GERIATRIC EVALUATION IN 27 CASES OF MUSICAL HALLUCINATION

Background: Musical hallucination (AM) is a type of complex auditory hallucination described as hearing musical tones, rhythms, harmonies, and melodies without the corresponding external auditory stimulus. This type of hallucination is relatively rare and is seen less often than other types of hallucination. Such hallucinations can be continuous or intermittent and are usually accompanied by a clear and critical awareness on the part of the patient. AM are found mainly in elderly women with progressive hearing loss, usually due to ear diseases or lesions. They also occur in neurological disorders, neuropsychological disorders (eg dementia) and psychiatric disorders, especially depression. Objective: To evaluate clinical and neuropsychological issues of the elderly with Musical Hallucinations Methods: Twenty-seven outpatient patients clinic of Geriatrics and Gerontology at FMJ from January 2010 to October 2019 were selected Results: Of the 27 patients, 20 were women. The average age was 83.47 years. The most prevalent diseases were systemic arterial hypertension, osteoporosis, diabetes mellitus, hypothyroidism, osteoporosis, chronic obstructive pulmonary disease and dementia syndrome. With the exception of one patient, all had hearing loss. The songs were the most varied from Gregorian chant to lullaby. Many had this picture for months and continuously (day and night). 40% of them had no insight into AM. We emphasize that all these patients sought medical care with the main complaint of musical hallucination. Conclusion: In general, AM has an uninterrupted, fragmentary and repetitive character. They are involuntary, intrusive and have an apparent exteriority. They differ from the simple mental image of auditory sensation in that they appear to come from outside the individual as if they actually hear an external device playing music. Currently, it is estimated that about 2% of elderly people with hearing loss also have AM. The neuropsychological basis of AM is not fully established. The phenomenological study, especially the perception of complex sequences and consistency with previous auditory experience strongly suggest the involvement of central auditory processing mechanisms. Normal musical auditory processing involves several interrelated brain levels and subsystems. While the recognition of elementary sounds is done in the primary auditory cortex, the recognition of musical characteristics such as notes, melody and metric rhythm occur in a secondary and tertiary association center, which in turn, are greatly influenced by regions linked to memory and emotion.