Why are my husband's dementia and hallucinations at night?

Gaillee asked...

My husband was diagnosed with lung cancer which had spread to his brain. This was two years ago. He was given 15 full brain radiation treatments for the tumors on his brain. Chemo, followed for the cancer which spread into the lymph nodes. Now, he is having hallucinations and dementia at NIGHT mainly. Why is this happening mainly at night? Will this become 24/7 soon? Hospice is not answering this very well. Thank you.

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

While many different kinds of cancer spread to other parts of the body, lung cancer is one that spreads to the brain. When this happens, the person may experience headaches, even seizures, and other neurological symptoms such as speech problems, confusion, and quite frequently, hallucinations. A hallucination is actually a false perception of reality, almost dreamlike (or even like a nightmare) that the person has while awake. Your husband may see or hear things that you do not. You're probably quite concerned when you observe this, but rest assured this is very common when the cancer metastasizes or moves from one site to the brain.

You talk about your husband having "dementia" at night. I'm thinking you are referring to confusion he is experiencing at night"”again a part of the spread of his cancer to his brain. And, just like you and I are more tired in the evening before we sleep, he, too, is more tired at night and is exhibiting the increased confusion. This would be true of the hallucinations, as well. Some of our hospice patients speak of seeing a loved one who has died before. While this may be alarming to us, for the person near death it can be quite comforting.

It is difficult to determine if the behavior your husband is showing will get worse. Or if he will show the confusion or hallucinations more frequently. While cure is longer an option for him (you state he has hospice), know that caring always is. Try to concentrate on the positive time you have with him and please use your hospice nurse as a resource.