been standing there all day.” And I looked at the bathrobe, hung there like a tall, skinny man in plaid, skinnier than my Uncle Dave but not by all that much, and I laughed too. But thinking about it later, I couldn’t figure out whether this was a mistake or a joke, a misreading or a hallucination. Who could say what was going on in what part of the brain?
And what were the impediments he saw late in his illness that caused him to tiptoe so carefully over something I couldn’t see, or to get down on the floor and crawl around it? Simple disturbances in his visual pathways, in the way he saw something
real?
or internally elicited disturbances that led him to invent something where there was nothing—to hallucinate?
Of course, he had delusions too. When we were visiting one day, he told my husband that there was an underground railroad at Sutton Hill. My husband laughed, thinking that Dad was making a joke about his wish to escape. But later in the day Dad soberly pointed out to him the spot where the train pulled in. And Marlene reported to me that she found him at this spot more than once, that he told her he was waiting for the train.
Oddly, this seems not unconnected to the intention of the design of Sutton Hill. The shops and the bank, post office, and grocery store were all arrayed along what was called Main Street, an indoor walkway with an old-fashioned clock tower at one end. All had whimsical storefronts. Why not give Main Street a railroad station in your imagination too?
Sometimes the delusions were painful, like the one about my sister being abducted by terrorists. I tried to reassure him that time; I reported that I’d spoken to her and she was safe in Denver. But he couldn’t be comforted. He persisted. He found me, I think, hard-hearted in the face of his certainty that she was in mortal danger. Finally I called my sister to ask her to get in touch with him herself and tell him she was all right.
Sometimes the delusions were pleasant. He told me about wild, elaborate gatherings with other residents. They were putting on a play together. They’d had a kind of combined lawn and pajama party. Sometimes he would have heard an old friend, often someone long dead, lecture or preach. Sometimes he’d see Mother. I came to feel that these were the residue of dreams, dreams that seemed no less real to him than the fractured reality he had to live through each day and so, in his interpretation, became a part of that reality.
Not all Alzheimer’s patients have hallucinations and delusions; the estimates vary wildly in the literature from 30 to 60 or 70 percent. For those who don’t, the course of the disease is simply progressive cognitive deterioration. But when they are present, they too are traceable to conditions in quite specific parts of the brain and probably also to failures within networks linking certain areas.
Hallucinations and delusions in AD patients are born in the same areas of the brain in which schizophrenics are also disturbed —primarily those areas responsible for receiving visual and auditory signals. But the nature of the Alzheimer’s hallucinations and delusions is generally different from those of the schizophrenic. More often, schizophrenics see themselves at the center of the delusion.
They
are being persecuted,
they
are being abducted by terrorists or monitored by the CIA. In any case, they are the main actors in the drama. The Alzheimer’s patient is more likely to stand to the side, as Dad did at this stage of his delusions. More likely to report that others around him are doing bizarre things or that someone else is in trouble or danger. More often he has been just a witness, as we so often are in dream life, to the strange misadventures and tragedies around him.
And oddly, though the presence of hallucinations and delusions is correlated with a more rapidly advancing version of Alzheimer’s and some researchers are inclined therefore to see it as a subset of AD, most
And what were the impediments he saw late in his illness that caused him to tiptoe so carefully over something I couldn’t see, or to get down on the floor and crawl around it? Simple disturbances in his visual pathways, in the way he saw something
real?
or internally elicited disturbances that led him to invent something where there was nothing—to hallucinate?
Of course, he had delusions too. When we were visiting one day, he told my husband that there was an underground railroad at Sutton Hill. My husband laughed, thinking that Dad was making a joke about his wish to escape. But later in the day Dad soberly pointed out to him the spot where the train pulled in. And Marlene reported to me that she found him at this spot more than once, that he told her he was waiting for the train.
Oddly, this seems not unconnected to the intention of the design of Sutton Hill. The shops and the bank, post office, and grocery store were all arrayed along what was called Main Street, an indoor walkway with an old-fashioned clock tower at one end. All had whimsical storefronts. Why not give Main Street a railroad station in your imagination too?
Sometimes the delusions were painful, like the one about my sister being abducted by terrorists. I tried to reassure him that time; I reported that I’d spoken to her and she was safe in Denver. But he couldn’t be comforted. He persisted. He found me, I think, hard-hearted in the face of his certainty that she was in mortal danger. Finally I called my sister to ask her to get in touch with him herself and tell him she was all right.
Sometimes the delusions were pleasant. He told me about wild, elaborate gatherings with other residents. They were putting on a play together. They’d had a kind of combined lawn and pajama party. Sometimes he would have heard an old friend, often someone long dead, lecture or preach. Sometimes he’d see Mother. I came to feel that these were the residue of dreams, dreams that seemed no less real to him than the fractured reality he had to live through each day and so, in his interpretation, became a part of that reality.
Not all Alzheimer’s patients have hallucinations and delusions; the estimates vary wildly in the literature from 30 to 60 or 70 percent. For those who don’t, the course of the disease is simply progressive cognitive deterioration. But when they are present, they too are traceable to conditions in quite specific parts of the brain and probably also to failures within networks linking certain areas.
Hallucinations and delusions in AD patients are born in the same areas of the brain in which schizophrenics are also disturbed —primarily those areas responsible for receiving visual and auditory signals. But the nature of the Alzheimer’s hallucinations and delusions is generally different from those of the schizophrenic. More often, schizophrenics see themselves at the center of the delusion.
They
are being persecuted,
they
are being abducted by terrorists or monitored by the CIA. In any case, they are the main actors in the drama. The Alzheimer’s patient is more likely to stand to the side, as Dad did at this stage of his delusions. More likely to report that others around him are doing bizarre things or that someone else is in trouble or danger. More often he has been just a witness, as we so often are in dream life, to the strange misadventures and tragedies around him.
And oddly, though the presence of hallucinations and delusions is correlated with a more rapidly advancing version of Alzheimer’s and some researchers are inclined therefore to see it as a subset of AD, most
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