Dementia and Hallucinations ~~~~ ~Dr. Domenico Pratico, MD, FCPP

A hallucination is an experience of something that does not exist, a perception of something in the absence of an external stimulus that has qualities of a real one.

It can involve any of our five senses, and for this reason we can divide hallucinations into five groups:

Visual hallucinations – seeing flashing lights, people, animals or objects.

Auditory hallucinations – hearing voices or footsteps.

Olfactory hallucinations – smelling things such as smoke or perfume

Tactile hallucinations – physically feeling things such as being touched, or even insects crawling over the skin.

Gustatory hallucinations – tasting things such as a metallic taste in the mouth.

The five types of hallucinations: visual, auditory, tactile, olfactory and gustatory

Most of the time, hallucinations are associated with mental health conditions such as  schizophrenia, bipolar disorder, or severe depression. In other cases, they can be the side effects of alcoholism, drug abuse, or certain prescription medications.

However, hallucinations can also be part of symptoms present in subjects with Lewy bodies and Parkinson’s disease dementia or Alzheimer’s disease.

In fact, the first “official’ case of Alzheimer’s disease described in 1906 by Dr. Alois Alzheimer, Auguste Dieter, a 51-year-old woman was brought to his attention because among other symptoms she presented hallucinations.

Auguste Dieter was a patient under the care of Dr. Alois Alzheimer. She was brought to his attention beacuse of severe hallucinations.

It is important to differentiate between hallucinations, misperceptions or misidentifications. 

To this end, we always must pay attention to how the person describes them.

For instance, if the person seems to have auditory hallucinations the first thing to do is have their hearing checked, or if their hearing aid is working properly.

If they describe a “swarm of insects crawling on the floor”, and there is a busy pattern on a carpet, it may be a misperception of that pattern. In this case, by simply changing or covering the carpet, this misperception will disappear.

At times we may witness people with dementia who we think they are apparently hallucinating when in fact, they are simply mistaken about what they have seen or heard.

Because we still do not know what causes hallucinations in most cases, there are no treatments available, and the few that can be used are often not very helpful, particularly for people with dementia.

Some antipsychotic medications like Haloperidol (Haldol) and Aripiprazole (Abilify), in certain cases can help to reduce severe hallucinations. They should only be used when other treatments have not worked, as they can cause unpleasant or dangerous side effects.

Pimavanserin (Nuplazid) is the first and only medication specifically approved by the U.S. Food and Drug Administration to treat hallucinations and delusions associated with Parkinson's disease.

In patients with symptoms of dementia secondary to Parkinson or Alzheimer’s disease having hallucinations can be one of the most distressing moments not only for the person living with the condition, but for the caregivers and anyone else who loves them.

It is a normal human reaction filled with uncertainty, disbelief and vulnerability for anybody who witnesses a loved one who begins to see, hear or feel things that aren’t there.

If we are present during these episodes when they affect a loved one with dementia, we must respond with calm, empathy and compassion.

If the hallucination feels frightening to the subject, we should try to remain as calm as possible and reassure our loved one that we are there to help.

Please avoid arguing or trying to convince the subject that “it is not real” and importantly check the surrounding environment for possible “triggers” of the hallucination itself like a shadow or a carpet pattern.

If we witness a episode of hallucination, we should try to remain as calm as possible and reassure our loved one that we are there to help.

It is not unusual that turning on a light, closing a curtain, distracting the loved one or offering a comforting touch can ease the stressful moment.

However, if these episodes appear more frequently it may be time to seek additional medical attention and help. This also applies when hallucinations cause intense agitation and fear and maybe even lead to behaviors that can be harmful for the patient.

In all these cases, this is the time to speak  with the family doctor or the neurologist or dementia specialist, or a community mental health team.

Please do  not forget that, although caring for a loved one with hallucinations can be very heavy from an emotional point of view, you are not alone.

It is perfectly okay to feel overwhelmed and to ask for help.

Seeking support is not a luxury nor a reflection on how much we care for the person with Alzheimer's disease or dementia; it reflects that we are normal and human.

We all deserve support just as much as the person we care for.

If you are interested in reading more of my blogs:

Check out the recent blog: A Good Diet for the Brain  ~ Dr. Domenico Pratico', MD, FCPP

Dr. Domenico Pratico' , MD, FCPP

Domenico Praticò, MD, holds the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor at the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.

For more information on the research conducted by Dr. Domenico Pratico, please visit this link.

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