Hallucinations, distorted senses common symptoms of dementia-related psychosis
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Individuals with dementia-related psychosis commonly experience visual hallucinations, auditory hallucinations and distortion of senses, according to data presented at the Alzheimer’s Association International Conference 2020.
“ACADIA is committed to understanding the lived experience of people with dementia-related psychosis, for whom there are no approved treatments,” Teresa Brandt, PhD, executive director of regulatory affairs at ACADIA Pharmaceuticals, told Healio Psychiatry. “The aim of this study was to capture the lived experience of people with dementia-related psychosis, either directly or via caregiver input, which can be exceedingly difficult in patients with cognitive decline who may no longer be able to act independently and raise their own voice. Although there are numerous publications noting the prevalence of psychotic symptoms across dementias, what was missing was an understanding of the specific impacts that hallucinations and delusions have on people living with dementia.”
To address this research gap, Brandt and colleagues partnered with the advocacy organizations UsAgainstAlzheimer’s and the Lewy Body Dementia Association to recruit participants for a two-part survey to determine how dementia-related psychosis impacts the daily life of individuals living with this condition, as well as to gain insights into the primary benefits of a new treatment. The investigators conducted the survey according to the approach outlined in the FDA’s 21st Century Cures Act — Patient Focused Drug Development. In the observational, non-interventional, prospective study, they analyzed interview answers of individuals or care partners of individuals who have a clinical diagnosis of all-cause dementia with psychotic symptoms. Date were available for 26 participants living with self-reported dementia-related psychosis and 186 care partners who answered on behalf of patients.
Results showed 89% of participants had visual hallucinations, 54% had auditory hallucinations and 54% had a distortion of senses. Among those who reported recent visual hallucinations, 61% said they occurred at least weekly. The most common symptoms identified by care partners were paranoid delusions (76%), visual hallucinations (75%) and a lack of trust for loved ones (52%). Further, 77% of care partners reported paranoid delusions among patients at least weekly.
“The qualitative interviews suggest that hallucinations and/or delusions can happen daily and sometimes multiple times per day,” Brandt told Healio Psychiatry. “It is documented in the literature that frequency and severity of hallucinations and/or delusions increase over time, and this was affirmed in this qualitative survey. Specific duration and frequency of symptoms experienced by individual patients is unique to them and can be influenced by personal history, daily routines and environmental factors. Caregivers frequently reported having to adapt daily routines based on when the hallucinations and/or delusions were causing distress to patients.”
According to Brandt, a need exists for greater education on dementia-related psychosis and efforts to reduce associated stigma, since most care partners reported that patients were uncomfortable discussing symptoms of dementia-related psychosis with those closest to them.
“An ideal treatment would relieve symptoms of hallucinations and/or delusions, thereby restoring a clearer picture of reality and improving confidence in one’s environment and relationships,” Brandt added.