Wednesday, December 31, 2014

Auditory Hallucinations

Auditory hallucinations are when a person believes they hear something that they actually did not hear.  A common example of an auditory hallucination is when someone hears one or more voices and those voices do not blond to anyone around them.  Auditory hallucinations can be a common occurrence with Alzheimer's patients.  According to the National Institutes of Health, as many as 53% of Alzheimer's patients experience hallucinations of some form during the moderate to severe (middle) stages of the disease.  Hallucinations can increase anxiety in the patient because they cannot get confirmation of what they have experienced or the hallucination is itself frightening.

Hallucinations may be a side effect of medication, a result of Sundowning, or over stimulation.  Because the hallucinations are frequently associated with psychosis which is a disconnect with reality, a patient may be prescribed antipsychotic medications to help mitigate the impact of the hallucinations.

Hallucinations may also be the result of misunderstanding a stimulus.  If a patient hears something, the patient may not process the sound accurately and may experience something other than what was actually happening as a result.  A 2013 study confirmed that Alzheimer's patients have significant hearing changes, particularly in their left ears, than others in the same age group without Alzheimer's disease.  To complicate matters, the progression of the Alzheimer's may make it difficult for the patient to describe what they have experienced in a way that is coherent to the caregiver.

I remember Grandma having visual and auditory hallucinations about 4 years before she passed.  I was home from college and helped care for her that summer when her hallucinations peaked.  Looking back, I wish we had known what was going on because we would have been better able to help her through the hallucinations and may have been less stressed ourselves.  I particularly remember sitting in her room with her one-day when she looked up and started talking to someone else.  She was convinced there was a man standing in the doorway to her room.  She was mad at me for not being polite and acknowledging him and blamed his departure on my behavior.  Mom reminded me of the time Grandma was mad that there were children in the apple trees out back stealing the fruit.  She calmed down when I went outside to chase them away.

Lyn has begun indicating she's hearing things which are not happening.  For example, she is convinced that people are racing their cars in front of the house.  This is a physical impossibility because they live on a dead end.  Cars do race down the road behind the house, but Lyn reports the racing is out front and at times when there's no racing out back.  She's also convinced that her oxygen condenser is making strange sounds.  Over the past week or so, Mom has gone in and sat beside Lyn with the condenser on, asking Lyn to just raise her hand when the strange sound occurs.  She doesn't raise her hand with Mom there.

Earlier this year, Lyn's hearing was checked and it was fine at that time.  However, it may be time to have it checked again.  I wouldn't be surprised if there was loss in the left ear.  At this time, Mom's able to use supportive techniques to assure Lyn that everything is OK without telling her that she's hearing things.  Denying the hallucination would increase the agitation.  Mom has started reminding Lyn that if there is a sound that needs to be worried about, Nikka will bark.  If Nikka is calm, then all is well.  Lyn accepts Nikka as an external check of the household status and, so far, allows herself to be redirected.

Lyn has Sundowned for years and the hallucinations may be a result of that.  They may also just be a result of the deterioration of her brain.  Given how little medication she's on; just a thyroid medication and a multi-vitamin, the hallucinations are not a result of her medical supports. Mom and I have talked about the hallucinations and the increasing bad attitude that Lyn is demonstrating.  We believe they are connected and are the progression of the disease.  We also believe that Lyn should be seen by her physician so that she can be evaluated.  It may be time to introduce additional medical supports to help ease the agitation and the hallucinations.


Additional Information:
Dementia and Hallucinations
Hallucinations and Alzheimer's

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