My mom had Charles Bonnet syndrome for 4 months, after her cataracts temporarily blinded her. The cataract surgery cured it, as soon as the bandages were removed.
What happens is that, without visual stimuli, the brain begins creating its own visual images. These visual illusions are different from those of typical dementia—though she did experience actual hallucinations, caused by meds that were supposed to help calm her down. (They didn’t.)
With Charles Bonnet syndrome, a person will see patterns; for instance, Mom’s vision was so bad, she thought she was seeing trees in a forest, or ripples on a lake, here in our house. The other type of visual disturbance is seeing people, usually what they call “lilliputian” (small) people. Mom would, for instance, ask me why there was a little girl in the room with us, when nobody else was there.
The big difference between Charles Bonnet syndrome and a regular hallucination is that, with Charles Bonnet syndrome, there is no interaction with what is being seen. In other words, when Mom saw a little girl, the “girl” wouldn’t speak to her or anything, because it was purely a visual image. However, when Mom was having a bad reaction to the meds, THOSE were real hallucinations; one time she thought she was piloting a boat, and kept asking me where she should dock it. When the meds wore off, those hallucinations went away, yet she would still see the “trees”, “water”, and the occasional “child”.
If your stepfather is talking to the people he sees, and they talk back, that’s NOT Charles Bonnet syndrome; that would be the dementia, or something else. If the people he sees just kind of stand there and don’t say anything, that’s Charles Bonnet syndrome. CBS is a purely visual disturbance.
It is very frightening to the patient, because they will believe what they see, over what you tell them is really happening. Dementia is going to complicate things a lot, as I’m sure you’ve observed by now. It’s going to be hard, if not impossible, to make your stepfather understand what is happening.
Charles Bonnet syndrome is not well understood, and it can last for a few weeks, to many years. My mother was very lucky, in that surgery corrected her vision, so she got over it just as soon as she could see again.
Thanks for that explanation, sounds horrible. You explained it so well.