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What Stage Of Alzheimer’s Is Hallucinations

Factors Which May Cause Behaviours To Change

The 3 Most Common Dementia Hallucinations
  • 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.

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.

Links To Disease Stage And Severity

Delusions and hallucinations in AD are associated with different patient characteristics: in a memory clinic sample of people with probable AD, delusions were associated with older age, depression and aggression, whereas hallucinations were associated with more severe dementia and longer duration of illness. An analysis of National Alzheimers Coordinating Center data found that delusions and hallucinations also showed differential associations with cognition and function, with hallucinations conferring greater cognitive and functional deficits than delusions. Individuals with delusions might represent a heterogenous group: persecutory delusions, such as delusions of theft, are the most common late-life delusions and occur earlier in the AD course than do misidentification delusions, such as TV sign and phantom boarder , which are associated with advanced dementia and greater cognitive impairment.

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What Causes Hallucinations And False Ideas

Dementia may cause the person to lose the ability to recognise things because the brain does not accurately interpret the information that it has received. Examples of this include failure to recognise a partner or the house in which the person lives.

Problems with memory, which occur in dementia, may lead to suspiciousness, paranoia and false ideas. If people with dementia are unaware that their memory is poor, they will often create an interpretation in which someone or something else is blamed. This is understandable when they may live in a world with no memory of recent events, where things disappear, explanations can be forgotten and conversations do not always make sense.

What Causes Sundowners Syndrome

Lewey Body Dementia

Some studies suggest that as many as 20% of Alzheimer’s patients experience worsening confusion, agitation, and anxiety beginning in the afternoon or evening. Again, doctors do not fully understand sundowners syndrome or its causes, but some potential triggers have been identified. Research suggests that contributing factors may include the following:

  • Sensory deprivation or overload
  • Unmet physical needs
  • Limited mobility or social isolation
  • Increased stress levels
  • Unfamiliar environment or unexpected change
  • Disrupted circadian rhythm, sleep deprivation

Is it Sundowners Syndrome or Delirium?

When it comes to treating and managing sundowning symptoms, the first step is to confirm that it is, in fact, sundowners syndrome and not delirium. Delirium is a medical condition that results in mental confusion and changes in attention span, perception, mood, and activity level. Though delirium is a stand-alone medical condition, people with dementia are highly susceptible to it.

The best way to tell whether your loved one is suffering from delirium or sundowners syndrome is to look at the timing. Delirium sets in quickly over the course of days or weeks rather than months or years, and its associated confusion may fluctuate throughout the day instead of along a predictable late-afternoon or early-evening timeline.

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Later Stage Alzheimer’s Treatments

The behavioral symptoms of Alzheimers can be distressing, for both the person with Alzheimer’s and their loved ones. Although most behavioral symptoms are due to the progression of the disease and subsequent brain cell loss, certain aspects of the environment can exacerbate behavior symptoms, like noise or clutter, as well as other medical conditions.3 While these treatments wont stop symptoms or halt the progression of Alzheimers disease, they can help minimize symptoms for a period of time.

Non-drug approaches are generally preferred as first-line treatment for behavioral symptoms with Alzheimers disease. This can include reducing over-stimulation in the environment, creating a calm space, following a routine, and having supportive caregivers. Medication that can help with behavioral symptoms includes antidepressants, anti-anxiety medications, and antipsychotics.3 Antipsychotics and anti-anxiety medications should be used with extreme care for those with Alzheimers, and its important to talk with the doctor about the risks and benefits of each medication. Patients might have to try different kinds of medications if one doesnt work, so don’t give up if the first one wasnt a good fit.

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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Changes In Mood Emotions And Perceptions

Changes in mood remain in the later stages of dementia. Depression and apathy are particularly common.

Delusions and hallucinations are most common in the late stage of dementia. They are not always distressing but they can explain some changes in behaviour because the persons perception of reality is altered.

People with later stage dementia often respond more to senses than words. They may like listening to songs or enjoy textures. For example, they may like the feel of different types of material.

Very Mild Impairment Or Normal Forgetfulness

How to Handle Dementia Hallucinations & What to Expect

Alzheimers disease mainly affects older adults, over the age of 65. At this age, its common to have slight functional difficulties like forgetfulness.

But for stage 2 Alzheimers, the decline will happen at a greater rate than similarly aged people without Alzheimers. For example, a person may forget familiar words, a family members name, or where they placed something.

Caregiver support: Symptoms at stage 2 wont interfere with work or social activities. Memory troubles are still very mild and may not be apparent to friends and family.

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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.

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.

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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.

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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.

Why Hallucinations Happen

How To Talk To Someone With Dementia Hallucinations

Hallucinations are one of the many symptoms of dementia and are most common in the later stages of the disease. Dementia is marked by significant cognitive decline, including memory loss and impaired thinking. The damage caused to the brain can result in sensory changes. Without proper sensory function, some seniors might have false perceptions.

Many hallucinations are triggered by things in the environment that cause seniors to think something else is happening. For example, a shiny spot on the floor may look like water. Voices on the television may cause an aging adult to think the people on the TV are in the room with him or her. Try to identify the source of your loved ones hallucination so you can handle it right away.

Symptoms such as hallucinations, confusion, and agitation are common in elderly people with dementia. Dementia can be challenging for seniors to manage, but they can maintain a higher quality of life with the help of professional dementia care Garland seniors can benefit greatly from the Cognitive Therapeutics Method , an activities-based program designed to promote cognitive health and delay the onset of dementia. CTM is included at no additional charge with any of the in-home care plans provided by Ambience In-Home Care.

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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.

Stages : Very Severe Decline

Stage seven is the final stage of Alzheimers. Because the disease is a terminal illness, people in stage seven are nearing death. In stage seven of the disease, people lose the ability to communicate or respond to their environment. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of Alzheimers, people may lose their ability to swallow.

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A Word About Progression

Alzheimers typically progresses slowly and transitions from mild to severe symptoms. The rate of progression varies widely between people. People with Alzheimers live an average of 4 to 8 years after their diagnosis, but some people live more than 20 years.

The risk of progressing to a higher stage increases with age. For example, in a

Frequently Asked Questions About Sundowners Syndrome

Reisbergs 7 stages of dementia (aka the Global Deterioration Scale)
  • What Are the Early Signs of Sundowners Syndrome?Sundowners syndrome causes a wide variety of behavioral changes that, in the early stages, can be subtle and inconsistent. Early signs of sundowners syndrome include restlessness, agitation, irritability, and mental confusion in the elderly at night. The patient may also appear disoriented, or they could become more suspicious or demanding. As the condition progresses, these symptoms may become more pronounced and may progress into more serious behavioral disturbances including extreme agitation, emotional outbursts, anxiety, paranoia, and hallucinations.
  • What Causes Sundowning?Doctors and researchers have not yet identified a clear cause for sundowning, but it may be related to the body’s internal clock and worsening dementia. Dementia typically causes progressive confusion and difficulty with processing and reasoning skills it can also change the body’s internal clock that differentiates between day and night. When the body’s internal clock is disrupted, it can lead to confusion and exhaustion which may exacerbate mental and behavioral symptoms commonly seen in sundowners patients.
  • When Does Sundowning Occur?The symptoms of sundowners syndrome typically develop between the hours of 4:30 in the afternoon and 11 at night. Symptoms start to develop as daylight begins to fade and may become progressively worse as day turns to night.
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    How Does A Person Experience Hallucinations

    Some people with dementia will have hallucinations in different senses for example:

    • auditory hallucinations hearing things that arent there, like voices or footsteps
    • olfactory hallucinations smelling things that arent there, such as smoke or perfume
    • tactile hallucinations physically feeling things that arent there, such as being kissed or insects crawling over their skin
    • gustatory hallucinations tasting things that arent there, such as a metallic taste in their mouth.

    Visual hallucinations are more common in people with dementia with Lewy bodies, and often take the form of complex, vivid and very realistic hallucinations of people or animals. They often last for several minutes and happen often.

    Hallucinations can be extremely distressing, and can lead to the person with dementia becoming frightened and in need of support. However, some people find the hallucinations pleasant or comforting. It often depends on what they are hallucinating and how others respond.

    How Long Can An 85 Year Old Live With Dementia

    Studies suggest that, on average, someone will live around ten years following a dementia diagnosis. However, this can vary significantly between individuals, some people living for more than twenty years, so its important to try not to focus on the figures and to make the very most of the time left.

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    In What Stage Of Dementia Are Hallucinations And Delusions Most Likely To Occur

    The type of dementia most associated with hallucinations is Lewy body dementia, which affects about 1.4 million people in the U.S. and is the third-most-common type of dementia . People with Lewy body dementia will often see colorful people or animals that arent actually present, often for a few minutes at a time. This is actually more likely to occur in the early stages of the disease than later. People with Lewy body dementia, in fact, often have hallucinations early and then, as they enter the middle stages, the hallucinations will go away completely as other symptoms, like problems walking, get worse.

    People with Alzheimers disease have been shown to sometimes have hallucinations, as have people with Parkinsons disease with dementia. This is rarer, however, and delusions are much more common with these illnesses. Both hallucinations and delusions in people with Alzheimers often occur in the late-middle to later stages of the disease.

    When To See A Gp


    If you’re worried about your memory or think you may have dementia, it’s a good idea to see a GP.

    If you’re worried about someone else’s memory problems, encourage them to make an appointment and perhaps suggest that you go along with them.

    Memory problems are not just caused by dementia they can also be caused by depression, stress, medicines or other health problems.

    A GP can carry out some simple checks to try to find out what the cause may be, and they can refer you to a specialist for more tests if necessary.

    Read more about diagnosing Alzheimer’s disease.

    Page last reviewed: 05 July 2021 Next review due: 05 July 2024

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