Hallucinations and delusions are symptoms of dementia caused by changes in the brain. They can make people see, hear, and believe things that aren’t real.

For a caregiver, witnessing a loved one’s hallucinations or delusions can be more troubling than any other dementia-related changes. Perhaps you’ve noticed your aging family member talking to people who aren’t there or even showing aggression toward you during these episodes. More than likely, your first instinct has been to help by convincing them that what they’re experiencing isn’t real.

While taking this approach seems logical to us, experts say it could backfire.

“It is not helpful to argue or rationally explain why something happened,” says Lisa P. Gwyther, MSW, LCSW, associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University and director of the Duke Center for Aging’s Alzheimer’s Family Support Program. “It just frustrates the person. They somehow know that you aren’t taking their thoughts and feelings seriously.”

You can assist your loved one who’s experiencing dementia hallucinations and delusions by learning about proper ways to respond. Additionally, it’s important to share your observations with their doctor. If it becomes unmanageable, they might prescribe medication to help minimize these behaviors.

Hallucinations vs. delusions from dementia

You might hear the terms delusions and hallucinations used interchangeably, but they’re actually different.

Delusions from dementia are fixed false beliefs that are often caused by declining memory, whereas someone who’s hallucinating could see, smell, feel, taste, or hear things that don’t exist. For people with dementia, delusions are typically more common than hallucinations.

Both delusions and hallucinations may worsen at night if your loved one is prone to sundowning.

Hallucinations

Dementia hallucinations can be relatively harmless or very frightening for patients and caregivers alike. Examples of common hallucinations include:

  • Hearing music or voices
  • Seeing bugs that aren’t there
  • Seeing people or animals that aren’t there (caregivers may observe a loved one with dementia talking to themselves as they attempt to interact with what they’re hallucinating)

For people with Alzheimer’s, hallucinations are more common during the middle and later stages of the disease. However, they can happen for brief periods at any stage. Experiencing hallucinations in the earlier stages — especially visual hallucinations — is common in seniors with Lewy body dementia.

People with vascular dementia can experience hallucinations, too. It’s one of several symptoms you might notice, which could also include delusions, depression, apathy, and a lack of willpower.

Hallucinations in the elderly aren’t only a symptom of dementia. Other possible causes could be:

  • Poor eyesight
  • Hearing loss
  • Medications
  • Dehydration
  • Urinary tract infections (UTIs)

Delusions

Delusions are a common symptom of dementia that usually appear in the middle and late stages. While some delusions won’t disrupt daily life, others can be especially stressful. In particular, paranoid delusions can be distressing for both the patient and their caregivers.

Examples of delusions in a person with dementia include:

  • The belief that an imposter has replaced their relative, which is known as Capgras syndrome
  • Fear that their home is being monitored or invaded by intruders
  • Suspicion that someone stole their valuables
  • Insistence that their spouse is cheating on them
  • Firm belief that they’re younger than they are
  • Feeling that they need to go home when they’re already home
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How to help someone with dementia who’s hallucinating

If you’re caring for a loved one with dementia, don’t try to convince them that their hallucinations aren’t real. This might lead to anger or aggressive behavior. Instead, try a more reassuring and comforting approach.

Marion Somers, Ph.D., author of Elder Care Made Easier: Doctor Marion’s 10 Steps to Help You Care for an Aging Loved One, suggests joining them in their version of reality. Ask what they’re experiencing as if it’s real so you can more effectively defuse the situation.

“Otherwise, you’re going to aggravate them, and you don’t want to increase the level of agitation,” Somers says.

Here are five other ways you could help someone with dementia while they’re hallucinating:

  1. Show compassion. For instance, you could say, “I see that you’re upset. I would be upset if I saw those things, too.” Tell them that they’re safe with you.
  2. Offer a comforting touch. Demonstrating that you’re physically there may help the person turn their attention to you and away from the hallucination.
  3. Find a distraction. You also can suggest that they move to a different room or take a walk to get away from whatever may have triggered the experience.
  4. Change the environment. Removing triggers (or removing the person from a triggering environment) may help reduce hallucinations. Triggers could include lighting that casts shadows, sounds that could be misinterpreted such as the TV, or mirrors that might cause them to think they’re seeing a stranger instead of their own reflection.
  5. Do nothing, which is sometimes OK. Realize that some hallucinations, such as seeing children or hearing music, might be comforting. If a senior is reassured by what they’re experiencing, caregivers shouldn’t feel compelled to stop it.

If hallucinations are significantly affecting your loved one’s safety and well-being, then antipsychotic medication may be prescribed to them. These medications carry risks for people with dementia, but you and your loved one’s doctor may determine that the benefits outweigh them.

Some of the antipsychotic medications used to treat hallucinations and other challenging dementia behaviors include:

  • Quetiapine (Seroquel)
  • Clozapine (Clozaril, FazaClo, or Versacloz)
  • Pimavanserin (Nuplazid)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)

Responding to delusions in the elderly

Delusions among dementia patients are typically a result of their cognitive impairment. They occur when a senior tries to make sense of a situation but their confusion and memory problems make it impossible.

“They end up filling a hole in a faulty memory with a delusion that makes sense to them,” Gwyther says.

For example, if a loved one can’t find their purse, they may conclude that it’s missing because someone stole it. This phenomenon is called confabulation.

Read: Confabulation in Dementia Can Feel Like Hurtful Lies

Here are four ways you can help a loved one if they’re experiencing delusions from dementia:

  1. Don’t take delusions personally. Delusions can be frightening for the person living with dementia, but they can also be very hurtful when caregivers themselves are the targets. Recognize that your loved one is living in a world that doesn’t make sense to them and that they’re probably scared.
  2. Support them. Reassure the person, and avoid asking questions that may only cause more confusion. If they’re looking for an item, tell them you’ll help them find it.
  3. Avoid offering explanations. Trying to convince your loved one that their delusions aren’t real will likely lead to agitation. Instead, take this opportunity to make your parent feel loved and reassured that you’re there to support them.
  4. Try redirecting them. Redirection is another strategy that dementia caregivers use, but it may not work for every patient or every false belief. If a loved one is experiencing a mild delusion, offering a favorite snack or activity may be sufficient to shift their attention.

Read: Managing Dementia Through Redirection and Relearning

Adjusting to a loved one’s delusions and hallucinations

Caregivers commonly struggle to adapt to their family member’s physical, cognitive, and emotional changes. Even after they’ve learned about proper ways to respond to dementia hallucinations and delusions, it still takes plenty of patience and practice. Repeatedly stepping into a loved one’s alternate reality is often exhausting.

Jacqueline Marcell, author of Elder Rage, or Take My Father... Please!: How to Survive Caring for Aging Parents, went through this challenging shift while caring for her mother and father simultaneously. Both developed Alzheimer’s disease that went undiagnosed for a prolonged period. In addition to memory loss, her parents experienced regular hallucinations and delusions.

“I learned to live in their reality of the moment, rather than cause confusion and make them feel bad by telling them that their minds weren’t working properly anymore. I can’t even describe to you the look of relief and thanks on my father’s face when I used this approach,” Marcell says.

Recognizing the causes of these dementia-related behaviors and understanding what a loved one goes through while enduring hallucinations and delusions may help you remain calm and find solutions.

“Sometimes, the only solution is the passage of time,” Marcell says. “But, if frequent hallucinations or a persistent delusion is causing a chronic increase in anxiety for your loved one (and for you), it’s time to speak to their doctor about other options.”

Home care is an option if you need help caring for a loved one with dementia or if it’s no longer safe for your senior to live alone. It supports families while enabling their loved ones to keep living in the comfort of home for as long as possible.

If living at home is no longer safe or manageable, memory care communities offer specialized care for people with dementia.

Sources:
Management of neuropsychiatric symptoms of dementia (https://www.uptodate.com/contents/management-of-neuropsychiatric-symptoms-of-dementia)
Clinical features and diagnosis of dementia with Lewy bodies (https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-dementia-with-lewy-bodies)
Advances in the treatment of visual hallucinations in neurodegenerative diseases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3717328/)
Etiology, clinical manifestations, and diagnosis of vascular dementia (https://www.uptodate.com/contents/etiology-clinical-manifestations-and-diagnosis-of-vascular-dementia)
Hallucinations (https://www.alz.org/help-support/caregiving/stages-behaviors/hallucinations)
Prognosis and treatment of dementia with Lewy bodies (https://www.uptodate.com/contents/prognosis-and-treatment-of-dementia-with-lewy-bodies)
Suspicions and Delusions (https://www.alz.org/help-support/caregiving/stages-behaviors/suspicions-delusions)

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