Hallucinations & Delusions

Some patients with dementia may experience hallucinations and delusions. This can be due to the changes in the brain, and are more common in people with Lewy Bodies dementia, and those in the later stages of Alzheimer’s disease.

A hallucination is seeing, smelling, tasting, or hearing something that isn’t really there. Some hallucinations may be frightening, such as seeing someone unfamiliar in their room. Others may be non-distressing, such as happily responding to voices they are hearing and having a conversation.

A delusion is a false belief. It can be a paranoid belief, such as believing that someone is stealing from them, or a more ordinary belief, such as thinking that they recently returned from a trip that did not occur. Like hallucinations, not all delusions are upsetting or frightening.

The first step to respond to hallucinations or delusions is to consult with your loved one’s doctor. While these may be a part of their dementia journey, they can also be caused by other conditions, such as pain or infection, medications, or other disorders. Individuals who have a history of schizophrenia and other mental illness may have continued symptoms related to that illness. It is important to work with your physician to check for physical causes.

If a person is experiencing hallucinations and delusions that are not upsetting, it is best to respond calmly, and meet the person in their reality.

If a patient is looking for their mother, you might offer to “help them look” and engage them in music or other activities to provide them entertaining experiences.

If their experiences do not provide a risk or danger to themselves or others, and the person is not distressed by the hallucination or delusion, it may not be necessary to try and treat it with medication.

If the patient is distressed, experiencing fear, or may act dangerously due to the delusion or hallucination, use the following tips to help navigate the situation and calm the person (Adapted from Alzheimer’s Association, 2015):

Offer Comfort and Reassurance.

Reassure them that they are safe, hold their hand and offer comforting touch, and validate their concerns “I know you are scared, I am here to help you.”

Use Distractions.

Move to a well-lit room with others and engage them in a favorite activity.

Don’t argue.

It’s fine to be honest “I know you see something, but I do not see it”. This validates their experience and avoids arguing with them about what is or is not there or happening.

Assess Reality.

Hallucinations and delusions can be misperceptions of things that look or seem real. Ask them to point out where they see, hear, or feel something and make sure it is not actually happening (such as voices being heard from a television).

Modify the environment.

Increasing lighting, reducing shadows, and moving items that may appear frightening may help reduce the hallucinations. Moving or covering mirrors may be helpful if the person believes they are seeing a stranger in the house- remember that they may not recognize their own reflection.  If the person has delusions about someone stealing from them, having duplicate items to provide to the person may be helpful.

Ask your doctor about medications.

Medications to reduce hallucinations or delusions may be helpful or even necessary when the non-medication approaches have been tried without success, or the person is extremely distressed by these experiences.