Sudden Onset Dementia With Hallucinations

What Is A Hallucination

A hallucination is a false perception of objects or events involving your senses: sight, sound, smell, touch and taste. Hallucinations seem real, but theyre not. Chemical reactions and/or abnormalities in your brain cause hallucinations.

Hallucinations are typically a symptom of a psychosis-related disorder, particularly schizophrenia, but they can also result from substance use, neurological conditions and some temporary situations.

A person may experience a hallucination with or without the insight that what theyre experiencing isnt real. When a person thinks their hallucination is real, its considered a psychotic symptom.

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.

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.

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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.

How Quickly Does Dementia Progress

For many people with dementia, progression can happen over a number of years the average falls between 4 and 10 years, but some live with the condition for 20+ years. For others, it may happen a lot faster. Things such as genetics, or previous health and medical history may play a part in how quickly dementia progresses, however the type of dementia can make a difference too.

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Diagnosis And Treatment Of Hallucinations

First, your doctor needs to find out what’s causing your hallucinations. They’ll ask about your medical history and do a physical exam. Then they’ll ask about your symptoms.

They may need to do tests to help figure out the problem. For instance, an EEG, or electroencephalogram, checks for unusual patterns of electrical activity in your brain. It could show if your hallucinations are due to seizures.

You might get an MRI, or magnetic resonance imaging, which uses powerful magnets and radio waves to make pictures of the inside of your body. It can find out if a brain tumor or something else, like an area that’s had a small stroke, could be to blame.

Your doctor will treat the condition that’s causing the hallucinations. This can include things like:

• Medication for schizophrenia or dementias like Alzheimer’s disease
• Antiseizure drugs to treat epilepsy
• Surgery or radiation to treat tumors
• Drugs called triptans, beta-blockers, or anticonvulsants for people with migraines

Your doctor may prescribe pimavanserin . This medicine treats hallucinations and delusions linked to psychosis that affect some people with Parkinsonâs disease.

Sessions with a therapist can also help. For example, cognitive behavioral therapy, which focuses on changes in thinking and behavior, helps some people manage their symptoms better.

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Whats The Difference Between A Hallucination And An Illusion

Hallucinations are a perception not based on sensory input, whereas illusions are misinterpretations of sensory inputs. In other words, hallucinations involve experiencing something that doesnt exist.

Illusions happen when you misinterpret something real in your environment.

For example, you might mistake a black bag sitting on a window sill for a black cat. Upon further examination, you realize that its a bag and not a cat. This is an illusion.

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Things To Know About Delirium And What You Can Do

1.Delirium is extremely common in aging adults.

Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where its been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.

Delirium is less common in the outpatient setting . But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimers.

What to do: Learn about delirium, so that you can help your parent reduce the risk, get help quickly if needed, and better understand what to expect if your parent does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Dont assume this is a rare problem that probably wont affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.

2. Delirium can make a person quieter.

What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your parent seems quiet and isnt agitated. Tell the hospital staff if you think your parent may be having hypoactive delirium. In the hospital, its normal for older patients to be tired. Itsnotnormal for them to have a lot more difficulty than usual making sense of what you say to them.

How Can I Care For Someone With Delirium

Often, treatments for delirium focus on the environment. Its best if the person is in a quiet setting. If you are caring for someone with delirium, try these tips:

• Promote good sleep habits: During the day, keep them awake, and expose them to sunlight. Avoid naps. Help them sleep at night by reducing noise and distraction.
• Provide reassurance: Help them understand their environment. Explain what is happening.
• Bring familiar objects: Surround them with items from home, such as photos, a blanket or a bedside clock. These things will help the person feel more comfortable in the environment. Try soothing music as well.
• Encourage eating: Make sure the person eats and drinks nutritious food throughout the day, if appropriate.
• Encourage movement: If its safe, help the person get out of bed and move around.
• Help orient them: Talk about current events and family news to provide mental stimulation. Reading out loud can be helpful as well.

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Who Is At Risk For Developing Delirium

Delirium happens more often in older people and hospitalized patients. Hospital delirium can affect 10% to 30% of those patients.

People in these high-risk populations may develop delirium:

• People who have had surgery.
• 80% of people who are at the end of life.
• 70% of people in intensive care units .
• 60% of people over age 75 in nursing homes.
• 30% to 40% of people who have human immunodeficiency virus .
• 25% of people with cancer.

People may also be at higher risk for developing delirium if they:

What Is The Average Rapid Onset Dementia Life Expectancy

Dementia is known for its gradual onset and slow progression. However, the condition does result in a reduced life expectancy. The average rapid onset dementia life expectancy ranges from 3 to 13 years after the onset or diagnosis. However, dementia suffers with rapid onset dementia may deteriorate much faster. Individuals with rapidly progressive dementia have an average life expectancy of 4 to 18 months after the time of diagnosis. To make this time as comfortable as possible for your loved one and to improve their quality of life, choosing an in-home care agency that offers special services for dementia can be highly beneficial.

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Movement Problems And Lewy Body Dementia

Some people with LBD may not experience significant movement problems for several years. Others may have them early on. At first, movement symptoms, such as a change in handwriting, may be very mild and easily overlooked. Movement problems may include:

• Muscle rigidity or stiffness

• Restless leg syndrome

How To Talk To Someone With Hallucinations Or Delusions

• It is usually not helpful to argue. Avoid trying to reason. Keep calm and be reassuring.
• You can say you do not see what your loved one is seeing, but some people find it more calming to acknowledge what the person is seeing to reduce stress. For example, if the person sees a cat in the room, it may be best to say, “I will take the cat out” rather than argue that there is no cat.

Page reviewed by Dr. Kathryn P Moore, Movement Disorders neurologist at Duke Health, a Parkinson’s Foundation Center of Excellence.

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Differentiating Delirium From Primary Psychiatric Disorder

Certain signs and symptoms can help physicians distinguish between delirium and a preexisting psychiatric disorder. For example, visual hallucinations are an indicator of an underlying metabolic disturbance or adverse effect of medication or substance abuse. While visual hallucinations can occur in patients with primary psychiatric illnesses such as schizophrenia, they are much less common than auditory hallucinations. In primary psychiatric disorders, visual hallucinations would be associated with other, more characteristic signs and symptoms of the disorders. Visual hallucinations that occur in patients with delirium can be formed or unformed .

Electroencephalography can be useful in differentiating delirium from other conditions. In patients with delirium, the EEG shows a diffuse slowing of the background rhythm. An exception is patients with delirium tremens, where the EEG shows fast activity. EEGs are also useful in detecting ictal and postictal seizure activity, as well as nonconvulsive status epilepticus, all of which can present as delirium. Abnormal EEG readings would not be expected in patients with psychotic disorders or depression. However, slowing may occur in patients with dementia.

Support For Families And Carers

Dealing with these behaviours day in and day out is not easy. It is essential that you seek support for yourself from an understanding family member, a friend, a professional or a support group.

Keep in mind that feelings of distress, frustration, guilt, exhaustion and exasperation are quite normal.

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Responding To Delusions In The Elderly

Delusions among dementia patients are typically a result of their cognitive impairment. They occur when a senior tries to make sense of a situation but their confusion and memory problems make it impossible.

They end up filling a hole in a faulty memory with a delusion that makes sense to them, Gwyther says.

For example, if a loved one cant find their purse, they may conclude that its missing because someone stole it. This phenomenon is called confabulation.

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Here are four ways you can help a loved one if theyre experiencing delusions from dementia:

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Hallucinations Vs Delusions From Dementia

You might hear the terms delusions and hallucinations used interchangeably, but theyre actually different.

Delusions from dementia are fixed false beliefs that are often caused by declining memory, whereas someone whos hallucinating could see, smell, feel, taste, or hear things that dont exist. For people with dementia, delusions are typically more common than hallucinations.

Both delusions and hallucinations may worsen at night if your loved one is prone to sundowning.

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Disorders Of The Heart And Lungs

The heart and lungs provide the brain with oxygen and nutrients that are necessary for proper functioning. Age is often accompanied by vascular disease that interferes with cardiac output or lung disease that interferes with the delivery of oxygen to the brain. These underlying diseases can cause MaND as well as whats commonly known as vascular dementia . They can also affect alertness, memory, and executive function..

Changes In Perception And Hallucinations In Dementia

Our senses hearing, sight, smell, taste and touch help us understand the world around us.

But in many people with dementia, the brain misinterprets the information from their senses. This can cause changes in perception, where they experience things differently from other people.

Changes in perception may also be caused by physical changes, such as their sight or hearing getting worse as they get older.

Some people with dementia have hallucinations. This is where they experience something that is not really happening, like hearing voices or seeing things that arent there . Visual hallucinations are more common in people with Lewy body dementia.

Signs that someone may be experiencing changes in perception or hallucinations include:

• not recognising where they are
• bumping into things or having frequent trips and falls, as if theyre struggling to see objects around them
• reacting to things other people cant see
• muttering under their breath, or talking like theyre responding to something you cant hear
• appearing frightened or distressed
• scratching or picking their skin as if they itch
• becoming more socially isolated

The good news is there are lots of things you can do to help people with dementia who are experiencing changes in perception and hallucinations.

Visual changes

Auditory changes

Taste changes

Changes in sense of touch

Changes in sense of smell

You can read and download our leaflet with The Lewy Body Society on Capgras syndrome.

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Is Delirium The Same As Dementia

Delirium and dementia have some similarities, but they are not the same.

• Delirium mostly affects a persons attention. Dementia affects memory.
• Delirium is a temporary state that begins suddenly. Dementia is chronic confusion that usually begins gradually and worsens over time.

However, someone can have both delirium and dementia. Seek care quickly if a person, especially one with dementia, begins to show symptoms of delirium.

Treatment Of Hallucinations & Delusions

Consulting with your doctor is vital to understand why your loved one is hallucinating or having delusions, and whether medication is necessary. 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. The most commonly used to help dementia-related hallucinations and delusions is Risperidone. It has only been shown to alleviate symptoms in the short term. The side effects of Risperidone are muscle tremors, weight gain, fatigue, and dizziness. Because of this, non-drug treatments are typically preferred. A doctor may, however, conclude that medication is necessary.

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The Seven Stages Of Dementia

One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.

Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.

Coping With Cognitive Changes

Some medications used to treat Alzheimer’s disease also may be used to treat the cognitive symptoms of LBD. These drugs, called cholinesterase inhibitors, act on a chemical in the brain that is important for memory and thinking. They may also improve hallucinations, apathy, and delusions. The U.S. Food and Drug Administration has approved one Alzheimer’s drug, rivastigmine, to treat cognitive symptoms in Parkinson’s disease dementia. Several other drugs are being tested as possible treatments for LBD symptoms or to disrupt the underlying disease process.

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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.