Responding to and Treating Hallucinations in Lewy Body Dementia

People with Lewy body dementia are more likely to experience hallucinations than those with Alzheimer's or vascular dementia, and in general, they experience them earlier in the disease process than people do with other types of dementia. For some people, these hallucinations may even be one of the first symptoms of Lewy body dementia they experience.

Halluciantions in Lewy Body Dementia
Hiroshi Watanabe DigitalVision 589889979/ Getty Images

Up to 80% of people with Lewy body dementia experience visual hallucinations. These hallucinations are often recurrent and very detailed. Hallucinations of adults, children, or animals are common.

Some research has found a correlation between the presence of hallucinations and an increased amount of cognitive impairment in Lewy body dementia. Hallucinations in LBD have also been associated with a decrease in quality of life; thus, having an awareness of how to respond to them can be very helpful for both the person living with LBD and their caregiver.

Responding to Hallucinations

It can be difficult to know how best respond to hallucinations in Lewy body dementia. Because these hallucinations often occur earlier in the disease process, some people respond well to gentle reality orientation and reassurance that the hallucination isn't real.

Although it's not recommended to try to persuade someone with Alzheimer's disease that what they're seeing or hearing isn't there, in Lewy body dementia, you may want to try that method first since there are usually fewer cognitive deficits in the person with Lewy body dementia when they're experiencing hallucinations.

If your family member directly asks you if you see the person that they see across the room, experts and family members recommend being truthful and acknowledging that although you don't see the person, you know that they do. Family members have shared stories about how their loved one with Lewy body dementia caught them in small untruths and became angry and agitated.

If your loved one is very upset and distraught about their hallucination, you will want to use caution and provide some extra space between the both of you. While in a state of distress, it's possible your loved one could mistake you for a hallucination or experience a catastrophic reaction and become combative. Provide reassurance and ask if you can come sit by them before entering their space.

You can also try using validation therapy and ask what the person looks like, how long they've been there, and what makes the person go away.

Other options include using distraction by going into a different room or for a walk outside, turning on some music, talking about the football game, or calling the dog over to your loved one for some pet therapy.


When someone with Lewy body dementia experiences hallucinations, treatment might follow a similar protocol to treatment of hallucinations in other kinds of dementia with a very important exception—the use of antipsychotic medications.

About half of people with Lewy body dementia are extremely sensitive to typical antipsychotic medications including Haldol and can experience severe and life-threatening reactions to them. Atypical antipsychotics may be less likely to provoke a serious reaction but caution is very important when considering the use of antipsychotic medications in Lewy body dementia.

It's also important to note that in some people with Lewy body dementia, Sinemet (carbidopa/levodopa)—a medication that may be prescribed to treat the movement challenges of the disease—can cause or worsen hallucinations in these people.

Research has shown that some people with Lewy body dementia who experience hallucinations have benefited from cholinesterase inhibitors. This class of medication has been approved by the Food and Drug Administration to treat Alzheimer's disease and is often used for other dementias as well. Cholinesterase inhibitors include the drugs donepezil (Aricept, Adlarity), rivastigmine (Exelon), and galantamine (Razadyne).

A Word From Verywell

Finally, remember that Lewy body dementia, like other dementias, is a disease that affects the whole family. No matter how much you love the person, caring for someone with Lewy body dementia can be very draining on both your physical and emotional energy. If you're running on empty or just at a loss for what to do, consider attending a support group or looking into other ways to provide in-home care or facility care for your loved one.

8 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.
  1. Lewy Body Dementia Association. Early visual hallucinations greatly increase odds of LBD over Alzheimer’s.

  2. Lewy Body Dementia Association. Emergency room treatment of psychosis.

  3. Mckeith I. Dementia with Lewy bodies. Dialogues Clin Neurosci. 2004;6(3):333-41. doi:10.31887/DCNS.2004.6.3/imckeith

  4. Connors MH, Quinto L, Mckeith I, et al. Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychol Med. 2018;48(11):1749–58. doi:10.1017/S0033291717003257

  5. Armstrong MJ, Weintraub D. The case for antipsychotics in dementia with Lewy bodies. Mov Disord Clin Pract. 2017;4(1):32–5. doi:10.1002/mdc3.12383

  6. NIH National Institute of Neurological Disorders and Stroke. Lewy body dementia: Hope through research.

  7. Corium. Corium receives FDA approval of Adlarity® (donepeziltransdermal system) for treatment of patients with Alzheimer’s disease.

  8. Alzheimer's Association. Medications for memory.

Additional Reading

By Esther Heerema, MSW
Esther Heerema, MSW, shares practical tips gained from working with hundreds of people whose lives are touched by Alzheimer's disease and other kinds of dementia.