Causes of Hallucinations & Delusions in Dementia and Caregiver Tips for Coping

Last Updated: September 20, 2018

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


What are Hallucinations?

Hallucinations are experiences when a person smells, tastes, feels, hears, or otherwise senses something that does not exist. Examples include hearing voices, seeing flashing lights, or watching bugs crawling on the floor. However, they are false perceptions, meaning they are not real. With certain types of dementia, such as Parkinson’s disease dementia and Lewy body dementia, hallucinations are more common. That said hallucinations are also seen in Alzheimer’s disease.


What are Delusions?

People with dementia may also experience delusions, which are false understandings (beliefs) about what is going on in the present. For instance, a person with dementia might believe that the nursing home is trying to poison her / his meals or perhaps that family members are stealing from her / him. Delusions can be frustrating and difficult to deal with because they affect how someone with dementia relates to those around him / 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.


Causes of Hallucinations and Delusions

Hallucinations and delusions can be the result of the changes that dementia causes in the brain, but there are several other potential causes in individuals with dementia. Too much stimulation in the environment (noise, people, and distractions), unfamiliar places and people, a variation in routine, and interactions between medications can all contribute to hallucinations and / or delusions.

Delusions are frequently the result of suspicion or paranoia on the part of the individual with dementia, and often memory loss and confusion from the progression of dementia play into it. For instance, a person with dementia may forget where he / she placed his / her eyeglasses, and due to poor memory and an unawareness of it, he / she may accuse someone else of having taken them.

Hallucinations are sometimes present in a phenomenon called sundowning, which is late day / evening confusion in people with dementia. In addition, poor lighting and bad eyesight can cause shadows and an individual with dementia might think he / she saw something that isn’t really there.

Make sure to consult a physician if your loved one is having delusions and / or hallucinations to rule out other causes unrelated to dementia. For example, mental illness and medical conditions, such as migraines, brain tumors, epilepsy, urinary tract infections, and dehydration can all be causes.


Tips for Caregivers on Dealing with Hallucinations & Delusions

As a caregiver of someone with dementia, 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 / her be. 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 explain away what your loved one is experiencing. Whether she / he realizes what she / he is experiencing is real or not, you can respond to his / her needs and react appropriately. This is not to say that you have to lie to or to “humor” your loved one when she / he hallucinates or has a delusion. You can be honest while also respecting him / her. For example, you might say ”I don’t hear or see anyone outside the window, but I know you do, and you seem worried.“


Consider the Situation
As you are responding to your loved one, try to think about why she / 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 him / her 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 to believe that she / he hears voices. Also, for someone who has delusions and believes that she / he is constantly being watched, curtains or shades might provide some comfort. 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? Do you think a night light would look nice in this room?”


Treatment of Hallucinations & Delusions

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. However, many of them cause unwanted side effects, especially sleepiness.