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Sounds like Alzheimers. People often think dementia is a disease when its q word describing symptoms. its like the word ITCH...A what is causing the itch is the real question. Look up EARLY STAGES OF ALZHEIMER'S DISEASE. There you have it. Take the to a doctor with symptoms- he will tell you all symptoms are surely dementia- then ask what is causing the dementia. Could be- medicatiins, urinary tract infection can case delusion, hallucinations, anger, irritability- or Alzheimers. Respiratol helped mom near immediately. Good luck.
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Your poor family! Please, please, try very hard not to let things beyond your mother's control ruin your relationship with her.

A brain MRI would not tell you conclusively what is causing her dementia or what type she has. It might provide clues and rule some things out, but it isn't a magic diagnosis tool.

Just know that there is something in her brain -- clumps or plaques or tangles or bodies of protein -- that doesn't belong there and that she has no control over. The only way currently to tell what is there is to open the brain -- that is, an autopsy can tell for sure. (Researchers are working diligently to identify biomarkers that could be easily tested for during life.)

Your mother does not want these hallucinations. She does not plan these outbursts. Chances are very good that she doesn't mean what she says, or even fully realizes what she says.

She is sick, not evil. She needs your love and understanding more than she ever has.

I hope the change in medications will result in a huge improvement.
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The recent outburst of anger lasted about an hour and horrible hateful things were said that I think has permanently altered her relationship with me and 3 siblings. Doctors reduced her medications from 16 down to 6 and I am waiting to see if that solves the issues. I don't know what is causing the dementia since she refuses a brain MRI but I am pretty certain it is due to damage from repeated blood pressure crises-if it is not from being over medicated.
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Your profile says that your mom has dementia. Some kinds of dementia involve sleep disorders and that could account for the timing. Several kinds of dementia include hallucinations.

Do the outbursts last long? Do they go away on their own? They may not need treatment is they are self-limiting. I'd tell her doctor about these symptoms in any case.
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This could be caused by medications taken at bedtime. It could be low blood sugar. Look up Hypnagogic Hallucinations. It happens when the patient cannot successfully transition from dreams to wakefulness.
My MIL would have a dream of some sort and think it really happened. This led to a label on her chart "delusional" and "somatoform disorder".
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