Hallucinations can vary between benign misperceptions of reality to horrifying experiences
that have no basis in reality.
They can involve sounds (especially voices), visions, olfactory (smells), gustatory (taste)
and tactile (feeling of being touched.
An example of a benign tactile hallucination is that of a patient who feels that the chorea
of his legs is caused by ghosts. A severe frightening visual hallucination could be the vision of a yawning mouth with bloody
People with Huntington's disease may often have benign, or non-bothersome (to them) hallucinations.
For example, a patient may stare off into space and laugh at something that appears to be just in front of them.
Treatment for this type of problem may be as simple as teaching the caregiver not
to be upset by the laughter. In the example above about the ghosts moving a young man's legs, convincing him to avoid frightening
movies and television shows.
Paranoia can be associated with hallucinations or even trigger hallucinations. One of our patients who was in a nursing
home became paranoid that people were trying to kill him, when the nursing placed a series of terminal patients as his roommate.
When he was matched with a roommate who more closely matched his age and general health the paranoia diminished.
The spouse of this patient taught him to orient himself by looking at all four corners of his room upon awakening
and labeling where his clothing and shoes should go. By training him to place his possessions in the same place every day,
they were able to decrease his misperception that people were stealing his shoes, when in fact he had not put them away where
Medications may be needed to help to alleviate or control some of the more severe behavioral problems. The
medications should be a second line of treatment after attempts have been made to understand or modify the behavior.
One excellent source for health care providers is the second edition of "A Physicians Guide To The Management of HD" by Adam Rosenblatt, M.D., Neal Ranen, M.D., Martha Nance, M.D., and Jane Paulsen Ph.D., printed by
the Huntington's Disease Society of America.