Frequently Asked Questions

Auditory hallucinations were common in this cohort of patients with probable dementia with Lewy bodies. Of 124 patients, 44 (35.5%) had auditory hallucinations, 75 (60.5%) had visual hallucinations, and 40 (32.3%) had both auditory and visual hallucinations within the previous month.

Among the 79 patients who had any hallucinations, the majority of those with auditory hallucinations also had visual hallucinations. Only 4 patients reported auditory hallucinations without visual hallucinations.

Yes. In this study, 90.9% of patients with auditory hallucinations also had visual hallucinations, and the authors described auditory hallucinations as usually appearing like a background "soundtrack" accompanying the visual scene.

Among 41 patients with verbal auditory hallucinations, 37 (90%) heard the visual hallucinations speak, and in 25 patients (61%), the visual hallucinations spoke directly to the patient.

They consisted mostly of human voices. Of the 44 patients with auditory hallucinations, 41 reported human voices, 1 reported the sound of running water, and 2 reported unspecified sounds.

The phenomenology was closely linked to visual hallucinations. In many cases, patients heard the figures they were seeing talk to each other or talk to them, which is why the authors characterized these experiences as a verbal soundtrack to visual hallucinations.

They were usually distressing rather than pleasant. Among patients whose auditory hallucinations consisted of voices, 29 (71%) described them as bad or unpleasant, while only 4 (10%) reported good or pleasant voices; the rest described voices that were neither good nor bad.

Examples of unpleasant content included hearing several people speak ill of the patient or discuss plans to frame them. Four patients also reported command content such as "Get up early."

Multiple logistic regression showed that auditory hallucinations were significantly associated with female sex (P = .04), hearing impairment (P = .004), and use of antipsychotics (P = .01).

In a separate multiple regression analysis of neuropsychiatric correlates, auditory hallucinations were independently correlated with visual hallucinations (P < .001), phantom boarder delusions (P = .001), and depression (P = .038).

Yes. In this study, hearing impairment was independently associated with auditory hallucinations (P = .004) in patients with probable dementia with Lewy bodies.

The authors defined hearing impairment as difficulty hearing to an extent that interfered with daily living. They suggested that hearing impairment may be a possible risk factor for developing auditory hallucinations in dementia with Lewy bodies, although the exact mechanism remains unclear.

Yes. Auditory hallucinations were independently correlated with phantom boarder delusions (P = .001) and depression (P = .038), as well as visual hallucinations (P < .001).

The auditory hallucination group also had higher frequencies of delusions, depression, and aberrant motor behavior than the non-auditory hallucination group. Among specific delusional themes, delusions of persecution, delusions of theft, phantom boarder delusions, and the TV phenomenon were more frequent in patients with auditory hallucinations.

Auditory hallucinations were strongly linked to phantom boarder delusions in this study. Multiple regression analysis found an independent correlation between auditory hallucinations and phantom boarder delusions (P = .001).

The authors noted that only 17.1% of patients with pure visual hallucinations had phantom boarder delusion, compared with 61.4% of patients with both visual and auditory hallucinations. They suggested that when a seen figure also speaks, patients may be more likely to believe that an uninvited person is actually present in the home.

Yes. Patients with auditory hallucinations had significantly higher neuropsychiatric symptom burden than those without auditory hallucinations, including higher total Neuropsychiatric Inventory scores (P < .001), higher total scores excluding the hallucinations domain (P = .005), and higher total scores excluding both the hallucinations and delusions domains (P = .02).

These findings suggest that, in dementia with Lewy bodies, auditory hallucinations may occur in the setting of broader neuropsychiatric involvement rather than as an isolated symptom.

This was an observational study of 124 consecutive patients with probable dementia with Lewy bodies seen at a dementia referral center between June 2007 and January 2015. Diagnosis was based on the DLB International Workshop 2005 criteria.

Auditory hallucinations, visual hallucinations, and other neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory based on caregiver interview, and clinical records were reviewed to characterize hallucination content. The investigators then used multiple logistic regression and multiple regression analyses to identify factors independently associated with auditory hallucinations.

The main limitations were that auditory hallucinations in dementia can be difficult to assess directly, diagnosis was based on clinical rather than pathologic criteria, repeated comparisons increased the risk of type I error, and some patients had already started medications before the first visit.

The authors also noted a possible selection bias in the diagnostic criteria that could make pure auditory hallucinations seem less common, and they stated that medication exposure, including cholinesterase inhibitors and antipsychotics, may have partly modified the results.