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Obviously the neighbor isn't in the house and I'm not having an affair as I am the only caregiver 24/7 and don't leave my husband alone. It just hurts so much.

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When Dad got to that stage, we helped to convince Mom that it was time to use a NH. Even with help, he was too much for Mom, and we and her friends were worried about her dying before he did.
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This is usual & basically happens to to the closest person to the person with dementia - take it as a badge of courage because that means he is most afraid that you won't be there for him so is making up a reason in his mind to cope with it - the odd thing being that this actually sometimes makes the other person leave due to stress of dealing with the accusations - you must not allow him to focus on that neighbour because you husband could try to harm him

If I were you, I'd say that while you are friends with your neighbour but that it hasn't gone any further & then do a small recommitment ceremony just the 2 of you over a nice dinner with flowers, candles etc & all dressed up to show him how much he means to you - buy yourself a small piece of jewelry like a ring to put on & say that shows your commitment to him & take pix - when he starts with it again tell him to look at the pix & show him the ring of recommitment you are wearing - it might not work but it might be worth a shot

The reason I say this is that once my mother came out of the blue with 'your father is such a bastard he didn't go to his own brother's funeral' to which I answered 'yes he did & so did you ...the reason I know is I was there with you both' however this ended that issue but another we didn't treat this way went on for months getting bigger & bigger all the time so we wished we had been firm in the begining
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Have you got recordings of music he really likes to sing along to? pop it on when he starts to talk about the 'affair'. Also consult a registered qualified music therapist for help
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Have you any pieces of Music that he really likes - usually from his teenage years? This could be a good way to get his delusional mood to change. Have it ready to pop on when he starts talking about the 'affair'. Also consult a qualified registered music Therapist for advice
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If this is new a check for a UTI is good. I would call his doctor. He may need a medication. Dementia patients will get something in their heads and not let go.
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Been there with my husband and the maintenance supervisor in our senior complex. And yes, it does hurt me and I am so afraid that when maintenance comes into our apartment for a repair, my husband will confront him with his hallucinations. I am careful to take my husband out for a ride just to avoid any confrontation. For some reason, his thoughts on this is getting less and less as he becomes more confused. Thank God.
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You start by calling his physician as one of his medications can be causing the hallucinations.
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Definitely check for UTI -- or even just treat for one.

Another possibility, especially with dementia -- is he not recognizing himself in the mirror? Sometimes people see the mirror and (not seeing themselves) ask 'who is that old man? what's he doing here?' It's a short step from that to deciding they know 'who' and 'what' -- especially if a mirror has shown the two of you together.

If you cover the mirrors, this delusion may go away.

This is such hard stuff. I'm so sorry you're having to deal with this.

Good luck!
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This must be so hard and sad. Do you have others coming in for visits sometimes, females but also males he’s known for a long time and trusts? To ‘people’ his head more and get his attention off you a bit. I pray you get out sometimes, you need and deserve other human connections to help balance this out. Your love and commitment to him does not mean you fight this battle alone. Praying for you both. Hugs.
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I dealt with the exact problem.
Talk to your doctor there are medications that can
help with this problem.
My husband is on resperidone .Very small dosage .
If I try to ween him off of the meds he starts again . For me I just keep
him on it.
Good luck. Eventual this part of the disease will pass.
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Talk to you doctor about this, I knew a man who got violent with his wife because of this delusion.
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Delusions, obsessions and paranoia are all part of Alzheimer’s/dementia. But knowing that doesn’t make it any easier to handle. When my mother first started voicing her delusions, I tried to convince her they weren’t true. I spoke with the Director of Nursing at her facility and he told me to develop “Teflon” skin.

Arguing with your husband and denying his accusations will not work. As Eyerishlass says, use diversionary tactics. That’s what I did with my mom. We’d go for a walk down the hallway to the lounge. I’d tell her stories about her Great-grandkids. I didn’t deny her delusions but I didn’t agree with her either. Sometimes I’d just give her a blank look and say, “Oh, really?”
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There is a book written by Xavier Amador titled "I'm Not Sick and I Don't Need Help". It is about dealing with schizophrenia but there are some very helpful tips for how to talk to someone who is absolutely convinced that what they see or hear or think is based in reality. You may find it helpful.
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My dad's delusions began innocently enough. He thought there was some kind of shadowy government agency after him but because he was aware of it (in his mind) he had the upper hand and wasn't concerned by it. Eventually this agency became a threatening presence in my dad's life and he became scared. I never tried to convince him that it wasn't real because to him it was very real. Instead I comforted him and reiterated to him that nothing bad would happen to him and that I would always protect him. This worked with my dad. 

I'm not sure it's a good idea to admit that the neighbor is actually in the house but I understand the point the poster was trying to make. Instead of agreeing that the neighbor is in the house you can tell your husband that because you keep the house locked up tighter than a drum no one is getting in without your permission. And then divert. Delusions change and evolve and while this neighbor may be having an affair with you (in your husband's mind) the neighbor could become threatening at some point (in your husband's mind). You don't want to concede to your husband that the neighbor is actually in the house.
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Lori, if this is new, i.e., a sudden change in mental status, I'd get in touch with his doctor. He might have a UTI, which sometimes causes delusions in elders.
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Dear lorijo
I’ll confess, since I don’t deal with Alzheimer’s I haven’t seen all the Teepa Snow videos but I think I would check them out for guidance. I know generally she suggests that you go along with and then divert. That you don’t try to argue or convince him to change his mind. 
“ I know it upsets you for him to be here in the house. I’m upset too.”  and then “ would you like to ride to the soda shop? I feel like a chocolate shake, what about you?”
Now this sounds nonsensical but so are his accusations and if it works then use it. 
It’s certainly crazy making to live with this situation. I’m so sorry. 
The best news I can give you is also the worst. The disease will progress. He will stop this behavior after awhile and there will be something else. Again, I’m very sorry. 
Hopefully others will have better suggestions. 
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