More on Hallucinations & Delusions

Last night I had the privilege of enjoying a quiet evening with my mother and grandmother at my home baking cooking and making dinner. It was a special time for me since I hadn’t had the chance to do this with my own children in a couple of years. It had been a tradition of our to do. We would stay up late, put Christmas cartoons on, and start making Christmas cookies. The kitchen would be a mess. But last night was July 1, 2015 and my grandmother passed away over two years ago.

I learned much of my cooking abilities from my grandmother. She taught me all of her secrets and was constantly giving me nifty little kitchen gadget. She always had a story to go with every scenario. She passed while living in a home. That night we laughed and baked as we decorated cookies. I got the privilege of writing down many of her recipes before the night was over. And it was double special for me. I haven’t been able to follow this same tradition with my own children in over two years. We had always put on Christmas cartoons or music followed by spreading out of the cooking making materials making a mess. By the time we were done the kitchen looked as if the Keebler Elf tree had been up rooted in my kitchen.

I became frantic the next day when I couldn’t find my recipes I copied. I searched everywhere. They were grandmother’s and I didn’t want to lose them. But I never wrote them down to lose them. I asked my wife about them and she never saw them and my mom never came by.

Dementia is a group of symptoms of many different complex conditions. Dementia affects the part of the brain that is responsible for our perceptions, what we see, hear, taste and smell, the cerebral cortex of the brain. The cerebral cortex is responsible for how an individual perceives a situation and how he or she responds.

Individuals suffering from dementia will experience a range of emotions and express thoughts which appear real to them at the moment. Even though these thoughts are typically imaginary or made up, they evoke feelings that are very real to the person and often times causes extreme anxiety, panic or fear.

Hallucinations

An individual with dementia may express that they see or can hear something that isn’t there. They may be insistent that these things exist even though they cannot be verified by another person. Hallucinations may result from changes in the brain, but may also be the result of medications, infections, vitamin deficiencies and other medical conditions.

It is understandable that individuals with dementia are completely unaware that their memory is poor or non existent. To compensate and to make sense of their world, the individual will create their own interpretation of events. So when things become missing or disappear or memories of recent conversations or recent events cannot be recalled, then explanations for things can be blamed on someone else. Directing the blame elsewhere helps things make sense to the individual at the moment.

Hallucinations and Delusions

Hallucinations are not a normal part of most dementias. There is a difference, however, between a hallucination and a delusion, and this is where family caregivers can become confused.

Delusions are ideas or false beliefs about things not based in reality that are thought to be going on in the present moment. An individual with dementia may have delusions that someone is trying to steal their money, poison them or is intent on harming them in some way. These delusions are reality for a person with dementia.

Delusions are very difficult to deal with in a person with dementia because it affects how an individual interacts with those around them.

Provide a Safe Environment

Providing a safe environment for a person suffering from dementia is critical, especially if he or she is experiencing hallucinations due to the disease. Creating this type of environment can be increasingly difficult as the dementia worsens. Moving your loved one into a memory care community may be an option that would not only provide a safe place but also peace of mind knowing that there are professionals on staff at all times in memory care communities that have experience with seniors that are suffering from dementia.

Hallucinations and Dementia Types

Many people think of hallucinations as primarily visual, but people with dementia can also experience hallucinations involving smell, taste, hearing and touch. Hallucinations affecting multiple senses are especially common in Alzheimer disease, which accounts for the majority of dementia cases. Another form of dementia, dementia with Lewy bodies, is commonly associated with visual and auditory hallucinations. Vascular dementia, which is caused by disordered blood flow to the brain, is often associated with visual hallucinations. While not all people with Parkinson disease develop dementia, those who do may experience hallucinations similar to those typical of Lewy body dementia.

Neurological Features in Alzheimer Disease

Doctors don't know for sure exactly what causes hallucinations, but different patterns of brain degeneration likely play a contributing role. In Alzheimer disease, the outer area of the brain, called the cortex, is progressively damaged. The disease starts with parts of the brain used for memory and processing auditory information, and moves next to attack areas important for self-monitoring, self-control and spatial processing. A 2013 study suggested that thinning of a particular part of the cortex, called the supramarginal cortex, may be linked with the presence of more visual hallucinations in some Alzheimer patients.

Neurological Features in Other Dementias

In comparison, vascular dementia and Parkinson disease affect deeper brain structures. In these dementia types, the structures damaged are important for movement. They also play a role in memory, and in processing information from the senses to understand the environment. The distinguishing feature of Lewy body dementia is the collection of abnormal proteins that affect how brain cells work. A study published in 2009 in the "American Journal of Geriatric Psychiatry" suggests that people with Lewy body dementia have a greater chance of experiencing hallucinations than those with dementia due to other causes.

Drug Effects

Sometimes the medications used to manage dementia symptoms can make hallucinations more vivid or frequent. Neuroleptics, a type of drug used to manage hallucinations and delusions, may actually increase hallucinations in some people. Similar problems may be seen with drugs that are commonly prescribed to people with Parkinson disease. If your loved one takes a lot of medications to manage her health, drug interactions are also a real concern. Talk to your family member's doctor to see if adjustments to drug types or doses may help.

Sundowning

"Sundowning" is a phenomenon in which dementia symptoms, including hallucinations, worsen in the late afternoon or early evening. The causes are not completely clear, but several factors might play a role, including fatigue, restlessness from not enough daily activity, a disrupted sleep-wake cycle, or even reduced lighting, which makes familiar objects look unclear or frightening. You may be able to help by planning any outings or activities earlier in the day. Keeping your loved one's room well-lit and free of obstacles might also help reduce hallucinations.