Did You Know

One form of dementia, called Lewy Body dementia, often includes the symptoms of hallucinations.

Caregiver Story

At first Grandma said a few odd things. She said she heard someone calling her in the basement when there was no one there. Another time she claimed she saw something and then changed her mind. And then she didn't say anything odd like this for a year so we thought it went away. We didn't find out she was hiding it from us until the police brought her home after finding her in a confused state at the grocery store, talking to an imaginary person. We brought this to the attention of her doctor who decided to prescribe an additional medication for her after these episodes got pretty frequent.

Dementia can affect how an individual perceives the world. A person with dementia may think that she can see or hear something that isn't there or believe something that is not true. In earlier stages of the disease, she will usually be able to recognize that this is simply a figment of her imagination. However, as the disease progresses, these individuals may begin to have more and more trouble distinguishing between fantasy and reality.

Understanding Hallucinations and Delusions

Hallucinations are experiences when a person smells, tastes, feels, hears, or otherwise senses something that does not exist. Hallucinations can be the result of the changes that dementia causes in the brain, but they can also be the result of health and medical problems, such as infections, fatigue, or nutrition.

People with dementia may also experience delusions, which are false understandings about what is going on in the present. For instance, a person with dementia might believe that her nursing home is trying to poison her meals or perhaps that family members are stealing from her. Delusions can be frustrating and difficult to deal with, because they affect how someone with dementia relates to those around her. It is important not to take it personally if you are accused of things you did not do -- remember it is the illness causing the problem. For both delusions and hallucinations, medications called atypical antipsychotics are sometimes prescribed; however, it is not clear how effective they are (Schneider, et al., 2006).

Suggestions for Caregivers

Be sure to consult with a doctor in order to best understand why your loved one is hallucinating or having delusions and whether medication is indicated. You may feel the need to stop or to control difficult behaviors when they arise. However, think carefully about whether or not your loved one is really disturbing or endangering themselves or others. If the answer is no, try letting him or her be – you may be surprised. Below are some more suggestions about dealing with hallucinations and delusions.

  • Employ the 3 R's (Reassure, Respond, and Refocus)

    As with anger and emotional reactions, do not simply try to correct or to explain away what your loved one is experiencing. Whether s/he realizes what s/he is experiencing is real or not, you can respond to his or her needs and react appropriately. This is not to say that you have to lie to or to “humor” your loved one when s/he hallucinates. You can be honest while also respecting him or her.

    ”I don't hear or see anyone outside the window, but you seem worried.“

  • Consider the situation

    As you are responding to your loved one, try to think about why s/he may be experiencing a hallucination in that particular moment or whether a similar event has happened before. While it is true that there can be mental and medical causes for hallucination, there can also be environmental and social causes as well. Many caregivers find it helpful to keep a journal or some sort of record of when, where, and how their loved one experiences delusions or hallucinations. Record how your loved one is feeling and acting at the moment, and what sorts of events have happened recently. At some point, with advanced dementia and extreme anxiety about a delusion, the kindest thing you may be able to do is to tell a small fib.

    “It was just me that made that noise, I dropped a pan. Do you feel safe now? “

  • Address the problem

    Creating an activity for your loved one to focus on can help someone move past a hallucination. Individuals also may experience hallucinations because their hearing and vision is failing. In addition to medical checkups, make sure that there is sufficient lighting in the room and not too many distractions. For instance, while a radio and a television might be comforting to one person, they might also cause your loved one believing that s/he hears voices. Also, for someone who believes that s/he is constantly being watched, curtains or shades might provide some comfort.

    “Would you like for me to stay here with you for a while? Do you think a night light would look nice in this room?”

View References Schneider LS et al. Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer's Disease. New England Journal of Medicine. 2006; 355(15):1525-38. Retrieved March 30, 2009.
Resources
Source: 
Alzheimer's Association
Description: 
This web page discusses how to recognize and respond when your loved one has hallucinations.
Source: 
Alzheimer's Society (United Kingdom)
Description: 
This web page discusses both delusions and hallucinations, listing common experiences of visual and auditory hallucinations.
Source: 
www.caregiver.com
Description: 
This article discusses the symptoms of paranoia in people with dementia, and gives advice to help you cope with your loved one's hallucinations or delusions.
Source: 
Better Health Channel (Australia – Victoria)
Description: 
This web page explains hallucinations, paranoia, delusions, and misidentification and their causes. It also lists factors that may make these behaviors worse and offers a list of things you can do to handle them.
Source: 
Understanding-Dementia.com
Description: 
This web page explains why paranoia sometimes accompanies dementia and how to communicate with someone who is having paranoia. It also provides some tips for caregivers on coping with their loved ones' paranoid behaviors.