Expert: Paula Damgaard - 3/14/2006

Question
Paula,

I ran across your website as I was looking for more information on dementia, its causes, and treatment, if any.

My father who was widowed 6 years ago, has always been an active very functional gentleman.  He is 82 years old, lives in his own home, takes care of himself, including housecleaning, yardwork, banking, grocery shopping, etc., although he is starting to slow down alittle.

About six months ago, he started seeing images, hallucinations, at night.  He thought at first he was dreaming, but then it became more often and during the afternoon hours.  He joked at first, but now as time has gone by, he is stressed about it, a little scared, and even though he says he knows it isn't real, there are times he talks like he really has people living in the house.  He sees people, children, adults, even animals. The strange thing is he only sees these images in his own house, not outside, restaurants, stores, or other peoples houses.

He went to see his doctor, who said he really didn't have experience with this, but felt it was not from his medication. (He is on two low dose prescriptions for blood pressure)  We then went to his eye doctor, because his eye sight in one eye is very poor ( they were going to do a cornea transplant until he had heart surgery two years ago) but the other eye is 20/30 with his hard contact in.  He was then taken off one of his eye drops, tomoptic, a beta blocker, incase that was causing the hallucinations.  No luck.  My dad just last week had an appointment with a new geriatric doctor and they did some cognitive tests along with a complete physical.  Some of the cognitive test, he had a difficult time with, but others he did just fine.

Now my question.  The geriatric doctor would like him to have an MRI, blood tests, chest x-ray, and complete psychological testing.  I do understand the reason for this, but my father says he has had enough of all these tests, and it is making him more depressed and stressed.  I think I have talked him into the blood tests and MRI, but he refuses to do any more cognitive, psychological test, I'm sure because some of them he has trouble with and it makes him feel worse about himself.  Is there any medication that can help with the hallucinations?  That seems to be the biggest problem at this time. He still is functioning well otherwise, but starting to obsess about the images he sees in the house. I see his attitude about life changing, his voice is softer, kind of a "I don't care attitude."  It has been six months and we still don't have any answers and we have another month until his appointment with the geriatric doctor who was then going to look at the results of his tests.

Is the psychological testing necessary?  Can a diagnosis possibly be made without it?

Any help or insight you could give me would be very much appreciated.

Sandy  

Answer
Hi Sandy, I know that he doesn't want to do some of the tests but unfortunately they are all equally important.  Would you make a cake with out the flour, cause you didn't like the taste of the flour, and expect to get the same results as if you did use it?  Sorry, just an example.  

Maybe you can use that though to get your Dad to do the tests.  If he is really worried about the hallucinations then try to explain it to him that way.  It is important to try to figure out what is causing them, before you start giving medications to get rid of them.  (another example: you wouldn't put a cast on an arm just because it hurts; without doing an xray to try to fix the hurt) Just trying to give you things to say to your Dad to get him to do all that can be done to figure out what is going on.

If they find out that perhaps he does have a dementia, then an atypical antipsychotic like Seroquel or Risperdal could help. Make sure that they start on a low dose.  Elderly people can't tolerate the same doses as younger people.

I wish you lots of luck with this.  I am sorry that he is going through this, and you too.  Let me know if I can help any other way.  Paula