Responding to and Treating Hallucinations in Dementia

Hallucinations in Dementia Can Be Frightening
:LWA/Larry Williams Blend Images 103925029/ Getty Images

There is no one-size-fits-all approach when it comes to addressing hallucinations in individuals with dementia. But if someone you love or take care of experiences hallucinations, there are a variety of practical techniques and some medications that may help manage the symptoms and ease the distressing or frightening aspects of hallucinating.

These include supportive non-drug measures, such as maintaining routines, adjusting the physical environment, and reassuring the person that their hallucinations aren't real and that they aren't in any danger. On the pharmaceutical front, antipsychotics and other medications have proven somewhat effective, depending on the kind of dementia you're dealing with.

While statistics vary, hallucinations are fairly common in several types of dementia. Anywhere from 7% to 35% of people with Alzheimer's disease, which accounts for 80% of all dementia, develop hallucinations at the mid- to later stages of the disease. Between 70% and 80% of individuals with Lewy body dementia (LBD)—the second most common form of dementia after Alzheimer's—experience visual hallucinations at an earlier stage of the disease than with other types of dementia. Hallucinations are also fairly common in Parkinson's dementia, which is diagnosed in 50% to 80% of people with the disease.

What Are Hallucinations

Hallucinations are sensory experiences that may seem real but are actually created by one's own mind, in the absence of any external source or event. They can be vivid—like a dream that takes place but in which your'e awake—frightening, or even oddly comforting. For example, someone may hallucinate an adorable puppy sitting on a chair in their living room.

Types of Hallucinations

Though hallucinations occur in all five senses (sight, sound, touch, smell, or taste), the most common ones are visual or auditory. Visual hallucinations often involve images of adults, children, animals, and objects. Multisensory hallucinations, which involve sight, sound, and touch, are very rare. But about half of all people with visual hallucinations and dementia, also experience auditory hallucinations.

The hallucinatory periods in Alzheimer’s tend to be relatively brief, lasting only a few weeks. In the Lewy body disorders, however, hallucinations are more persistent and may go on for months or years.

That said, hallucinations should not be confused with delusions, which are also fairly common in dementia. A delusion is a strongly held belief without any supporting evidence to the contrary. For example, an individual with dementia may believe a loved one is having an affair or stealing their money. While delusions occur in a range of other psychiatric diseases, they are very common in dementia.

Causes

Hallucinations develop in dementia because of changes in the brain due to disease. The memory loss and other cognitive problems that are typical in many types of dementia cause confusion—such as the inability to remember certain objects or recognize faces—that can contribute to both hallucinations and delusions.

Other possible causes of hallucinations in dementia include:

Studies have found that changes in visuospatial abilities—which are the understanding of what we see around us and an ability to interpret spatial relationships—are related to an increased risk for developing hallucinations in Lewy body dementia. 

Evidence suggests that Lewy body and Parkinson’s dementia may be linked to the same underlying abnormalities in the brain's processing of alpha-synuclein, which is a protein in the brain that is believed to be compromised in people with dementia. Another complicating factor is that many individuals with Lewy body dementia or Parkinson’s disease dementia also contain the plaque and tangles that are characteristic of brain changes linked to Alzheimer's disease.

Treatment

While medications can sometimes be effective in treating hallucinations in dementia, experts also suggest a variety of non-drug strategies.

Convey to people experiencing hallucinations that their visions are common in a number of neurodegenerative conditions, and that they often spontaneously reduce in number or prevalence and disappear over time. Point out that they can be controlled. Stress that there is nothing to be afraid of.

Guidelines also include managing risk factors that may contribute to the frequency of hallucinations:

Don't Argue. For many people with dementia, hallucinations seem real, so arguing otherwise is probably not going to be effective. On the contrary, it may increase frustration and anxiety. It can also make someone feel like their concerns are being dismissed.

Verify the Truth. Investigate the hallucination, and make sure it is not based in reality. If someone with dementia insists they saw a man at the window, make sure there were no window-washers on the premises. Don't dismiss anything until you rule out the possibility that the experience did happen.

Provide Reassurance. Let someone with dementia-related hallucinations know you will check in on them frequently. If they live in a care facility, advise staff and caregivers of their hallucinations and fears.

Adjust the Environment. Help alleviate fears by making some small adjustments. For example, in dealing with someone with hallucinations, you can show them that the window is locked. Pull down the shade if they have hallucinated a stranger at the window. A night light can also be reassuring. If the hallucination is persistent, consider adjusting the position of the bed so they're not facing the window.

Maintain Routines. Maintain a routine as much as possible. If the person is living in a facility, help facilitate consistent staff assignments.

Use Distractions. Sometimes, soothing musicpet therapy or even something as simple as walking into a brightly lit room, can help defuse a hallucination.

Offering soothing responses. A caregiver's response can aggravate behavior. Avoid correcting and quizzing a person with dementia. Offer reassurance and validation of his or her concerns.

Medications

Deciding whether medication is needed to treat hallucinations should be based on these questions: Are the hallucinations distressing to the individual? Are they negatively affecting his or her quality of life? If so, medications may be a viable solution. If not, the best course of action may be no action at all. Not everyone with hallucinations in dementia has trouble handling them.

The medications that treat hallucinations vary in their efficacy and the particular type of dementia.

Antipsychotic medications are often fairly effective at treating hallucinations and also addressing paranoia and delusions. In some cases, they can eliminate or reduce the intensity of all of these visions, and can have a calming and sedative effect.

Cholinesterase inhibitors are used to treat Alzheimer's disease and other dementias. With names such as Aricept (donepezil), Exelon (revastigmine), and Razadyne (galantamine), they work by increasing the levels of chemical messengers believed to be important for memory, thought and judgment (neurotransmitters) in the brain. This can help improve alertness and cognition, and may help reduce hallucinations and other behavioral problems.

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

However, some medication also have serious side effects and are associated with a higher rate of death in people with dementia These includes some antidepressants and drugs for Parkinson’s disease, which should be taken only under the care of a doctor and closely managed. And some people with LBD are at particular risk of severe adverse reactions to antipsychotics. Sinemet (carbidopa/levadopa)—a drug prescribed to treat the movement challenges of the disease—can cause or worsen hallucinations with Lewy body dementia.

A Word from Verywell

If a loved one or someone you care for with dementia seems to be experiencing hallucinations, consult a physician for evaluation and to decide the best treatment. It may also be helpful to track the timing of the hallucinations to determine if there is a pattern as to when they occur.

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 policy to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Chaudhury S. Hallucinations: Clinical aspects and managementInd Psychiatry J. 2010;19(1):5-12. doi:10.4103/0972-6748.77625

  2. Collerton D, Taylor JP. Advances in the treatment of visual hallucinations in neurodegenerative diseases. Future Neurol. 2013;8(4):433-444. doi:10.2217/fnl.13.19.

  3. Ralph SJ, Espinet AJ. Increased All-Cause Mortality by Antipsychotic Drugs: Updated Review and Meta-Analysis in Dementia and General Mental Health CareJ Alzheimers Dis Rep. 2018;2(1):1-26. doi:10.3233/ADR-170042

Additional Reading