Novant Health

Why do some elderly people continually experience visual or auditory hallucinations? This question plagues caregivers and clinicians as our loved ones experience dementia while aging. Whether it is a face, a sound, or some non-distinct object, we have all heard about and consequently investigated the fictitious presence reported to by an elderly loved one.

A complex visual hallucination has been clinically defined as seeing a recognizable thing that is not there nor perceived by others. An auditory hallucination is naturally defined as hearing a recognizable sound that is not there nor perceived by others. Over the past two decades, scientists have struggled to concisely map out a single brain pathway to visual and auditory hallucinations. However, many agree that these events are a direct result of compromised visual and auditory neural connectivity and/or processing, weakened attention networks, and poor perception. In the elderly population, these states are believed to be a direct result of physical aging. They also possess the ability to enhance symptoms of dementia.

Since we all agree that several physiological and cognitive factors can collectively influence the presentation of visual and auditory hallucinations, we must be creative and strategic in planning care interventions for our clients and loved ones. What does this mean? It means asking a series of poignant questions about the quality, frequency, and severity of the hallucinations. Common questions include when hallucinations occur. Are they typically noticeable at particular times of day, and are they partnered with a preexisting event or activity? How frequently do they occur? Are they rare and sporadic, or are they persistent and unwavering? Finally, are they characteristically uniform when compared to what is reported by other elderly patients of the same age and gender and medical history? Thoroughly answering these questions arms the caregiver and clinician with critical information that guides the course of treatment, i.e., will a behavioral therapeutic intervention be considered a medication option or possibly a combination of the two?

Several treating physicians prefer to address the low-lying fruit first when treating elderly patients for hallucinations. They will explore the existence of sensory processing deficits and request a routine and hearing screening. While insignificant, this is a critical step in the care planning process. As mentioned earlier, neurocognitive studies have associated these opportune events with compromised processing of sensory information in the brain. A minor tweak of the hearing aid or eyeglass prescription may yield benefits. Conversely, ruling out functional decline in sensory processing may guide the clinician to reevaluate brain changes due to aging and or other comorbid health conditions.

An auditory hallucination naturally is defined as hearing a recognizable sound that is not there nor perceived by others.

Once we have ruled out functional changes in sight and hearing, it is necessary to consider deeper brain changes that result from aging. Scientists believe our attentional and emotional brain networks have an influential role in the formation of complex hallucinations. Over our lifespan, our attentional focus and our emotional states are crafted by life experiences and form our memories. Our hippocampus, an intricate region of our brain, has supported us in this journey of lived experiences. It codes our experiences into units of information that are initially stored in our short-term memory and moved to a long-term memory, which we carry with us to the next experience. These memories are wrapped in layers of human emotion that guide our reactions, behaviors, and thoughts. Our vigilance and our perception are byproducts of this process. Unfortunately, science has shown us that the hippocampus is one of the initial regions to suffer damage due to dementia and aging. Therefore, it is reasonable to anticipate that hypervigilance in the form of auditory or visual hallucinations may present among elderly patients advancing in their dementia.

In the therapeutic spaces, clinicians have leaned on sensory therapy to address the emotional and attentional networks of patients presenting with auditory or visual hallucinations. Sensory therapy is a useful tool for reducing patient anxiety and is currently being utilized in several memory care centers to manage dementia-related behavioral challenges. Therapies can be scheduled and administered based on the timing and frequency of the events. Patients experiencing visual hallucinations can be exposed to calming visual cues in therapeutic or home settings in the same manner patients experiencing auditory hallucinations may be exposed to calming auditory cues. The calming effect is unique to the patient. They can be as simple as soundscape sounds or family photo albums. The key is finding a sensory cue that calms the hypervigilance associated with the complex hallucination and attracts your elderly loved one. The process is slow and can yield short-lived rewards. However, it can serve to improve the quality of life of an elderly dementia patient who is dealing with this unwelcomed guest.