My guess is that it's medication related. I'd start with the pharmacist.

It could definitely be medications, depending on what he takes.

I suggest taking him to a neurologist for a workup, preferably one with an interest in the elderly or mental health [although any good neurologist has a firm grasp of this type of mental health issue, including organic reasons for it].

Alternatively, you could take him to a psychiatrist or psychologist but the quality of care there can be iffy depending on his/her focus on aging-related issues. IMHO, neurologists are better skilled at ruling out organic etiology [which is obviously more and more possible the older the patient].

You should note any other symptoms that are abnormal, even seeming personality traits like mild paranoia or lying. The type of hallucinations is very important, as is any possible hearing loss. History of stroke, etc is entirely important to mention. Memory loss, confusion, paranoia and any personality changes, etc are important to look for and note on a daily basis [frequency can matter to the diagnosis].

You might look up delirium and see if the episodes of hallucinations include any symptoms of delirium or whether they seem to be standalone symptoms [or more towards paranoia] but a good doctor will ask those questions anyway.

Interestingly, hearing loss combined with age [among other things] can cause hallucinations, so it's not necessarily serious. It does NOT necessarily mean Alzheimer's, so don't let anyone decide that without running tests first. Good luck!

It could be anything from a urinary tract infection to Alzheimers. See a physician.

MichaelAT

Upon reflection, my previous reply seems a little brief. It wasn't meant to be. UTI's are a leading cause of confusion and delirium in the elderly. AAMOF, confusion/delirium is often the only sign of a UTI in the elderly.

Please see a physician and rule out the simple things first before moving on to more esoteric possibilities.

MichaelAT

Because it's a very complex subject [and could be so many things], it is hard to look up. Here is a link to a book that might help you get a good grasp on the kinds of diagnoses made [hopefully including the 'medical' stuff]. Pt 3 looks promising.

Here is a link that might be useful: Good Book, looks like

Hmmm, in case I wasn't clear, the diagnoses also factor in how many times it has happened, etc. So knowing that a diagnosis requires 6 months of something, for example, can be helpful if you are worried. It could end soon, too and be relatively simple... don't let me make you think otherwise :)

Thanks, all.
We know we've got a complex problem.
A diagnosis two years ago of early to mid stage Alzheimer's, hearing loss, current resistance to taking prescribed medicine, probable recent small strokes (loss of memory related to how to start a car is the most blatent), and diabetes. His short term memory, though, still seems fine.
What we've accomplished so far is to stop the driving, get him meals on wheels to improve his nutrition, he's got one of our cats on loan to nag him for food (cat is three times the size when she went to him and she purrs him to sleep and keeps him on a sort of schedule), but now he's decided to stop his meds and one doctor has told him not to come back until he's willing to take his medicine, etc.

The minimental test two years ago was a disaster, in part because he's a bit of a smart alleck, and not able, in the best of times, to choose when to be straight with folks and when to give 'don't give a XXXX' answers. He doesn't want to go back to that physician, but has mentioned needed to see a psychiatrist, so Meredith's suggestion of a neurologist makes more sense. (He thinks the psych from two years ago just wanted to collect a warm body with great insurance for a nursing home. So he's still got some wits about him.)
The urinary tract infection is also a stronger than you might expect lead as he's had major problems for the past 20 years with infections and with recurrent bladder tumors.
Thank you all so much.

Yes, you do have a complex situation on your hands and yes, it could be anything.

For starters, an intact short term memory and Alzheimer's don't go together. The reverse is true.

Nor does an intact short term memory fit well with polypharmacy which has an immediate effect upon short term information processing.

Loss of long term memory, i.e. "forgetting how to start a car" sounds vascular in origin.

With his history of small strokes (occlusive?) and diabetes I'd want the physician to reevaluate his cardiac status or carefully explain why it isn't necessary.

These are things I'd suggest to a physician:

1) Yet another EKG

2) Echocardiogram to look at overall heart function
ejection fraction, and the presence of any clots.

3) A carotid doppler to evaluate their patency.

4) An EEG for comparison to previous EEGs. Possibly a MRI--again for comparison.

5) All baseline bloodwork, CBC, comprehensive metabolic panel, thyroid function.

6) 24 hour Holter monitor--he doesn't sound very compliant so this might be a good excuse to put him in overnight and use the opportunity to run the other tests as well.

Is he on anticoagulants? Coumadin? Does he have a history of atrial fibrillation or other abnormal heart rhythms?

Atrial fibrillation can take a paroxysmal form where it "comes and goes" with a sharp, "temporary," reduction in baseline bloodflow--transient fatigue, irritability, malaise, and yes hallucinations.

His diabetes is an equally plausible source of hallucinations although, once again, if that's the cause I doubt he'd be remembering them and exhibiting an awareness of them.

Good luck to you and him.

MichaelAT

Ann-
Lewey body dementia can be associated with hallucinations.
Had a pt who had early stage Lewey body dementia and he continued to do consulting work as an architect.
He had sleeping difficulties and reported hallucinations.
I only followed him for about a year after his diagnosis, so am not sure about the progression of his disease.

It would be the simplest explanation for dementia and hallucinations.

Janelle

Janelle (and Michael and Meredith)
Thank you for the suggestions. The Lewey's fits somewhat but fortunately he isn't falling. The gait fits, though.
I am not going to google anymore tonight...am going to sleep with a cat at my head to purr me to sleep...and concentrate on thinking of flowers blooming well with cats controlling the mice. (saw three deer today, one to the east, two fawns to west didn't see their Mothers who were doubtless munching nearby. So glad we fenced the species bed and made easy ingress into the yard harder.)
Night, all.