Dementia With Lewy Bodies
Lewy bodies are deposits of protein that develop throughout the brain, including in the cerebral cortex, which oversees language and thinking. They damage and kill nerves in the brain over time.
In the early stages of dementia with Lewy bodies, alertness and attentiveness may vary wildly from day to day or even throughout the same day.
People with this type of dementia may hallucinate, and they often feel persecuted as a result.
The symptoms may start to resemble Alzheimers as this type of dementia progresses, with episodes of memory loss, shouting, and confrontational behavior. These symptoms can be especially challenging for caregivers.
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.
Where To Live With Dementia
Eventually, caregiving for someone with dementia wont be appropriate anymore. The needs of a person with progressive dementia become overwhelming, and moving into a full-time residence with trained staff becomes necessary. You should plan for this well before it becomes necessary, by visiting communities and asking the right questions.
Depending on your loved ones stage of illness, different living options are available:
Assisted Living in Early StagesAssisted living residences combine room and board with medical and personal care, and are often sufficient for someone in the early stages of Alzheimers disease or related dementia. Full-time supervision means residents are safe, with living units like private studios or apartments so someone with mild dementia can still feel a sense of independence.
Services offered in assisted living include meals, help with activities of daily living , social activities, and transportation to and from doctors appointments. Before moving in, the residence will assess your loved one to make sure its a good fit.
Memory care residences have physical designs that are appropriate for people with dementia. Someone with Alzheimers, for instance, may become upset when encountering a wall, so memory care buildings have circular hallways. Because people with dementia are prone to wander, memory care residences have increased security and supervision, and special locks on doors.
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Building A Lewy Body Dementia Care Team
After receiving a diagnosis, a person with LBD may benefit from seeing a neurologist who specializes in dementia and/or movement disorders. Your primary doctor can work with other professionals to follow your treatment plan. Depending on an individual’s particular symptoms, physical, speech, and occupational therapists, as well as mental health and palliative care specialists, can be helpful.
Support groups are another valuable resource for people with LBD and their caregivers. Sharing experiences and tips with others in the same situation can help people find practical solutions to day-to-day challenges and get emotional and social support.
Preclinical Polymodal Hallucinations For 13 Years Before Dementia With Lewy Bodies
1Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Unità Operativa Complessa di Geriatria, Via Pace 9, 20122 Milan, Italy
2Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy
3Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Via Della Commenda 9/12, 20122 Milan, Italy
1.1. Hallucinations in Dementia with Lewy Bodies
1.2. Mild Cognitive Impairment-DLB
1.3. Account of the DLB Hallucinations
Impairments of visual perception and visual attention are usually reported in the dementia phase of DLB . Moreover, DLB patients with visual hallucinations are more impaired in visual perception compared to DLB patients without hallucinations . Thus, visual hallucinations in DLB are related to visuoperceptual function impairments .
A different account for DLB visual hallucinations assumes that this phenomenon, together with other DLB symptoms , etc.), may reflect a narcolepsy-like REM-sleep disorder . Hallucinations in narcolepsy are vivid sensory experiences, including visual, tactile, kinetic, and auditory phenomena, that occur during transitions into or out of sleep . They are considered to be intrusions of dream imagery into wakefulness .
2.1. Case Report
2.2. Phenomenological Study of the Hallucinations
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What Are Lewy Bodies
According to the National Institute of Aging , Lewy bodies are abnormal protein deposits that disrupt the brains normal functioning.
Lewy body dementia affects different regions in the brain. Lewy body dementia and Alzheimers Disease share similar symptoms and therefore, often misdiagnosed for Alzheimers Disease.
The parts of the brain that are affected include those that are responsible for processing information, thoughts, language and movement. Lewy bodies have also been found in the parts of the brain that regulates emotions and behavior, sleep and forming new memories.
Scales For Rating Dementia
Rather than simply using early stage,middle-stage, and late-stage dementia as descriptors, there are scales that provide a more comprehensive description. These scales help better understand the different stages of Alzheimers disease based on how well a person thinks and functions . These scales are the Global Deterioration Scale for Assessment of Primary Degenerative Dementia, the Functional Assessment Staging Test, and the Clinical Dementia Rating.
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Global Deterioration Scale / Reisberg Scale
The most commonly used scale is often referred to simply as GDS, or by its more formal name, the Reisberg Scale . The GDS divides into seven stages based on the amount of cognitive decline. This test is most relevant for people who have Alzheimers disease because some other types of dementia do not always include memory loss.
Someone in stages 1-3 does not typically exhibit enough symptoms for a dementia diagnosis. By the time a diagnosis has been made, a dementia patient is typically in stage 4 or beyond. Stage 4 is considered early dementia, stages 5 and 6 are considered middle dementia, and stage 7 is considered late dementia.
|Global Deterioration Scale / Reisberg Scale|
Clinical Dementia Rating
|Clinical Dementia Rating Scale|
|Average duration is 1 year to 2.5 years.|
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Middle Stage Or Moderate Dementia
As they progress through the seven stages of dementia, elderly people require more intense care and supervision. Someone with middle stage dementia often needs some caregiver assistance with regular day-to-day activities, such as dressing, eating, or bathing.
Dementia stage 5: moderately severe cognitive decline
This stage marks the onset of what many professionals refer to as mid-stage in the seven stages of dementia.
At this point, a person may no longer be able to carry out normal activities of daily living , such as dressing or bathing, without some caregiver assistance. They know major facts about themselves such as their name and their childrens names but they may not remember grandchildrens names, their longtime address, or where they went to high school.
Stage 5 dementia symptoms
- Further reduced mental acuity and problem-solving ability
How Do We Support People With Dementia Experiencing Hallucinations
One thing that we should not do is ignore or make fun of the person affected by Lewy Body who is experiencing hallucinations, especially if they seem frightened, anxious or concerned. Remember for them, these hallucinations can be very realistic and detailed.
Think about it this way. You saw a slender piece of dark driftwood and you momentarily thought it was a snake. You got frightened. Your body reacted as if it was a real snake. You screamed in fear. Your heart was pounding.
Its similar for people living with certain types of dementia. Its just as real to them as you mistaking the piece of driftwood and reacting to it as if it was a real snake.
A recent example made news, when we heard of a Care Aide in a Long-term Care home making fun of one of her residents who asked her where her three friends ran off to who were at the end of her bed. Instead of mocking the situation or ignoring the resident by going to eat a piece of cake, maybe we could better support this resident if we used effective dementia care techniques.
To start, ideally one would want to dig deeper and investigate why this resident is asking for her friends. Is this a new behaviour?
Is there anything physical going on? Could she be experiencing pain or discomfort? Did something happen recently? Were there new staff in the facility? Once we know why, perhaps there are small changes that can be made that will make a positive impact.
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Hallucinations In People With Dementia
They normally seem real to the person who is experiencing them, but other people cannot see them the way the person hallucinating is.
Hallucinations typically involve the senses of a person who has dementia.
In most cases, however, they will affect the visual or auditory senses where a person can see something that does not exist or hear voices or noises that are not there.
For example, a person can be convinced that they are seeing crawling bugs on their bed or seat but they are not actually there.
What Causes Delusions In The Elderly
Delusions among dementia patients typically result from 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.
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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.
Stage : Normal Outward Behavior
Alzheimerâs disease usually starts silently, with brain changes that begin years before anyone notices a problem. When your loved one is in this early phase, they won’t have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether they have Alzheimer’s.
As they move into the next six stages, your friend or relative with Alzheimer’s will see more and more changes in their thinking and reasoning.
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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.
Why Does Dementia Cause Delusions Hallucinations And Paranoia
When healthy nerve cells in the brain begin to degrade and cease to connect with other cells in the brain, the symptoms of dementia that often include delusions, paranoia or hallucinations will begin to appear. In general, people will lose a certain percentage of neurons as they grow older, but seniors who suffer from dementia will suffer a higher percentage of cell loss than normal. Dementia is usually found in seniors, and those aged 85 and up are more likely to have at least some form of the condition. That being said, there are many seniors who live well past the age of 90 and will never experience any form of dementia. A specific form of dementia, frontotemporal disorders, is typically experienced by middle-aged people as opposed to seniors.
Dementia is used as a catch-all term for a series of conditions and diseases that present with an overall decline in certain functions. A decline of language, memory, basic thinking skills, and the ability to solve problems are the main symptoms. Dementia sufferers also often experience what is called Sundowners Syndrome. Memory loss is one of the most notable side effects of dementia, and Alzheimers disease is the leading cause of dementia in senior citizens.
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Stage : Moderately Severe Mental Decline/moderate Dementiaquality Of Life: Moderate Impact
Your loved one will likely remember some of their past and still recognize loved ones. He or she may have trouble making healthcare decisions. You may need some care in the home for day-to-day activities. You may see your loved one:
- Experience personality changes and mood swings.
- Repeat the same questions over and over again.
- Have gaps in memory and become confused about the date, where you are, or your address and phone number.
- Need help with eating or using the toilet.
- Have trouble choosing clothing, such as what kind of close to wear for the season.
- Have bladder problems.
How You Can Help:
If you havent already helped your loved one document his or her care wishes, talk with the health care team and the options for care.
If you have, help the health care team follow your loved ones care preferences.
- Help with dressing, toileting, and other daily activities.
- Respond to repeated questions with patience.
Signs Of Dying In The Elderly With Dementia
Dementia is a general term for a chronic or persistent decline in mental processes including memory loss, impaired reasoning, and personality changes. Alzheimers disease is the most common form of dementia, accounting for 60-80% of all cases of dementia. It is also the 6th leading cause of death in the United States, and over 5 million Americans are currently living with Alzheimers disease.
Alzheimers disease and most progressive dementias do not have a cure. While the disease inevitably worsens over time, that timeline can vary greatly from one patient to the next.
Caring for a loved one can be challenging and stressful, as the individuals personality changes and cognitive function declines. They may even stop recognizing their nearest and dearest friends and relatives. As dementia progresses, the individual will require more and more care. As a family caregiver, its important to be able to recognize the signs of dying in elderly with dementia. Hospice can help by offering care wherever the individual resides, providing physical, emotional and spiritual care to the patient and support their family.
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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 : Very Mild Changes
You still might not notice anything amiss in your loved one’s behavior, but they may be picking up on small differences, things that even a doctor doesn’t catch. This could include forgetting words or misplacing objects.
At this stage, subtle symptoms of Alzheimer’s don’t interfere with their ability to work or live independently.
Keep in mind that these symptoms might not be Alzheimer’s at all, but simply normal changes from aging.
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