When an older person develops dementia, it can come with a number of different symptoms.

Some people struggle with memory dysfunction and others with mobility, while some people live with symptoms that are difficult to explain – like hallucinations and false ideas.

Experiencing things like hallucinations and false ideas can lead to anxiety, depression and extreme paranoia. The person with dementia may feel like they cannot tell what is real and who to trust, and with challenges in communication, they are unable to express their discomfort.

To better understand what the older person is experiencing, carers and loved ones need to understand what the different symptoms are.

Hallucinations are sensory experiences that cannot be verified by anyone other than the person who has them. It is usually when someone sees, hears, smells or feels something that does not actually exist and is unpleasant.

This should not be confused with delusions, which are “ideas” that are not based on reality – for example when a person thinks others are stealing from them or that people around them are trying to harm them.

Another symptom is misidentification, which is where a person may believe they are someone other than themselves, or they are convinced that people they know as someone else.

This can extend to thinking their reflection in the mirror is another person, or being unable to identify the difference between people in the room and people on the television or radio.

These symptoms occur in people with dementia because the degeneration of the brain interferes with how they interpret information.

While dementia does not have a cure, there are viable treatments available to manage hallucinations and false ideas, such as antipsychotics.

But before anyone is put on such strong medications, rigorous screening by a psychiatrist needs to be undertaken to ensure the correct treatment is used.

For family members and carers, feelings of distress, frustration, guilt, exhaustion and exasperation are quite normal and they should not feel guilty about this.

Charles Bonnet Syndrome

Not all hallucinations that occur in the elderly happen to those living with dementia. Older people who still have good cognition can also experience hallucinations.

Charles Bonnet syndrome, which is more prevalent in older people, is characterised by visual hallucinations in combination with deteriorating vision.

An example of Charles Bonnet syndrome is an 87 year old widower, Mr K, who lived alone.

Mr K had reported seeing people and animals in his house—including bears and cattle, as well as swarms of flies and blue fish darting across his apartment. He said he had been seeing them for the past six weeks.

He knew that these visions were not real and they didn’t bother him much, but he thought he might be losing his mind.

His cognitive examination was normal for his age, but he was registered blind. He had never had hallucinations before.

In Mr K’s case, an early dementia diagnosis seemed like the obvious explanation. But upon further research, it was found that Mr K did not have dementia.

Charles Bonnet syndrome is a less frequently diagnosed but rather common cause of complex visual hallucination.

It can occur anywhere from 10 to 15 per cent of older people with visual impairment

It should be noted that the syndrome is not related to mental illness, which for many older people is a relief as they are already struggling with failing vision, social isolation, and other medical problems.

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