Clinical Summary
Clinical Summary: Clinical Features of Auditory Hallucinations in Patients With Dementia With Lewy Bodies: A Soundtrack of Visual Hallucinations
Patients with dementia with Lewy bodies often present with distressing hallucinations that drive caregiver burden, but auditory hallucinations are less often characterized than visual hallucinations. This study clarifies how often auditory hallucinations occur in dementia with Lewy bodies, what they sound like, and which clinical features travel with them.
Design
We recruited 124 consecutive patients with probable DLB (diagnosis based on the DLB International Workshop 2005 criteria; study period: June 2007-January 2015) from the dementia referral center of Kumamoto University Hospital.
N
124 consecutive patients with probable DLB
Population
124 patients with probable DLB were consecutively selected from those who attended the dementia referral center of Kumamoto University Hospital between June 2007 and January 2015.
Duration
study period: June 2007-January 2015
Key Findings
- Of the 124 patients, 44 (35.5%) had auditory hallucinations and 75 (60.5%) had visual hallucinations; 40 (32.3%) had auditory plus visual hallucinations, and 90.9% of patients with auditory hallucinations also had visual hallucinations.
- Auditory hallucinations were predominantly verbal: 41 patients heard human voices, and among the 41 patients with verbal auditory hallucinations, 37 patients (90%) heard the visual hallucinations speak; in 25 patients (61%), the visual hallucinations spoke to them.
- Auditory hallucinations were often distressing: 29 (71%) patients whose auditory hallucinations consisted of voices experienced bad or unpleasant voices, while only 4 patients (10%) reported good or pleasant voices.
- Multiple logistic regression analysis showed that the presence of auditory hallucinations was significantly associated with being female (P = .04), the presence of hearing impairment (P = .004), and the use of antipsychotics (P = .01).
- Multiple regression analysis revealed that the presence of visual hallucinations (P < .001), phantom boarder delusions (P = .001), and depression (P = .038) was independently correlated with the presence of auditory hallucinations.
Clinical Bottom Line
In dementia with Lewy bodies, auditory hallucinations are common, usually occur alongside visual hallucinations, and typically function like a verbal "soundtrack" to the visual scene. Their presence should prompt clinicians to look for hearing impairment, depression, phantom boarder delusions, and greater overall neuropsychiatric burden.
Practice Implications
- When evaluating dementia with Lewy bodies, ask specifically whether visual hallucinations "speak" or whether the patient hears voices or sounds accompanying the scene, since only 4 patients reported auditory hallucinations unaccompanied by visual hallucinations.
- Check for hearing impairment in patients with dementia with Lewy bodies who report auditory hallucinations, because hearing impairment was independently associated with auditory hallucinations (P = .004).
- Assess the emotional tone and content of voices, as 29 (71%) patients described unpleasant voices and 4 patients reported command content such as "Get up early."
- If auditory hallucinations are present, screen carefully for depression and phantom boarder delusions, which were independently associated with auditory hallucinations at P = .038 and P = .001, respectively.
