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.
Factors Which May Cause Behaviours To Change
- Sensory defects such as poor eyesight or poor hearing
- Side effects of some medications
- Psychiatric illness
- Inadequate lighting making visual clues less clear
- Physical conditions such as infections, fever, pain, constipation, anaemia, respiratory disease, malnutrition, dehydration
- Unfamiliar caregivers
- Disruption of familiar routines
- Misinterpretation of environmental cues often a result of forgetting to use a hearing aid or glasses
- Sensory overload because of too many things going on at once.
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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Psychotic Symptoms And Dementia
Some people with dementia experience psychotic symptoms, although hallucinations are more likely to be something the person sees rather than hears. It may be thought that someone is experiencing delusions when actually they have misinterpreted what is going around them, for example the person believes that someone has stolen their money because they dont remember where they put it.
Hallucinations and delusions are more common in some types of dementia than others. People who have dementia with Lewy bodies , for example, are quite likely to experience the same visual hallucinations over and over again because of the way this type of dementia affects the brain.
Antipsychotic medication was first prescribed to treat the psychotic symptoms that some people with dementia experience, although they quickly began to be used to treat a wider range of what are sometimes called behavioural and psychological symptoms in dementia . These include aggression, agitation, restlessness, depressed mood, anxiety as well as the more severe difficulties such as hallucinations or delusions.
Coping With Dementia And Hearing Loss
Living with both conditions is more difficult than living with either on its own. Both dementia and hearing loss can have an impact on how someone copes day to day for example, making it harder to communicate. They can also both lead to increased social isolation, loss of independence, and problems with everyday activities, and as a result make the persons dementia seem worse.
However, there are things that can help.
- Having regular hearing checks and making the most of the hearing the person does have for example, by using hearing aids.
- Improving the environment, for example by reducing background noise and distractions and making sure the area is well lit.
- Finding out the persons preferred way of communicating for example, lip reading.
- Using gestures and expressions, and letting people see your face when communicating.
- Using visual clues and prompts.
If the person needs hearing aids, these are available free on the NHS, or you can buy one privately. Many older people struggle to use a hearing aid correctly all the time. It can take time for a person to get used to a hearing aid, and it will take a person with dementia longer. It is also important to consider whether a hearing aid is the best option an audiologist should be able to advise.
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How To Prevent Voice And Speaking Problems
Because they have many different causes, it might not be possible to keep them from happening. But you can take steps to make them less likely.
- Help your loved one drink plenty of fluids, such as water, soup, and juice. Ask their doctor how much is right for them.
- Help them cut down or stay away from alcohol and caffeine.
- Include plenty of whole grains, fruits, and vegetables in their diet. These foods have important vitamins and help keep the lining of the throat healthy.
- Help them exercise regularly. Exercise makes muscle tone better and helps provide good posture and breath control, which are necessary for a healthy voice.
- Voice exercises can help keep problems from happening. For instance, encourage the person to read a book aloud for 10 to 15 minutes a day, or have them sing along to their favorite music.
- Donât buy mouthwash that has alcohol or chemicals that irritate. If your loved one really wants to gargle, try to get them to use a saltwater rinse instead.
- Unless their doctor says otherwise, try to stay away from most cold or allergy medicines. These can dry out their vocal cords.
- Try to stay away from things that irritate the nose and throat, like smoke, air pollution, and fumes. Also stay away from things that trigger allergies for some people, like dust, animal dander, mold, and pollen.
- If they smoke and might be able to stop, ask a doctor about programs and products that may help.
Examples Of Delusions In Pd
- Belief: Your partner is being unfaithful.
- Behavior: Paranoia, agitation, suspiciousness, aggression.
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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.
Speaking And Voice Problems And Stroke
If you see someone with the following symptoms, call 911 right away:
- They suddenly have trouble trying to speak, they slur their words, or mumble.
- They struggle to read, write, or understand others when they could before.
- When you ask them to smile, their face looks uneven or droops on one side.
- They have new weakness or numbness in one or both arms or in one or both legs.
Talk to a doctor about ways to prevent a stroke, including watching your loved oneâs blood pressure, blood sugar, cholesterol, and weight. Try to get them to exercise for at least 30 minutes a day and to eat a healthy diet with lots of fruits and veggies. Help them remember to take all their medicines at the right times every day.
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Stage : Age Associated Memory Impairment
This stage features occasional lapses of memory most frequently seen in:
- Forgetting where one has placed an object
- Forgetting names that were once very familiar
Oftentimes, this mild decline in memory is merely normal age-related cognitive decline, but it can also be one of the earliest signs of degenerative dementia. At this stage, signs are still virtually undetectable through clinical testing. Concern for early onset of dementia should arise with respect to other symptoms.
Responding To Paranoia In Elderly Dementia Patients
Paranoia tends to worsen as a dementia patients cognitive abilities decline. According to the Alzheimers Association, when paranoia occurs, caregivers should assess the problem and devise solutions by considering these questions:
- What happened right before the person became suspicious?
- Has something like this happened before?
- Was it in the same room or at the same time of day?
- Can a trigger be removed or altered to avoid eliciting suspicion?
If someone is exhibiting paranoid behavior, it is important to discuss their medications with their doctor. Sometimes medications interact with one another or the dosages are too large, notes Somers. That can bring on paranoia, but a doctor can address problems and adjust the seniors regimen to minimize issues.
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What Causes Hallucinations
Visual hallucinations are usually caused by damage to the brain. They are more common in people with dementia with Lewy bodies and Parkinsons disease dementia. People with Alzheimers disease can also have hallucinations.
Hallucinations can also be caused by physical illness including fever, seizure, stroke, migraine and infection. Diseases that cause inflammation and infection, such as pneumonia, can interfere with brain function and cause delirium. Some people with delirium will have hallucinations. Delirium is a medical emergency.
Hallucinations are a rare side effect of many medications. The drugs for Parkinsons disease can often trigger hallucinations. Speak to your GP before making any changes to medication.
Some people with worsening vision start to see things that arent there because of their deteriorating sight and not from any other condition, such as dementia or a mental health problem. This is called Charles Bonnet syndrome.
Stage : Mild Dementia
At this stage, individuals may start to become socially withdrawn and show changes in personality and mood. Denial of symptoms as a defense mechanism is commonly seen in stage 4. Behaviors to look for include:
- Difficulty remembering things about one’s personal history
- Difficulty recognizing faces and people
In stage 4 dementia, individuals have no trouble recognizing familiar faces or traveling to familiar locations. However, patients in this stage will often avoid challenging situations in order to hide symptoms or prevent stress or anxiety.
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Dementia And Hearing Loss
Many people with dementia will also be living with hearing loss. It is common for people to develop gradual hearing loss as they age. People with hearing loss are also more likely to develop dementia, although at present we dont know why this is. Living with both conditions can present challenges, but there are many things which can help people to live well with both hearing loss and dementia.
Someone may have acquired hearing loss which has developed during the persons lifetime . Other people may have been born deaf or became deaf at a young age and are considered to have profound deafness. They may consider themselves as Deaf , use British Sign Language as their first language and identify with the Deaf community.
In this section we look at acquired hearing loss the problems with telling the difference between signs of dementia and acquired hearing loss, and how to help someone who has both.
When Trouble Might Occur
Visual hallucinations are one of the hallmark symptoms in Lewy body dementia and often occur early in the illness. In other dementias, delusions are more common than hallucinations, which occur well into the disease cycle, if at all, and are less often visual.
Fluctuating good days and bad days are another hallmark of LBD. On a good day, thinking is clear, and these illusions, hallucinations and delusions may not occur on a bad day, they may be intense.
As LBD progresses, these types of symptoms may first intensify, then later burn out.
In dementia, symptoms always change, so what a person experiences this month may not be happening the next month, though such distressing symptoms seem to last an eternity for the caregiver.
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How Can Hallucinations Be Treated
Drug treatments are often not that helpful for people with dementia. However hallucinations, particularly in people with dementia with Lewy bodies, may respond to anti-dementia drugs.
Antipsychotic medication can sometimes help to reduce severe or distressing hallucinations. They should only be used when other treatments have not worked, as they can cause unpleasant or dangerous side-effects. This medication should be regularly reviewed.
People with dementia with Lewy bodies are at particular risk of severe harmful reactions to antipsychotic medication. For more information see Non-drug approaches to changes in mood and behaviour.
Causes Of Hallucinations And Delusions
Hallucinations and delusions can be the result of the changes that dementia causes in the brain, but there are several other potential causes. Too much stimulation in the environment , unfamiliar places and people, a variation in routine, and interactions between medications can all contribute to hallucinations and delusions.
Delusions are frequently the result of suspicion or paranoia on the part of the individual with dementia. Memory loss and confusion from the progression of dementia play into it. For instance, if someone with dementia forgot where he put down his glasses, because of poor memory and lack of awareness, he may decide someone stole them.
Hallucinations are sometimes present in a phenomenon called sundowning, which is characterized by increased anxiety in someone with dementia that hits late in the day, typically around sunset. Poor lighting and bad eyesight can cause shadows, and an individual with dementia might get startled by something that wasnt really there.
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Environment Modification & Medical Intervention
Changing the environment is another effective way to reduce or even abort an episode of delusion or hallucination. If a person imagines they see people in the window, you can open or close the curtains to modify the environment. Maintaining a well-lit space is another way to reduce fear by eliminating shadows. Some seniors may have trouble identifying themselves during an episode and will claim that a stranger is looking at them through the mirror. Covering the mirror or moving them away from it will help reduce the intensity of their episode. Many seniors who suffer from dementia will feel that people are stealing from them. In actuality, most often items have simply been lost, misplaced, or put away in a new location. Keeping duplicates of commonly lost items on hand can also help arrest an episode.
Most holistic and interactive interventions work well for seniors suffering from dementia, but there are times when medications may be the only option. A medical professional can evaluate the senior to ascertain if medication to reduce delusions and hallucinations is the best option. Seniors who suffer from separate mental illnesses like schizophrenia may be suffering from delusions and hallucinations due to that condition and not dementia.
Which Dementias Cause Hallucinations
Hallucinations are most common for people with Lewy body dementia, an illness caused by the buildup of proteins called Lewy bodies that disrupt communication between brain cells throughout the brain or kill the cells altogether. Visual hallucinations will often occur in the early stages of the disease, though they eventually stop somewhere in the middle stages and wont recur. People with Lewy body dementia often fluctuate between good days, when theyre thinking normally or at least fairly well, and bad days. In the early stages, those bad days are likely to include visual hallucinations.
Hallucinations will also occur for people with Parkinsons disease with dementia, and for people with Alzheimers. Both those diseases are also associated with a buildup of proteins in the brain. With these dementias, though, hallucinations are more likely to be associated with hearing or feeling. Someone might have conversations with an imaginary person, for example, or think theyre being touched by something that isnt there.
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Supporting A Person Who Is Experiencing Hallucinations
If the person you care for regularly hallucinates, make an appointment for them to see their GP.
Make sure the person has regular medication reviews with a pharmacist or GP as new medications, or the combination of their medications, can be a cause of hallucinations. See further down this page for a list of information to take when you visit the GP.
Keep It From Happening Again
You can do some things to help make hallucinations and delusions less likely:
- If your loved one needs glasses, a hearing aid, or dentures, try to make sure they wear them. Check that their glasses are clean and the right ones for the distance. Make sure their hearing aid works and is turned on. Have their eyes and ears checked regularly.
- Make sure all rooms are well-lit. Turn on lights to get rid of shadows and reflections. Shut off sounds that might confuse them, such as noise from a TV, radio, furnace, or air conditioner.
- Keep their home and routine as close to what theyâre used to as you can. Have them be with people they know as much as possible.
- If the same thing always causes them to have problems, change it or take it away if you can.
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