Dementia may lead to hallucinations

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SouthBendTribune.com

Debbie Haws

The progression of dementia on memory and cognition may lead to personality and behavioral changes that include hallucinations, delusions and paranoia. Let’s begin by defining the terms.

Hallucination is a false perception that appears to be real. For example, a man dying of thirst in a desert thinks that he sees an oasis. It is so real to him he drinks the sand. Hallucinations are sensory experiences. They can appear in the form of visions, voices or sounds, feelings, smells or tastes. I hear something, I smell something, I feel something on my skin that is not there. A dream isn’t a hallucination because you aren’t awake or conscious. Hallucinations can be induced by drugs, including LSD and certain strong types of marijuana. Hearing the voice of, or briefly seeing, a loved one who has recently died can be a part of the grieving process.

Delusion is a fixed persistent belief. I believe this thing to be true no matter what you say. I believe you are my mother and no matter how many times you tell me different I'm going to insist you are my mother. The most common are delusions of persecution, jealousy and grandeur (I'm a rock star or on a “special mission”).

Paranoia is an extreme, irrational distrust of others. For instance, a person with dementia might believe that the nursing home is trying to poison their meals or perhaps that staff members or family are stealing from them. They may feel that someone is following them or “out to get them.”

It is very common with this disease process for people to misperceive occurrences in their environment. Sometimes this may happen because the individual is over stimulated and there is too much noise and chaos or they are under stimulated and they are feeling isolated. If the TV is on in the background with other conversations and noises, they make think the voices from the TV are real. If they are under stimulated and don’t have structured activities, they have a tendency to disconnect or pull back, creating isolation for themselves. This allows the opportunity for more delusions and hallucinations.

People lose memory in the reverse way they acquire it. The things learned very early as a child and in young adult life are the things that stay well into the end of the disease process. The most recent information _ adult children, a second marriage, career _ is the first lost. Their reference to people are usually relationships from long ago. Through their eyes they are young, so it doesn't make sense to them that they would have an adult child; therefore, "you must be my sister because I'm too young to have a daughter." You may look very similar to someone they remember from their past so that’s who you become.

At other times, they may think their reflection in the mirror is a stranger and become frightened; or think it must be their mother who came to visit.

Hallucinations and delusions can be ignored if they are harmless and do not cause the person to become agitated. Allowing them their own idea of truths and understanding is an actual nurturing process. Supporting their reality is very important.

To help them move past a hallucination, it may help to focus their attention on an activity or concentrate on their favorite hobbies. If they feel someone is watching them, close the curtains or blinds on the windows or cover the mirror. Keep their area well lit and reduce background noises.

When paranoia and delusions becoming life threatening, such as refusing to eat for an extended time for fear of it being poisoned, it may require professional intervention. This condition can be related to psychosis, an underlying condition that happens sometimes as the disease progresses. Psychosis is an actual break in reality and may call for anti-psychotic medication and temporary clinical treatment. That's not true for everyone.

Behavior that is caused by this disease process happens progressively and over a long time. If the onset of symptoms occurs quickly, from one day to the next, it is probably not disease oriented, but a result of health and medical problems, such as infections, fatigue or nutrition. Arrange for a medical checkup to eliminate the presence of physical or psychiatric problems and to check the effects of medication.

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