Hallucinations are false notions on non existing objects or happenings. Hallucinations may affect all our senses. Visual hallucinations are commonly experienced by people who have Alzheimer’s disease. They may report seeing the face of a former friend or people whom they used to fear. The latter is very common among Alzheimer’s patients who experienced the horrors of war. Hearing hallucinations involve hearing people’s conversations or a single person’s voice.
Usually patients “hear” the voices of people they know saying innocuous phrases – never commands to take specific actions. This distinguishes Alzheimer’s from other mental disorders, such as schizophrenia, with mainly hearing hallucinations that may govern patients’ abnormal behavior. Less frequently, Alzheimer’s patients experience hallucinations from senses of touch (a feeling of being touched), smell (smelling odors not sensible to others, and taste (having a feeling of strange taste).
The reason Alzheimer’s patients’ hallucinate is complex, but three major categories of problems can be distinguished. First, in the Alzheimer’s brain, the processing of various environmental stimuli delivered by difference senses is affected; that’s related to damage of nerve cells and loss of connections between them. Simply, Alzheimer’s patients may mistake a shadow for the face of somebody they knew in the past. Also, they have problems separating what is taking place now from what occurred in the past. In normal persons, more recent events replace former experiences; Alzheimer’s patients who can’t record new events may hang on to old memories more easily.
The second category of problems contributing to hallucinations are impairments of vision and hearing, which occur to a lesser or greater extent in the overwhelming majority of older people, not only in Alzheimer’s patients. Common visual problems such as cataracts, glaucoma, macular degeneration, and damage to the retina caused by diabetes, contribute to distortion of visual images which may then be misinterpreted by the ailing brain. Difficulties with hearing and with understanding somebody’s voice in a noisy background are a part of a syndrome called Presbyacousis, an age-related hearing loss of higher tones, which is common in older adults.In a noisy environment, Alzheimer’s patients may hear voices belonging to persons not present.
The third reason for hallucinations is medications. Older adults may have multiple health problems and may take a number of medications for heart, diabetes, cancer, and other conditions. Some of these medications, especially those with a tendency to build up in the system, may cause various forms of hallucinations as a negative effect. This type of problem is more likely to occur in Alzheimer’s patients or in those with other types of dementia than in normal-thinking adults.
If the hallucinations occur randomly, you may choose to ignore them; however, if they start to happen more frequently, you should discuss them with the patient’s physician. The physician should try to determine their likely cause by examining the patient for problems with vision and hearing, by performing blood tests, and by reviewing the patient’s medications list to see whether any are likely to cause hallucinations. The rate of visual and auditory hallucinations sometimes can be greatly decreased by simple measures such as prescribing glasses or a hearing aide, or withdrawing one offending drug. In other instances, ophthalmological (eye) surgery or treatment my help.
Although these measures may decrease the frequency of hallucinations, many people with Alzheimer’s may still experience them at times. The hallucinations may result in periods of fear, but they may also trigger episodes of agitation and delusions.
As a caregiver, you can take a few simple measures in response to hallucinations and to prevent their occurrence. If patients report hearing or seeing something that’s obviously a hallucination, respond in a calm, supportive manner and offer assurance. Try to distract them from paying attention to the hallucination by bringing attention to you. Either grab their hand or tap a shoulder.
Try to avoid arguing about what is seen. Try to share their fear and ask about feelings behind the hallucinations, whether they’re worried or frightened. Distract their attention from the content of the hallucinations by starting a conversation or bringing them to another room, preferably well lit and occupied with other people.
Remember: Unclear background noises, darkness, and being alone fuel hallucinations in Alzheimer’s affected people. Try to pay attention to these factors and eliminate them as much as possible.