Responding to and Treating Hallucinations in Dementia

Is Your Loved One Seeing Bugs that Aren't Really There?

Hallucinations in Dementia Can Be Frightening
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Figuring out how to respond to and treat hallucinations induced by dementia begins with an elementary understanding of what hallucinations are and where they come from.

Hallucinations are sensory experiences that may feel real but are actually created by the mind and aren't based on any external source or event. They can occur in any of the five senses:

  • Sight (visual)
  • Hearing (auditory)
  • Touch (tactile)
  • Smell (olfactory)
  • Taste (gustatory)

The most common hallucinations are auditory or visual in nature. Some hallucinations are anxiety-producing and distressing, such as hearing someone yelling your name when you are home alone or feeling like bugs are crawling on your skin. Others can be pleasant and even comforting, such as seeing a cuddly puppy sitting in a chair across the room. Whatever emotion they evoke, it's important to remember that hallucinations aren't real.

Why People with Dementia Hallucinate

Hallucinations develop in dementia because of changes in the brain due to the disease. They typically occur in the later stages of Alzheimer's disease and in other types of dementia such as Lewy body dementia.

Other possible causes of dementia-related hallucinations include:

Prevalence of Hallucinations in Dementia

The prevalence of hallucinations varies with different types of dementia. Studies have concluded that anywhere from 7% to 35% of people with Alzheimer's disease develop hallucinations. An estimated 80% of people with Lewy body dementia—which is the second most common form of dementia after Alzheimer's—experience hallucinations.

Hallucinations or Sensory Misperceptions

Sometimes a sensory misperception can be mistaken for a hallucination. For example, a hearing or visual deficit can prevent you from receiving sensory information and, in turn, generate hallucinations. As simplistic as it sounds, poor lighting in a room can cause a visual misinterpretation that may feel like a hallucination.

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

Assessing Delirium as a Cause of Hallucinations

There are several possible causes of hallucinations in dementia, one of which is delirium. Delirium is a sudden increase of confusion that is often caused by an infection, medications or drug interactions. Someone with dementia who experiences a sudden onset of hallucinations should be evaluated by a physician for possible delirium, which is treatable.

Responding to Hallucinations

Dealing with dementia-related hallucinations in a friend or loved one can be understandably challenging. Experts recommend the following strategies:

Don't Argue

For many people with dementia, hallucinations seems 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 music, pet therapy or even something as simple as walking into a brightly lit room, can help defuse a hallucination.

Medications for Hallucinations

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.

If hallucinations are persistent and distressing, physicians will often prescribe an antipsychotic medication with the goal of reducing or eliminating them. Antipsychotic medications are often fairly effective at treating hallucinations in addition to paranoia and delusions. That said, this class of medications can cause significant side effects and are associated with a higher rate of death in people with dementia.

Lewy body dementia tends to lead to a higher risk of negative side effects from antipsychotic medications.

A Word from Verywell

If a loved one with dementia seems to be experiencing hallucinations, it's advisable to consult with 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.

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