In older adults, it is particularly important to first rule out organic causes of psychoses, as primary psychoses rarely present in this age group and elderly patients have a higher burden of medical comorbidities and polypharmacy that predispose to organic pathologies. Aug 10, 2023 · Opiates are not typically associated with psychosis. Feb 13, 2023 · Auditory hallucinations, or paracusias, are sensory perceptions of hearing in the absence of an external stimulus. Objective: We surveyed 125 men and women aged 65 years and over referred to the Audiology department of a university-affiliated primary acute-care hospital. If you believe Hallucinations. Some people with dementia have hallucinations. Oct 16, 2019 · The prevalence of any psychotic symptoms in delirium is estimated to be 42. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management Understanding hallucinations. When a person is high and seeing things, they can quickly end up in a situation that’s dangerous to both themselves and Apr 14, 2023 · The classic symptoms of a urinary tract infection (UTI) are burning pain and frequent urination. These hallucinations are prevalent in specific groups, interacting with other neurological diseases to create concerning consequences. Method: To determine the prevalence and phenomenology of auditory hallucinations among elderly subjects with hearing impairment. Apr 23, 2024 · The hallucinations were associated with sulfonamides (68%), quinolones (67%), macrolides (63%), and penicillin procaine (68%). D. The exact mechanism by which hearing impairment can predispose an individual to 4 days ago · Causes of Hallucinations in the Elderly. 3. Jun defines a hallucination as a visual perception or distortion that cannot be explained by external visual stimuli. Apr 16, 2024 · Brain tumor. Aug 29, 2022 · A A. Not all auditory hallucinations are associated with mental illness, and studies show that 10% to 40% of people without a psychiatric illness report hallucinatory Oct 12, 2017 · Delirium in Hospitalized Older Adults. 11 These hallucinations often do not upset patients, and they may be pleasant. 4% to 37% prevalence rate of hallucinations among the elderly. The risk for new onset of psychiatric illness after a brain injury goes on for a long time and can be seen with any severity of traumatic brain injury. Severe illnesses like brain cancer, liver failure, kidney failure, etc. This specific subset of paracusias is particularly associated with schizophrenia but is not specific to it Mar 31, 2022 · There are neurological conditions that may be responsible for auditory hallucinations, including: cerebral tumors, growths of atypical cells in the cerebral part of the brain. Between 20-40% of people with Parkinson’s report the experience of hallucinations or delusions. Our results suggest that hallucinations are uncommon in early stage AD. A person experiencing a delusion may feel that they are Jul 7, 2021 · While your response to the immediate hallucination or delusion would remain the same, follow up with your loved one’s physician to rule out any underlying medical issues. Mar 1, 2016 · Dear Editor, Musical ear syndrome (MES) is a condition that causes patients with hearing impairment to have non-psychiatric auditory hallucinations. High fevers might do it, too, which sometimes happens in children. An auditory hallucination, or paracusia, [1] is a form of hallucination that involves perceiving sounds without auditory stimulus. Jul 7, 2017 · KEY POINTS Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts. These approaches can be divided into five main paradigms, which we describe below. Dec 22, 2023 · In the context of the elderly, visual and auditory hallucinations are the most common types experienced. Illnesses - brain cancer, liver or kidney failure. Those side effects included thrombocytopenia (decreased blood platelets), increased agitation, gait disturbances, tremor, sedation and sleepiness, nausea, vomiting, and diarrhea. , complete blood count, serum electrolyte levels, and renal and liver function tests were normal. They can take the form of paranoia, which makes the person feel threatened, even if there is no or little reason to feel this way. Hallucinations can occur if a tumor presses on a nerve that sends sound signals from the ear to the brain. room; several patients have believed Oct 6, 2020 · According to a recent review of studies in Psychology Research and Behavior Management, COVID-19 infections have been triggering such hallucinations, as well as things like delusions and paranoia in patients with no history of mental health issues. However, research has shown that there are a variety of possible treatments and Jan 13, 2005 · The commentary hallucinations in the present patients might be explained as resulting from exhaustion caused by stressful life events, subtle senile organic brain changes, and a subsequent decline Aug 26, 2010 · Confusion at night in unfamiliar surroundings, such as a hospital, can be associated with visual and auditory hallucinations in the elderly. Published in the July 2018 issue of Today’s Hospitalist. Oct 18, 2017 · Seizures were controlled, but the patient began experiencing visual and auditory hallucinations (e. . It results in confused thinking and a lack of awareness of someone's surroundings. Acetylcholine: associated with learning and memory Many drugs block Acetylcholine Anticholinergic effects include: dry mouth, urinary retention, constipation, confusion Anticholinergic effects Dec 1, 1999 · Potential toxic effects, including seizures and psychosis, may result from high bupropion plasma levels and the accumulation of bupropion metabolites in the elderly or in those with impaired liver function (10). Apr 11, 2024 · Understanding the UTI-hallucination connection is crucial for healthcare providers to recognize and address these symptoms promptly. , 2012). Oct 6, 2020 · Certain medications can cause hallucinations, including auditory hallucinations. Delirium often occurs due to an underlying medical condition or as a side effect of medications. Rule of thumb…. Migraines. Some hallucinations might be due to problems like delirium which is a medical emergency and requires immediate attention. Generally, these hallucinations are short-lasting. Oct 14, 2022 · Delirium is a serious change in mental abilities. Dementia is a term that covers a wide spectrum of disorders and diseases, including Alzheimer’s. Mar 6, 2024 · Understanding these common causes of hallucinations in the elderly is a key step towards improving diagnosis, treatment, and overall management of this complex issue. Delirium can often be traced to one or more factors. Mental illness is one of the more common causes of auditory hallucinations, but there are a lot of other reasons, including: Alcohol. Learn more. 1097/JCP. Dehydration can disrupt the delicate osmotic balance in the body, leading to electrolyte imbalances such as hyponatremia, which can result in Mar 18, 2024 · Summary. Jul 6, 2017 · In contrast, studies have found that schizophrenia patients experiencing auditory hallucinations were more likely to incorrectly attribute the source of words they uttered themselves to the experimenter (i. The elderly can, of course, hallucinate as part of severe depression or a life-long schizophrenia, but the clinician should assume that there is an organic basis when an elderly individual begins to develop visual Changes in perception may also be caused by physical changes, such as their sight or hearing getting worse as they get older. Most of the time, the hallucinations are not dangerous and may even What medications cause auditory hallucinations? Many psychiatric medicines, including olanzapine (Zyprexa), quetiapine (Seroquel), and haloperidol (Haldol), have been linked to the development of hallucinations, as have others, including zolpidem (Ambien), eszopiclone (Lunesta), clonazepam (Klonopin), lorazepam (Ativan), Mar 10, 2010 · These hallucinations are also relatively common in bipolar disorder (20% to 50%), in major depression with psychotic features (10%), and in posttraumatic stress disorder (40%). doi: 10. Jul 25, 2021 · Hallucinations in the elderly are mostly auditory. Visual and auditory hallucinations associated with citalopram treatment J Clin Psychopharmacol. They involve hearing sounds that aren’t real, like music, footsteps or doors banging. High fever. Jan 1, 2004 · Abstract. Nutritional deficits, including low levels of vitamin D and vitamins B1, B3, or B12. Apr 12, 2024 · Dehydration as a Hallucination Trigger Moving from the exploration of dehydration-induced hallucinations in the elderly, we now focus on the role of dehydration as a trigger for hallucinations. a way that makes the patient feel unsafe in his or her surroundings. The brain's attempt to compensate for the lack of auditory stimuli may lead to auditory hallucinations in elderly individuals with hearing impairment. 3 Hallucinations secondary to hearing loss may be more common in left-side hearing loss. Some infections, like meningitis, can trigger hallucinations as one of their symptoms. A person with dementia may believe Aug 22, 2017 · Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. Apr 21, 2018 · In the largest sample thus far, we report a low prevalence of hallucinations in probable AD patients, comparable to rates in non-demented elderly. Many cases of paranoia in the elderly are the result of dementia. This is commonly called "sundowning. By recognizing the signs early and seeking appropriate medical help, the impact of hallucinations on the quality of life of elderly individuals can be significantly reduced. Depending on where it is, it can cause different types of hallucinations. Psychosis. 5 Nerve degeneration, the primary cause of dementia, localized in different parts of the nervous system, can trigger visual hallucinations. Certain medications. Auditory hallucinations can refer to a plethora of sounds; however, when the hallucinations are voices, they are distinguished as auditory verbal hallucinations. Minor hallucinatory phenomena: this is where there is sensed the presence, visual illusions, and passage hallucinations. Schizophrenia. Apr 4, 2001 · Delirium. , 2000). 2. Most are visual, but about half of people who see things that aren't there also may hear nonexistent noises or voices (auditory hallucinations). Dementia and Alzheimer's disease. 5. 6. Anticholinergic Drugs. Jun 26, 2022 · Auditory (sound) hallucinations: These are the most common type of hallucinations. A common form of auditory hallucination involves hearing one or more voices Sep 28, 2017 · Auditory Hallucinations (AH) are nowadays regarded as symptoms following a continuum; from a (transient) phenomenon in healthy individuals on one end to a symptom of (psychiatric) illnesses at the other. Auditory hallucinations are linked to poorer well-being in dementia. It can affect the way you feel, act, and think. The source of these hallucinations are derived from underlying psychotic illness or hearing impairment. Older adults may not experience the classic symptoms of a UTI. Part of dying process - some seniors experience visions and hear people while they come closer to dying. Anti-seizure medications. L) MDD. Aug 24, 2000 · Thus, for elderly patients with psychosis associated with dementia, 5 mg/day of olanzapine seems to be the most efficacious dose, as opposed to the 12-mg/day dose commonly used for elderly schizophrenic patients. There may be nutritional causes for hallucinations. The differential diagnosis and the diagnostic tools relevant in clinical practice will be presented as well as the pathogenesis of deafferentiation-induced MH. C. Multisensory hallucinations are rare. When treating agitated patients with dementia, olanzapine dosage should be started at 5 mg/day and increased to 10 mg/day if necessary. Hallucinations and delusions are symptoms of dementia caused by changes in the brain. Hallucinations are false perceptions of objects or events involving the senses. It’s rare for medications to cause MES. Psychosis refers to a complete break from reality. Any new symptom in an elderly person, including hallucinations, is very likely a side effect of a medication. Bipolar disorder. Musical hallucinations (MH) are probably more frequent in the elderly than those reported in the literature. Such numbers depend on the duration of the hallucination (month-long vs. 4. There are various medical conditions that can cause hallucinations in people of any age. , my mother is calling, a snake is coming, it is going to bite me, and catch the snake) 3–4 times a day. Research has shown that blocking the action of IL-6, a protein involved in the immune response, could potentially alleviate delirium in elderly patients with UTIs, reducing the incidence of hallucinations. Severe dehydration may cause dehydration. Oct 2, 2018 · In Dr Blazer’s review, the focus was on psychosis risk among the elderly. Multiple reasons may lead to under-recognition and under-reporting of this adverse drug effect, by both patients and physicians alike. Many patients, in their final weeks, see animals (rabbits, rats, penguins, and horses have all been reported), sometimes in great numbers, in the. Raleigh, N. 24% had auditory hallucinations in the same time frame. The prevalence rate increases as time passes. Drug and alcohol use. Some people hear voices when no one has spoken. Clinicians should be aware of such rare presentations of hyponatremia and should evaluate serum sodium levels among patients, especially the elderly, presenting with new-onset auditory hallucinations. On the other hand, auditory hallucinations involve hearing voices, sounds, or music that have no external source. An accumulating number of epidemiological studies focused on the prevalence of AH in the general population, but results vary widely. e. They can have various causes, from medication to other variables like the duration and severity of the disease, impaired vision, and sleep problems. Mar 1, 2015 · Dr. 9 These patients present with disorientation, an inability to focus or sustain attention, impaired memory, perceptual disturbances (delusions and hallucinations), psychomotor changes of hypoactivity or Jul 16, 2013 · Auditory hallucinations occur at a rate of 6. The person may see the face of a former friend in a curtain or may see insects crawling on his or Apr 17, 2017 · When an elderly person complains of visual hallucinations without auditory hallucinations, it is advisable to assume there is a biological basis – especially if they develop these hallucinations for the first time in their lives. Visual hallucinations, without auditory hallucinations and in the elderly, are not usually based on previous psychiatric illness. Auditory hallucinations are a frequent symptom in schizophrenia. According to the NHS, increasing the dose of an antibiotic could increase the chance of experiencing side effects, such as hallucinations. Dec 1, 2020 · Post-traumatic amnesia occurs because the brain is in a vulnerable, confused state after a head injury. May, due to vision changes, see straight things such as walls wavering in. Some other medical causes that can cause hallucinations or delusions include dehydration, urinary tract infections, kidney or bladder infections, or pain. Dosing titration of fluoxetine must be done carefully in this population: “The long half MH is more common among women (70% to 80% of cases) and is highly comorbid with psychiatric disorders such as schizophrenia, obsessive-compulsive disorder, or (as was the case for Ms. L. Although more research on potential confounding factors is necessary, clinicians should Dec 1, 2020 · The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Depression is a common problem among older adults, but clinical depression is not a normal part of aging. Perhaps you’ve noticed your aging family member Feb 15, 2012 · Metoprolol, a widely used beta-blocker, has been associated with visual hallucinations and CNS disturbances. , may also result in the same. Alzheimer’s disease and other forms of dementia, Parkinson’s disease, and the general decline that comes with getting older can all make it harder for the brain to work as well as it should. However, people may experience psychotic symptoms like hallucinations, delusions and irritability while under the influence of opioids or while experiencing withdrawal. These false perceptions are caused by changes within the brain that result from Alzheimer's, usually in the later stages of the disease. 2013 Aug;33(4):583-4. A reported 86% of these hallucinations are visual in nature . When followed as the disease progresses over the years, this number increases. Musical hallucinations are infrequent and have been described in 0. It is crucial to identify and address the underlying cause of delirium promptly. Already in 1955, Sem-Jacobsen et al reported on brain activity related to hallucinations. Conclusions: Our findings reveal that auditory hallucinations are common among patients with hearing impairment, and increase with impairment severity. Visual hallucinations involve seeing things that are not there, such as people, objects, or patterns. Elderly individuals experiencing delirium may have visual or auditory hallucinations, along with other symptoms such as confusion, disorientation, and agitation. Auditory and visual hallucinations are the most common, but it is also possible for them to involve smell, touch, and taste. 7%, and delusions 25. May 8, 2018 · However, Cole et al 30 reported that auditory hallucinations are frequent in elderly people with hearing impairment, and Golden and Josephs 21 reported that formed auditory hallucinations such as musical hallucinations can occur in patients with hearing loss. Hallucinations are different from illusions, in which real objects are misinterpreted. Musical hallucinations (also known as auditory hallucinations, auditory Charles Bonnet Syndrome, and Oliver Sacks' syndrome [1]) describes a neurological disorder in which the patient will hallucinate songs, tunes, instruments and melodies. People commonly see moving patterns and shapes, or vivid images of faces, animals, or scenes. We will illustrate the clinical findings of MH with 3 personal cases. Article Information Apr 12, 2024 · Specifically, advanced age, female gender, and high doses were risk factors for developing thrombocytopenia during treatment with valproate. 2 Common causes of hallucination in the elderly. Instead, they may have a change in Apr 23, 2024 · The hallucinations were associated with sulfonamides (68%), quinolones (67%), macrolides (63%), and penicillin procaine (68%). The voices may be positive, negative or neutral. Dementia. Clinical reports in the elderly demonstrate that lower (75 to 225 mg/day) doses of bupropion are associated with fewer side effects Mar 1, 2003 · The course of early-onset schizophrenia in older age is relatively stable and non-deteriorating. g. 8% in elderly populations diagnosed with Parkinson's disease; with depression and sleep difficulties being predictive of those psychotic symptoms, over and above motor or cognitive symptoms (Lee and Weintraub, 2012; Mack et al. Another cause of hallucination after brain injury is psychosis. It plays havoc with the mind and causes rapid deterioration, triggering visual and auditory hallucinations, confusion, and agitation. Apr 25, 2018 · Auditory hallucinations (or ‘voices’) are a distressing experience that can detrimentally affect the lives of people with psychosis. However, a study showed that literature indicated a 0. , a reality monitoring problem called an externalizing bias) compared to controls and similar effects were found in samples of non Auditory hallucinations mostly consisted of voices (51%), music (36%), and doorbells or telephones (24%). Read “UTIs and hallucinations ” and other informative Delusions (or strongly held false beliefs) are a common symptom for a person with dementia. Laboratory investigations, i. Oct 3, 2022 · High fevers and infections. Cuddy, PhD. 4%, tactile hallucinations 2. Sep 21, 2022 · People with dementia may experience hallucinations. Stroke. Psychiatric diagnoses. Abstract. Clinicians that encounter hallucinations in patients with early AD should be sens … May 27, 2022 · Hallucinations will also occur for people with Parkinson’s disease with dementia, and for people with Alzheimer’s. Such temporary symptoms of psychosis have become yet another surprising effect the virus has on Apr 28, 2022 · Conclusions. May 30, 2023 · The aetiologies of acute psychosis are shown in Box 1. epilepsy, a Jun 6, 2004 · Visual hallucination is defined as a perception of an external object when no such object is present. Weakness. The prevalence of hearing loss increases as people age. Visual hallucinations are the most common type, especially in DLB, in which the frequency is estimated to be up to 80%. In advanced age, it could be confused with dementia. Hallucinations in the Elderly : Advice, practical tips, and support for caregivers providing care for an elderly loved one experiencing hallucinations caused by cognitive decline or mental illess- caregiver tips for coping with visual, auditory, olfactory, or tactile hallucinations that often accompany dementia and Parkinson's. Jun 16, 2015 · Musical hallucinations (MH) are auditory hallucinations characterized by songs, tunes, melodies, harmonics, rhythms, and/or timbres (Coebergh et al. In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems than younger people. 0b013e31829771ca. Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in May 20, 2024 · Headache. The auditory hallucinations are popularly associated with psychiatric disorders or degenerative neurological Elderly people often have hallucinations because their minds are getting worse. May 2, 2022 · Musical hallucination is an uncommon phenomenon that consists of a complex form of auditory hallucination (Alvarez Perez, 2017). This is where they experience something that is not really happening, like hearing voices (auditory hallucinations) or seeing things that aren’t there (visual hallucinations). You might also see spots Auditory hallucinations, specifically hearing sounds or voices that are not present, can be prevalent in individuals with hearing loss. The increase does not mean that the hallucinations are persistent across the majority of people with PD. Delirium is an acute, reversible state of confusion characterized by changes in cognition and consciousness that is frequently unrecognized or misdiagnosed in an elderly population. Turkington et al (Reference Turkington, Lebert and Spencer 2016) outline a range of approaches that individuals can be encouraged to use to cope with their voice hearing experiences. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. Factors may include a severe or long illness or an imbalance in the body, such as low sodium. While functional imaging studies have suggested the association of certain patterns of brain activity with sub-syndromes or single symptoms (e. Make the Person Comfortable: Instead of laughing or creating stress and confusion, make them feel comfortable, as awkwardness and discomfort can enhance the symptoms of hallucinations. With these dementias, though, hallucinations are more likely to be associated with hearing or feeling. Here, the term ‘commentary hallucination’ is used as a comprehensive term describing a condition where the subject hears voices that comment on, command, or describe the subject's actions or behavior. Three elderly females with commentary hallucinations are presented. The scientific interest in these phenomena has increased significantly over the past 25 years, but so far no evidence-based treatments have been established. If you or a loved one is living with hallucinations due to Parkinson’s disease, speak with a healthcare provider. Musical hallucinations: this is where one experiences music or different musical aspects that can have or not have any lyrics or voice when there is evidently nothing being played. While in this state, the patient can experience hallucinations and delusions. The disorder usually comes on fast — within hours or a few days. Instead, they may have a change in Hallucinations are another common psychotic symptom in dementia, occurring in up to half of patients with dementia. 6%. The true incidence of visual hallucinations related to metoprolol is unknown. positive symptoms such as hallucinations), there has been only limited evidence from structural imaging or post-mortem studies. This suggests that these hallucinations need to be minimised as much as possible to enable the person with dementia to live well. Most elderly people with schizophrenia are symptomatic and disabled but not demented and are living in the community. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment. 8. Other causes of hallucinations in the elderly. Medication side effects. , 2009 ). Feb 23, 2024 · Hallucinations are sensory experiences that seem real but actually are created in the mind in the absence of an external source or event. Dehydration. Visual hallucinations can occur in various medical, neurological, ocular, and psychiatric disorders and drug induced states. Feb 1, 2001 · Our article 2 focused on the more frail elderly patient who often responds differently to medications. They can make people see, hear, and believe things that aren’t real. 16% of a general hospital population. There are a variety of causes for hallucinations in elderly. Aug 22, 2022 · Hence, it is unclear if elderly hallucination prevalence increases or decreases over time. Dementia can make a person suspicious of the people around them. Over time, several approaches have evolved. If it's in an area that has to do with vision, you may see things that aren't real. Hallucinations (auditory, visual) Brain tumors (both cancerous and benign) can cause auditory hallucinations, particularly if they affect certain parts of the brain. Haldol has many good uses, but not in older adults with dementia. Dizziness. 4 In a 2005 study, Warner et al 5 found religious music such as Jul 4, 2023 · This can be done by involving them in activities like playing games, looking at an old album, or listening to music. Delirium is an acute confusional state that is extremely common among hospitalized elders and is strongly associated with poor short-term and long-term May 16, 2011 · Many studies have used neurophysiological methods to study auditory hallucinations. Negative symptoms persist, whereas positive symptoms tend to show a modest improvement with aging (Cohen et al. " Dec 16, 2010 · Answer: Psychiatric issues, including hallucinations and delusions, are certainly more common after traumatic brain injury. Oct 24, 2023 · In conclusion, there was a clear association between hyponatremia and auditory hallucinations in our case. Oct 3, 2022 · Causes of Auditory Hallucinations. Depression is a serious mood disorder. Dementia and hallucinations are closely linked in the later stages of the disease. For a caregiver, witnessing a loved one’s hallucinations or delusions can be more troubling than any other dementia-related changes. 7%, with a specific prevalence of visual hallucinations being 27%, auditory hallucinations 12. Intense stress Aug 22, 2017 · Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. Anyone having hallucinations should be evaluated by a doctor to determine the cause and provide treatment. Jun 26, 2023 · Types of auditory hallucinations Auditory hallucinations can manifest in different forms, including: Simple hallucinations : These involve hearing sounds, such as buzzing, ringing, or hissing noises. Hallucinations are a common symptom of Parkinson’s disease. •. This is more likely to involve hearing voices or noises. Under Implications for Practice, I have highlighted a potential pathway for this. 9 Older adults are at particular risk for developing psychosis secondary to drugs, toxins, and other underlying medical Feb 28, 2017 · Musical hallucinations constitute a complex type of auditory hallucination characterized by perception of melodies, music, or songs. Simple hallucinations, also known as elementary or nonformed, appear as lights, colors, lines, shapes, or geometric designs; complex, or formed, hallucinations may include images of people, animals, objects, or lifelike scenes. However, it is important to note that these statistics sometimes Dec 8, 2023 · Hypnagogic hallucinations are hallucinations that happen during hypnagogia, or the transition period between wakefulness and sleep. In addition, MES is suggested to be a variant of Charles Bonnet syndrome (visual hallucinations in visually impaired patients) by some authors Apr 14, 2023 · The classic symptoms of a urinary tract infection (UTI) are burning pain and frequent urination. lifetime). Jul 11, 2018 · Hospitalists should consider treating hallucinating patients for a UTI and sleep deprivation, not a UTI and hallucination problem. Hallucinations may be the result of extreme stress, emotional exhaustion, fatigue, posttraumatic stress disorder, loss of a beloved, sleep deprivation, depression, or insomnia. Both those diseases are also associated with a buildup of proteins in the brain. ijdrxawblnglxrnjkmag