The Experts Answer

More Than Cognition Ask the Expert Questions and Answers

These 4 questions and answers will be posted on the designated content pages of with the Phase 4 (August 2020) update. Hyperlinks to related assets on the website may be included with select answers.

View the video below for some suggestions by Jacobo Mintzer, MD, MBA.

[Transcript] Oftentimes when we talk about hallucinations and delusions in patients with dementia, primary care doctors will ask me how you know they are there. There’s a sense of unpleasantness to ask that question.

So, let me start from the beginning. The first thing, or the first reason, why patients don’t share with us the experience of hallucinations or delusions they have is because we never ask. So, the first thing is to create a discussion in which it’s not embarrassing for the patient to disclose their experiences. For example, we can tell the patient, “You know, sometimes people experience events or things that they are like a dream or other people don’t relate in plain daytime. Do you experience something like this?” Or you can ask, “Have you ever seen something or experienced something that other people don’t see but it frightens you, or concerns you, or makes you upset?” And that opens the conversation. It’s very interesting to see that it’s rare that a patient will refuse to share this experience because it’s so relevant to them, so much to their core, and they are so frightened many times, that they don’t, they are looking for opportunity to share that with somebody.

Hallucinations and/or delusions may be associated with worse outcomes in patients with dementia; they have a significantly higher risk of cognitive or functional decline, institutionalization, and even death.1 Maintaining an index of suspicion for hallucinations and delusions requires understanding that these neuropsychiatric symptoms can occur throughout the patient’s journey from the point of diagnosis, not just at the later stages of that journey.2

1. Scarmeas N, Brandt J, Albert M, et al. Delusions and hallucinations are associated with worse outcome in Alzheimer Disease. Arch Neurol. 2005;62(10):1601-1608.
2. Jost BC, Grossberg GT. The evolution of psychiatric symptoms in Alzheimer’s disease: a natural history study. J Am Geriatr Soc. 1996;44(9):1078-1081.