Treating Hallucinations in Dementia

One sad pensive senior Indian woman looking up

VikramRaghuvanshi / Getty Images 

Hallucinations are a common symptom of dementia. They can be frightening for those who experience them and challenging for caregivers. If you live with or care for someone with dementia who sees or hears things that appear not to be based in reality, you probably know this all too well.

There are a number of effective ways for dealing with dementia-related hallucinations. These include knowing how best to respond to someone who is frightened or concerned about what they're experiencing, practical ways to help prevent hallucinations, and medication.

Hallucinations in Dementia

Hallucinations are sensory experiences that seem real but actually are created in the mind in the absence of an external source or event. Most are visual, but about half of people who see things that aren't there also may hear nonexistent noises or voices (auditory hallucinations). Multisensory hallucinations are rare.

Hallucinations should not be confused with delusions, which also are common in dementia. A delusion is a strongly held belief that has no supporting evidence. For example, a person with dementia may believe a loved one is having an affair or stealing their money.

For people with Alzheimer’s disease, hallucinations tend to occur during relatively brief and distinct periods of time, typically just a few weeks. For those with Lewy body dementia (LBD), however, hallucinations are persistent and long-term.

A 2013 review found that 82% of people with dementia living senior care facilities had at least one neuropsychiatric symptom.

Causes

Hallucinations are experienced by people with dementia largely due to changes in the brain caused by the disease. This may be compounded by memory loss and other cognitive issues typical of dementia, such as the inability to remember certain objects or to recognize faces.

In Lewy body dementia, impairment of visuospatial ability is believed to contribute to hallucinations. Visuospatial ability refers to correctly interpreting what we see as well as the size and location of our surroundings. 

Furthermore, hallucinations in LBD and Parkinson’s dementia may be linked to underlying abnormalities in the brain's processing of alpha-synuclein, a protein in the brain believed to be compromised in people with dementia.

There are other potential causes of hallucinations in dementia, some of which can easily be managed in order to eliminate hallucinations altogether:

Management and Treatment

Seeing things that aren't there can be unsettling and even frightening, even if what is being imagined isn't scary. For that reason, an important aspect of helping someone with dementia who is having hallucinations is to reassure them that what is happening is not unusual and that it may stop occurring over time.

It also can be helpful to explain that hallucinations can be controlled and that there is nothing to be afraid of. Don't argue with someone who insists that what they're seeing or hearing is real. To them what they're experiencing is real; by trying to convince them otherwise you may create frustration and anxiety that could make things worse and cause them to feel their concerns are being dismissed.

Practical guidelines for helping someone deal with hallucinations include:

Verify the truth. Make sure the hallucination really isn't based in reality. If someone with dementia insists they saw a man at the window, make sure no one actually happened to be outside.

Offer reassurance. Let someone with dementia-related hallucinations know you will check in on them frequently. If they live in a care facility, explain to staff and caregivers that the person sometimes has hallucinations that upset or scare them.

Alter the environment. Make adjustments that are related to what the person imagines. If they "see" strangers looking through an outside window, make a point of showing them the window is locked or keep the shades or curtains closed. Rearrange furniture, install night lights, and make any other changes you can that might interrupt hallucinations.

Maintain routines. The more normal and reliable a person's day-to-day experiences are, the less likely they are to stray from reality. If the person is living in a facility, try to arrange for daily consistency in staff and other caregivers. It may also help to keep a record of when hallucinations tend to occur and under what circumstances.

Use distractions. Soothing music or even something as simple as walking into a brightly lit room can help defuse a hallucination.

Medications

When hallucinations are scary or distressing for the person who has them, or they have a negative impact on quality of life, it may be necessary to turn to medication. There are several prescription drugs for treating hallucinations.

Antipsychotic medications often are effective for treating hallucinations, either by eliminating or reducing the frequency with which they occur or by having a calming effect that makes them less distressing.

Cholinesterase inhibitors. These medications, which treat Alzheimer's disease and other dementias, work by increasing the levels of certain neurotransmitters in the brain—chemical messengers important for memory, thinking, and judgment. As such, they help boost alertness and cognition as well as potentially reduce hallucinations and other behavioral problems. Examples of cholinesterase inhibitors include Aricept (donepezil), Exelon (revastigmine), and Razadyne (galantamine).

Nuplazid (pimavanserin). This is the first drug approved to treat hallucinations and delusions associated with psychosis experienced with Parkinson’s disease dementia.

Some medications have serious side effects and are associated with a higher rate of death in people with dementia; these include certain antipsychotic medications, which should be closely managed. In addition, carbidopa/levodopa, a drug commonly prescribed for patients with Lewy body dementia, can cause or worsen hallucinations in these patients. Rytary (carbidopa/levadopa)—a drug prescribed to treat the movement-related symptoms—can cause or worsen hallucinations caused by Lewy body dementia.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Related Articles