Lewy body hallucinations are sensory experiences that seem real but are products of the brain. These hallucinations are a primary symptom of Lewy body dementia (LBD), a progressive neurodegenerative disorder.
Characteristics of Lewy Body Hallucinations
Visual hallucinations are a frequent and often early sign of Lewy body dementia. These are realistic and detailed visions, such as seeing children or animals in the room. Unlike hallucinations associated with some psychiatric conditions, those in LBD are not always frightening. The person experiencing them might be curious or indifferent to the presence of an unfamiliar person or animal that is not actually there.
These sensory events are often recurrent, appearing and disappearing without a clear trigger. While visual experiences are the most common, some individuals may have hallucinations affecting other senses. This can include auditory hallucinations, like hearing voices or conversations when no one is present, or tactile sensations. Other less frequent types can involve perceiving smells or tastes that have no source.
The nature of these hallucinations can fluctuate significantly. One day a person might see brightly colored figures, and on another, they may misinterpret a real object, like mistaking a coat rack for a person. This misperception of an existing object is an illusion, another common feature of the disease. The level of insight a person has into their hallucinations can also vary; sometimes they may question if what they are seeing is real, while at other times they are fully convinced of its reality.
The Neurological Causes
The cause of Lewy body hallucinations lies in abnormal protein deposits within the brain. These deposits, known as Lewy bodies, are composed of a protein called alpha-synuclein. In LBD, this protein misfolds and clumps together inside neurons, disrupting their function and eventually leading to their death. These Lewy bodies develop in brain regions responsible for thinking, memory, and motor control.
This disruption of brain cells affects the brain’s chemical signaling systems. A primary factor in LBD hallucinations is the loss of neurons that produce acetylcholine, a neurotransmitter for perception, attention, and memory. The resulting deficit in acetylcholine is thought to contribute directly to the visual disturbances and misperceptions that characterize the condition.
The dopamine system, which is involved in mood, motivation, and movement, is also dysregulated. The same protein deposits found in LBD are also a hallmark of Parkinson’s disease, affecting dopamine-producing neurons. This complex interplay and disruption of neurotransmitter systems, particularly acetylcholine and dopamine, create a brain environment where it is difficult to distinguish between internal thoughts and external reality, leading to detailed hallucinations.
Responding to Hallucinations as a Caregiver
When a person with LBD is having a hallucination, the caregiver’s response can significantly influence the person’s emotional state. Do not argue about the reality of what the person is seeing or hearing. Attempting to convince them that their experience is not real can lead to frustration, agitation, and a breakdown of trust, as the hallucination feels entirely real to them.
A more effective approach is to remain calm and offer reassurance. Acknowledge the person’s feelings by saying something like, “I know seeing those people in the room must be confusing for you.” This validates their experience without confirming the hallucination’s reality. Gently asking about the hallucination can provide insight into whether the experience is benign, pleasant, or frightening.
Investigate the environment for potential triggers. Poor lighting, shadows, reflections in mirrors, or even patterns on wallpaper can be misinterpreted by a brain affected by LBD. Modifying the environment by increasing light, closing curtains to reduce reflections, or turning off a noisy television can sometimes lessen the frequency or intensity of hallucinations.
Gentle redirection can also be a powerful tool. Shifting the person’s focus to a real and engaging activity can help pull their attention away from the hallucination. This could involve playing a favorite song, looking at a photo album together, or starting a simple task. A calm touch or a comforting presence can also help ground the person in reality and reduce any anxiety the hallucination might be causing.
Medical and Therapeutic Treatments
Consulting with a neurologist or a specialist is the first step in managing LBD symptoms. Pharmacological options are available that may help reduce the frequency and intensity of hallucinations. Cholinesterase inhibitors, a class of drugs originally developed for Alzheimer’s disease, are often the first line of treatment. Medications like donepezil or rivastigmine work by increasing the levels of acetylcholine in the brain, which can improve cognitive symptoms and lessen hallucinations.
Caution is necessary with certain medications. People with LBD have an extreme sensitivity to traditional antipsychotic drugs, which have historically been used to manage hallucinations. These medications can cause a severe worsening of motor symptoms, profound confusion, and other serious side effects that can be permanent. If such medications are deemed necessary, newer “atypical” antipsychotics like quetiapine may be considered at very low doses under close supervision.
Non-pharmacological strategies are also part of a comprehensive treatment plan. Ensuring good sleep hygiene is important, as disturbances in the sleep-wake cycle can exacerbate symptoms. Managing other health issues, such as infections or dehydration, is also necessary, as these can cause delirium, which worsens confusion and hallucinations. Therapies like music therapy, occupational therapy, and physical therapy can improve quality of life and reduce stress.