Alzheimer’s disease and Lewy Body dementia are similar and yet significantly different.  Those differences are the hall marks of Lewy Body dementia. Because Alzheimer’s disease represents  the largest amount of people identified as having dementia, it may be assumed early on that this is the disease process the elder has. However once the elder begins to exhibit the classic signs of Lewy Body dementia, it becomes easier to diagnose.

Lewy Body dementia can have fluctuating attention and alertness. Person’s with Alzheimer’s disease have a ongoing progression of the disease without fluctuation. Clara was assumed to have Alzheimer’s disease, when one day when entering her room in the nursing home, Clara clearly asked “Where am I?” The nursing assistant then had a nice conversation with Clara, (who before this had only spoken in non-sensical word salad) while we called her daughter, telling her to come now to visit Clara. Clara maintained this higher level of function for the rest of that day.

Persons with Lewy Body dementia will often have visual hallucinations. While the person with Alzheimer’s disease can have hallucinations they are the result of other disease processes. The person with Lewy Body dementia may or may not be disturbed by these hallucinations. Sometimes the hallucination presents in a similar way to the child who has an imaginary friend, not in any way causing alarm.

The person might also appear to  have hallucinations during sleep. However these night terrors are usually identified as a REM sleep behavior disorder. The person may start to yell, scream, punch, fight, thrash, kick, get up and pace or even run around, and at times fall out of bed all the while appearing to be asleep. This is a very difficult part of the disease process for the caregiver to still manage at home.

Lewy Body dementia will resemble Parkinson’s disease with movement problems; stiffness, slowness, rigidity and difficulty walking. A rule of thumb has always been that a person with Parkinson’s disease might not have Lewy Body dementia, but person’s with Lewy body dementia will have Parkinson symptoms.

There is a saying in healthcare when working with a patient with Lewy Body dementia to “go with the flow.” Every day might be different and it is the caregiver who needs to adjust, the patient can’t.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing





One of the signs and symptoms of delirium can be hallucinating. Hallucinating does not mean that you have dementia but most likely a form of delirium.

Signs of delirium are:

  • Sudden confusion /acute change in mental condition
  • inattention
  • hallucinations
  • disorganized thinking
  • altered level of consciousness

I very well remember sitting with my Dad in the hospital every time he had surgery, because for him it was a given he would have delirium. Delirium with hallucinations. Every time Dad had anesthesia I knew he would come out of it talking about bugs.

As Dad was talking about the bugs he saw crawling up and down the walls of his hospital room, he was certainly concerned. Because he didn’t have  Alzheimer’s disease he could rationalize that what he saw was impossible. Yet, these bugs were very real to Dad at that moment. Seeing those bugs were a huge distraction, requiring me to sit directly in front of Dad. all the while making eye contact. Reminding and reassuring Dad that he was going to be fine, that this wasn’t real. Saying repeatedly “Look at me Dad,” all the while smiling into his concerned face.

Delirium from a metabolic disorder, head injury, alcohol, drug use, and for the elderly many times an infection or as in my Dad’s case surgery may result in hallucinations.  With Dad, as long as the hospital health care professionals could be persuaded to not medicate him(and that was possible as long as I provided one-on-one) for his hallucinations, we could wait until the drugs were out of his system.

After he had recovered from the delirium, for some time he would refer back to that time. He couldn’t get over how real his hallucinations and how real those bugs were.

The answer for my Dad and the anesthesia was just giving him time, one-on-one care and attention.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing