Visual hallucinations as the presenting symptom of dementia — A variant of the charles bonnet syndrome?

The presentation of functional symptoms with related behaviour disturbance in elderly patients may deflect the attention of clinicians from an underlying cognitive impairment. The objectives of the case presentation below are to demonstrate the relatively independent course of different symptoms within the natural history of a dementing disorder, and to look also at how they might have arisen: is there a single organic aetiology, or a more complex interplay between perceptual disturbance and the release of past experience? The intention is to discuss diagnostic issues and also to address the most appropriate investigation and management.