Hallucinations and Delusions

Hallucinations and delusions are common among people with dementia. Kate is no exception, but I often find it difficult to distinguish between the two. I know that hallucinations are sensual experiences that feel real but are not. Delusions are false beliefs that occur when there is no evidence that they are correct.

Applying those general definitions to specific incidents is not always easy. For example, Kate often believes she is some other place when she is home. Most frequently, that involves her believing our house is some type of lodging like a hotel and that there are other people staying here. When she wakes up, she often says, “I want to get out of here.” I think of this as a delusion because it is a false belief. On the other hand, that must occur because she has had a sensual experience that she doesn’t recognize as our own house. When I point out a few things like our backyard (that is, giving her evidence that is to demonstrate it is our house), she realizes she is really at home. That sounds more like it was an hallucination.

As I was about to get out of bed yesterday morning, she asked, “What do I have to do today?” I told her it was a day without any special obligations, that she could relax and do what she wanted to do. Then she said something about having to give a talk someplace. I told her I didn’t know about anything like that and suggested she may have had a dream. She reacted quickly and strongly saying, “It was not a dream.” I didn’t pursue it further. After I was dressed and about to go to the kitchen for breakfast, she brought up the subject again. This time I knew what not to say. Again, I told her it was a day when she could relax. When she asked about her “talk,” I said, “I think that’s tomorrow. You don’t have to worry about it right now.” She was relieved.

Most of her hallucinations/delusions are like those I just mentioned; however, this past Tuesday afternoon she (and I) had an experience that was a first. She had been resting on the sofa of our family room for about two hours while I was seated across from her. She fell asleep for a short time. Then she awoke and saw me. She had a big smile on her face and greeted me like someone she knew, but not as her husband. She began a conversation that made me think she was not really awake but dreaming.

I went over and sat beside her. She said, “Are you from around here?” I told her I was. Then she said, “Well, how familiar are you with what is going on?” I told her I wasn’t familiar at all. She said, “Oh, then I better start from the beginning and tell you about myself.” That led to a thirty-minute conversation during which she did most of the talking. Her aphasia was quite evident. She struggled for just the right words and how to tell her story most clearly. She would start out and then get confused. Then she would start over. I recorded a short portion that occurred about fifteen minutes after our conversation began. I transcribed the section below as she tried to explain “things” to me.

Kate: What is interesting to me is how quickly we can get in and out here. <pause, reaching for the words> Yeah, I can’t just get over with what you can do with <pause, reaching for the words> uh, with, well, you know with what. (She laughed.)

Richard: Well, you seem very happy. You don’t seem like you have a problem.

KateI don’t have a real problem, but I do get discouraged sometimes. Just because. Let me see. <pause, reaching for the words> All right. <pause, reaching for the words>

Richard: You get discouraged? For what?

Kate: Oh . . . Oh. <pause, reaching for the words> just little things, you know. and the big things I take pretty well. And, uh, there’s a guy that I had never met before, but he’s a nice guy. Are you familiar with around here?

Richard: A little bit.

Kate: Well, OK. Um. I’m from Fort Worth, Texas, and um. <pause> And my family was religious, and uh, but anyway, I, I, uh grew up in the church. So <pause>, reaching for the words> But, ya’ know, all of these things have changed.

Richard: In what way?

Kate: (She laughed and called me for help.) Richard. <pause> Richard! <pause> Richard!! <longer pause> Richard!!!

Richard: Who are you looking for?

Kate: That’s my . . . <pause>

Richard: Who is that? <no response> You were about to say?

Kate: He’s with us.

Richard: Richard?

Kate: With this church.

Richard: Richard is with the church?

Kate: Who?

Richard: You’re saying somebody is with the church.

Kate: Oh, yeah.

Richard: Who is that?

Kate: Oh, a lot. <pause> (She laughed.) We do. This is a little hard for get around here, but, uh. Anyway, let me start with me. I grew up in this right <pause> this big area.

Richard: You grew up around here.

Kate: And, uh . . . (She laughed). There were in the area in which all my friends grew up with we all went to school. You know some get out way . . .

I think that should give you an idea of the conversation. She called for me again, and I told her I would go get “him.” When I walked back into the room, I greeted her as though I had not been in the room with her moments before, but I didn’t give her my name or tell her I am her husband. She seemed to recognize me, and I suggested we go to dinner.

I’m not clear on whether she was having an hallucination or a delusion or both. Maybe it’s best just to say she was confused. That is clear, but what prompted it? That’s another thing I’ll never know.

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