4213 to discuss how we can give you the peace of mind that comes from knowing your loved one is being cared for with professionalism and compassion.
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Emergence Of Psychosis In Later Life
An important and ongoing issue is the relationship between the emergence of psychotic symptoms in later life and the risk of incident cognitive decline and dementia. As reflected in the Jeste and Finkel criteria for psychosis in AD, psychotic symptoms were included only when they emerged after a dementia diagnosis. However, psychotic symptoms have been observed in people with MCI. Specifically, hallucinations are present in 1.32.6% and delusions in 3.110.5% of patients with MCI. Most,,, but not all, longitudinal studies have found an increased risk of dementia associated with psychosis. For the negative studies, low baseline psychosis frequency in the study sample and short median duration of follow-up might have been confounding factors. Although more research is required, the evidence to date suggests that psychosis in MCI is part of the neurodegenerative disease process, supporting the inclusion of MCI or mild neurocognitive disorders in the new IPA criteria.
Neurobiological data are also emerging to link late-life psychosis to neurodegeneration. For example, a post-mortem study has shown an association between argyrophilic grain disease a four-repeat tauopathy and psychosis in individuals aged 65 years. In this age group, people with psychosis had sixfold increased odds of having this neurodegenerative condition compared with non-psychiatric controls.
Ways To Respond When Someone Is Experiencing Dementia Hallucinations
1. Determine if a response is neededThe first step is to determine whether the hallucination is bothering your older adult.
If its pleasant, you might not want to respond or call attention to it.
Just know and accept that its a dementia symptom and thankfully isnt causing distress.
If the hallucination is upsetting them or causing them to do something unsafe, then its time to quickly step in to provide comfort or redirect to a safe activity.
2. Stay calm and dont argue or try to convince using logicWhen someone is having a dementia hallucination, its important to stay calm and avoid contradicting them.
What theyre seeing is a dementia symptom and is very real to them.
Trying to explain that it isnt real simply wont work because of the damage that dementia has caused in their brain.
In fact, knowing that you dont believe them might make them even more upset and agitated.
If theyre calm enough to explain, it may also help to understand what theyre seeing. Listen carefully and try to pick up clues to what theyre seeing.
But keep in mind that dementia damage in the brain may affect their ability to use the correct words. For example, they could unintentionally say cabbages when they mean green cushions.
3. Validate their feelings and provide reassuranceBe careful not to dismiss your older adults experience.
Brushing off what theyre seeing by saying something like, Dont be silly, theres nothing there, is likely to upset them.
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When This Happens What Do We Do
If you are a caregiver and your loved one is seeing bugs that you do not see, or accusing you of stealing something, it is human nature to respond with What bugs? or I didnt steal anything. Remember though, that your loved ones behaviors are likely coming from changes in the brain related to the Alzheimers or dementia. Becoming dismissive, defensive or arguing your point will not be effective.