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August 14, 1996

Charles Bonnet Syndrome in a Centenarian

Author Affiliations

Hunter Holmes McGuire VA Medical Center Richmond, Va

JAMA. 1996;276(6):451-452. doi:10.1001/jama.1996.03540060027027

To the Editor.  —Charles Bonnet syndrome (CBS) includes visual pseudohallucinations (hallucinations with preserved insight), visual deprivation, and preserved cognitive status.1 We present a patient who improved without medications.

Report of a Case.  —A 103-year-old widow presented with a 1-year history of visual hallucinations, which she recognized as unreal. They appeared during the day and disappeared when she closed her eyes. The visions were related to past experiences, such as when she was a child or a teacher, and were often pleasant. She was previously treated with phenothiazines, but without effect. She had glaucoma of the right eye and a cataract in the left eye. She had decreased visual acuity (OD 20/200, OS 20/100). Results of her neurological examination, cognitive status, Geriatric Depression Scale, and computed tomographic scan were normal. Increasing communication and occupational therapy decreased the frequency of the visions.

Comment.  —The diagnosis of CBS is by exclusion of