Hallucinations and Alzheimer's

Losing grip of reality can be frustrating, even scary or traumatic for Alzheimer's patients and their caregivers. Learn about auditory and visual hallucinations.

Some people with Alzheimer's may experience hallucinations or delusions, but it doesn't mean that everyone with Alzheimer's will be affected in this way and not everyone who has these problems has Alzheimer's. Here are some ways of handling these experiences.

A person with Alzheimer's may sometimes experience hallucinations. They may see, hear, smell, taste or feel things which are not really there. That's contrasted with a delusion, which is something a person thinks, something they strongly believe to be true, which is not. Because both maladies seem so real to the person experiencing them, it is often quite difficult to convince them otherwise.

The most common hallucinations are those which involve sight or hearing.

The reaction of the person with Alzheimer's to the hallucinations may vary

• They may realize that their imagination is playing tricks with them and pay no attention to the hallucination.
• They may find it difficult to decide whether or not the hallucination is real. In this case they may like you to go with them to look at the place where they thought they saw something. Or it may help if you check the room where they thought they heard voices or other noises. You can then confirm for them that nothing is there.
• As the Alzheimer's becomes more severe the person may become convinced that what they are hearing or seeing is real. They can find this very frightening. Try to let them know that, although you are not sharing their experience, you understand how very distressing it is for them. Distracting the person may help. There is absolutely no point in arguing about whether or not the things that they are seeing are real.
• Hallucinations are less likely to occur when the person is occupied or involved in what is going on around them.
• Not all hallucinations are upsetting. Sometimes it may be better to go along with the person rather than distract them. It depends on the situation.

If the hallucinations persist or the person with Alzheimer's becomes distressed by them, speak to the GP. Medication can sometimes help but, if prescribed, should be regularly reviewed by the doctor.

Visual hallucinations and Alzheimer's

Visual hallucinations are the most common type in Alzheimer's. The person may see people, animals or objects. Sometimes these involve quite complicated scenes or bizarre situations.

Such hallucinations can be the result of the person's brain misinterpreting everyday objects. They may believe, for example, that they see faces in patterns on fabrics, that pictures on posters are real people or animals, or that their reflection in the mirror is another person.

Many people with Alzheimer's who experience visual hallucinations only experience them occasionally. However, sometimes they are more persistent and troublesome.

Possible causes of visual hallucinations include:

Illness. Hallucinations can result from physical illness such as infections. They can also be side-effects of some types of medication. A doctor should be able to help rule out these possibilities.

Eyesight. Visual hallucinations may be due to poor eyesight. This cannot always be improved but you should:

• Arrange regular eye checks and encourage the person to wear their glasses if they need them
• Check that any glasses worn are clean and that the prescription is correct
• If cataracts are the cause of poor sight, discuss whether they should be removed with the GP
• Make sure that the lighting in the home is good. Changes in the brain. A person sometimes experiences hallucinations because of changes that are occurring in their brain as the Alzheimer's progresses.

  People with Alzheimer's with Lewy bodies often have a mixture of the symptoms found in Alzheimer's disease and Parkinson's disease. People with this form of Alzheimer's are more likely to have persistent visual hallucinations together with stiffness and slowing of movement and marked fluctuations in their abilities. In these cases, antipsychotic medication, which is sometimes prescribed for hallucinations, can make the stiffness worse. It should, therefore, only be prescribed in small doses, if at all, and reviewed regularly.

Auditory hallucinations and Alzheimer's

These occur when the person hears voices or noises although nothing is there. As with visual hallucinations, it is important to rule out physical causes such as physical illness and the side-effects of medication. It is also worth checking the person's hearing and make sure that their hearing aid is working properly if they wear one.

One indication that the person may be experiencing auditory hallucinations is when they talk to themselves and pause, as though waiting for someone else to finish speaking before continuing. However, talking to oneself is very common - not everyone who does this is having an hallucination.

Shouting at people who are not there also suggests the possibility of hallucinations.

People are less likely to hear voices when they are talking to someone real, so company can help.

Sources:

• Jacqueline Marcell, Hallucinations and Delusions: How to Help Loved Ones Cope, July 2006.
• Alzheimer's Society - UK - Carer's Advice Sheet 520, Jan. 2000