Challenges in the management of visual and tactile hallucinations in elderly people

Abstract

This letter provides a concise review of the pertinent literature on visual and tactile hallucinations in elderly patients. The discussion addresses differential diagnoses and potential underlying mechanisms, as well as the psychopathology associated with tactile hallucinations, and emphasizes the necessity for investigation into the possibility of coexisting delusional infestation (parasitosis). These symptoms frequently manifest in patients with primary psychotic disorders, organic mental disorders, and substance use disorders. The proposed pathophysiological mechanisms may involve dopaminergic imbalances and dysfunction of the striatal dopamine transporter.

Keywords: Delusional infestation; Dementia; Haptic hallucination; Scratching behavior; Tactile hallucination; Visual hallucination; Alzheimer’s disease

Core Tip: When elderly patients present with visual and tactile hallucinations, it is imperative to first exclude organic etiologies and substance use before considering primary psychotic disorders such as schizophrenia. For patients with evident cognitive decline, additional assessment is warranted to evaluate potential impairments in instrumental activities of daily living and executive functions. Psychotic symptoms that emerge in late life are predominantly observed in individuals with dementia, particularly Alzheimer’s disease. The occurrence of visual hallucinations and delusional infestations with associated scratching behaviors in elderly individuals may be linked to increased extracellular striatal dopamine levels in synapses, which is a consequence of striatal dopamine transporter dysfunction.