Hallucinations, Delusions, and Paranoia in People with Alzheimer’s and Dementia

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People with Alzheimer’s and other forms of dementia can be beset by hallucinations, delusions, and paranoia. Sometimes, these distortions can be directly caused by changes to the brain, but they may also be due to eyesight or hearing problems, kidney or bladder infections or dehydration, or the side effects of medication.

Delusions and paranoia due to Alzheimer’s or dementia

Delusions are false beliefs. For instance, the person may think his or her spouse is in love with someone else when that’s not the case, or that they live with someone else when in reality they live alone. Delusion typically results from a person’s cognitive impairment as a result from Alzheimer’s or dementia. Often, the confusion occurs when a person tries to make sense of a situation, but cannot due to the disease. For instance, if a person couldn’t find his wallet, he might believe a loved one stole it. (Related: How to Join the Reality of Someone With Dementia.)

Paranoia is a specific form of a delusion in which a person is suspicious without reason. Examples might include believing others are purposefully mean or lying to him the person, or that people or the government is “out to get them.” This can result in more suspicion, fear, or jealousy. Paranoia is less common than hallucination or general delusion, but can be a frightening experience.

Strategies to help stop or reduce delusion or paranoia in a loved one with Alzheimer’s or dementia include:

  • Remain calm and resist the urge to argue or use logic to “win.” Instead, provide reassurance and safety, making sure your loved one knows that they are safe and that you are here to protect them, not steal or lie to them.
  • Scope the environment. Are there any immediate triggers that you can remove to stop the delusion or paranoia? Has something like this happened in the same room or the day before?
  • Use distraction. Taking a walk, looking at photos, playing a game, or participating in another activity that you know your loved one enjoys is a way to remove them from the delusion or paranoia.
  • Make sure the delusion or paranoia is not reality. Investigate if he or she might have really been a victim of theft or whatever else the person with Alzheimer’s or dementia  is worried about.

If a loved one with Alzheimer’s or dementia experiences delusions or paranoia, talk to his or her primary care doctor or neurologist about possible negative medication interactions. The doctor can also determine if there is another underlying cause of the delusions, and to see if there is medication available to help safely decrease them. (Related: Behavioral Challenges and Solutions for Alzheimer’s Caregivers.)

Hallucinations in people with Alzheimer’s or dementia

Hallucination—which is the false perception of something that is not really there—can occur in any sense, but people with Alzheimer’s most often experience visual hallucinations, due to changes in the brain as a result from the disease, usually in the later stages of the disease. A person might imagine that they can see, hear, smell, or feel things that aren’t actually present, such as a person they used to know or even bugs crawling on them.

Non-drug solutions and practices to help a loved one who that is hallucinating include:

  • Distracting the person. Suggest that you and your loved one walk to another room, listen to music, or participate in another enjoyable activity. Try gently touching their back for reassurance.
  • Changing the environment. Improving lighting levels, reducing visual clutter, turning off sounds that might be misinterpreted (such as a TV), cleaning glasses (and occasionally making sure they are at the correct prescription) can help.
  • Respond to them calmly and gently, using phrases like “Don’t worry. You’re safe. I’m here for you.”
  • Cover mirrors with a cloth if the person thinks their reflection is a stranger.
  • Acknowledge the reason and emotions behind the hallucination and what it might mean to your loved one. Say phrases such as “It sounds like you’re worried” or “I know this must be scary for you.”
  • If the hallucination isn’t frightening or disturbing, caregivers shouldn’t feel the need to stop it. If the person is comforted by the experience, caregivers can let it occur as long as it’s not scary, disruptive, or keeping him or her from proper care.

If your loved one suffers from hallucinations, caregivers should consult with their loved one’s primary care doctor or neurologist to have a medical evaluation to rule out other potential causes of the hallucinations and determine if an antipsychotic medication is necessary to help. (Related: Caregiving in the Mid-to-Late Stages of Alzheimer’s and Dementia.)

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