… It’s in the room. It’s something like a bug. She saw it, heard it, even felt it crawl across the skin on her foot. It moves things. It speaks. It controls the lights. It’s wrong, and frightening.
… The water bottle is missing again. He left it where he always leaves it. It’s been stolen. It must have been stolen, or it would be right there. He needs his own water bottle, because if he drinks from the one his nurse gives him, he’ll die. She’s stealing his things, and slipping him poison.
As dementia advances in the minds of our loved ones, their perceptions warp and, unfortunately, misinform. Hallucinations and delusions are symptoms of Alzheimer’s disease and related dementia, and it is vital for caregivers to understand what they are, and how to cope.
Hallucinations are the senses being wrong about what’s real. They are most often sights and sounds that do not exist outside the hallucinating person’s perception, but other senses can also be tricked by hallucinations (like feeling something touching skin when nothing is actually there). Typical hallucinations include hearing voices, seeing flashing lights, or watching bugs crawling on the floor.
With certain types of dementia, such as Parkinson’s disease dementia and Lewy body dementia, hallucinations are more common. Hallucinations are also seen in Alzheimer’s disease.
Hallucinations are false feelings; delusions are false beliefs. For example, a person with dementia might believe that workers in a nursing home are poisoning meals or stealing. Delusions can be frustrating and difficult to deal with because they affect how someone with dementia relates to others. (Remember not to take offense; the behavior is caused by the disease.)
Delusions also take the form of paranoia, a general sense in someone that people are lying, acting in bad faith, or conspiring. Paranoia can come without any logical reasoning, and worsens as someone’s memory deteriorates.
Hallucinations and delusions can be the result of the changes that dementia causes in the brain, but there are several other potential causes. Too much stimulation in the environment (noise, people, and other distractions), unfamiliar places and people, a variation in routine, and interactions between medications can all contribute to hallucinations and delusions.
Delusions are frequently the result of suspicion or paranoia on the part of the individual with dementia. Memory loss and confusion from the progression of dementia play into it. If someone with dementia forgot where he put down his glasses, for instance, because of poor memory and lack of awareness, then he may decide someone stole them.
Hallucinations are sometimes present in a phenomenon called sundowning, which is characterized by increased anxiety in someone with dementia that hits late in the day, typically around sunset. Poor lighting and bad eyesight can cause shadows, and an individual with dementia might get startled by something that wasn’t really there.
Consult a physician if your loved one is having delusions or hallucinations, to rule out other causes unrelated to dementia. Mental illness and medical conditions such as migraines, brain tumors, epilepsy, urinary tract infections, and dehydration can all be causes.
Resist the need to stop or control difficult behaviors. Think carefully about whether or not your loved one is causing a problem. If the answer is no, try letting it be. This is not to say that you have to lie to or “humor” your loved one; you can be honest while also showing respect. For example, you might say, ”I don’t hear or see anyone outside the window, but I know you do, and you seem worried.”
Remember the 3 R’s: Reassure, Respond, and Refocus.
Consider the situation. Investigate why a hallucination or delusion is occurring in that particular moment. Beyond mental and medical causes, there can also be environmental and social causes as well.
Keep a journal to record when, where, and how your loved one experiences delusions or hallucinations. Record how your loved one is behaving, and what sorts of events have happened recently.
Control the environment. Make sure there is sufficient lighting in the room and not too many distractions. A radio or TV, for example, might cause your loved one to hear voices and not understand that what’s coming from the speakers is not actually in the room. Also, pulling curtains or shades can provide comfort for someone afraid of being watched.
Have backups. If there’s something like a favorite mug or glasses that your loved one keeps misplacing, have multiples of that same item. That way, frustration and the need to search won’t boil over into aggression.
Be flexible. Sometimes the kindest thing you can do is to tell a small fib. “It was just me that made that noise. I dropped a pan. Do you feel safe now?”
Employ the art of distraction. Creating an activity for your loved one to focus on can help to move past a hallucination. Music can help (for more information, click here), or getting out a photo album.
Demonstrate caring. Hallucinations and delusions are frightening, so address the feelings behind the behavior. Offer reassurance and show your loved one that you care. For instance, you might ask, “Would you like for me to stay here with you for a while?” or “Do you think a night light would look nice in this room?”
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. For both delusions and hallucinations, medications called antipsychotics are sometimes prescribed. Antipsychotics, also called “neuroleptics,” are prescribed for health conditions including schizophrenia, and have been shown to help people with dementia who struggle with these symptoms.
Doctors may prescribe any of a number of antipsychotics after evaluating your loved one, but the drug most often used to help dementia-related hallucinations and delusions is Risperidone, which has been shown to alleviate symptoms in the short term. The side effects of risperidone and other antipsychotics can be severe – including muscle tremors, weight gain, fatigue, and dizziness – and non-drug treatments (suggested above) are typically preferred. A doctor may, however, conclude that medication is necessary.
Another non-pharmaceutical option is cannabidiol (CBD). Studies of the brain have shown that CBD’s effects can include alleviating hallucinations, delusions, and other behaviors associated with psychosis, without the harsh side effects associated with antipsychotics. CBD is extracted from the cannabis (marijuana) plant, but excludes the THC that produces the “high” effect from marijuana. It can be taken any number of ways besides smoking, and is fast becoming more readily available throughout the United States. For more information about CBD’s benefits for loved ones with Alzheimer’s or a related dementia, and whether it’s available in your state, click here.