Behavior Changes with Dementia: Hallucinations

Dec 20, 2019 | Living with Dementia

This article is part of a 3-part series on the behavior changes that come with dementia. You can find the rest of the series below.

Behavior Changes with Dementia: Sexually Inappropriate Behaviors
Behavior Changes with Dementia: Aggression

When a person with dementia hallucinates, they experience something very real to them that nobody else does, because they sense something that isn’t there.

Real-life hallucination examples:

Someone tore up the lawn. Look at what got dug up. The grass had been mown but had not been raked. The person with dementia saw the rows of unraked grass clippings as trenches dug in the yard.

There are spider webs on the fan. I cannot believe the filthy conditions in this room. The fan was turned on and the person with dementia saw the blade movement as spider webs, which led her to believe the entire room was filthy.

Understanding Hallucinations

Hallucinations are sensory experiences caused by changes in the brain that involve someone seeing, hearing, smelling, tasting, or feeling things that do not exist.

In people with dementia, hallucinations are commonly triggered by sights and sounds that are not within the person’s perception.

Tip: Dementia is caused by damage to or loss of brain nerve cells, and is caused by a number of factors and symptoms of various diseases. Hallucinations in persons with dementia are more common when dementia is caused by Parkinson’s disease, Lewy body, as well as Alzheimer’s.

Causes of Hallucinations

Other factors may cause behaviors to change and lead to hallucinations in people with dementia, such as alterations in environment or caregivers, disruption of familiar routines, or sensory overload when too much is going on at once, as well as:

Sensory failings such as poor eyesight or poor hearing (or forgetting to wear glasses or a hearing aid)
Side effects of medications
Psychiatric illness
Poor lighting
Hidden physical conditions such as infections, fever, or pain
Malnutrition or dehydration

Hallucinations are also a symptom of sundown syndrome, also known as sundowning or sundowners syndrome, which typically includes a series of symptoms including “late-day confusion,” which is triggered by many of the same events that lead to hallucinations in people with dementia.

Hallucinations or Delusions?

Hallucinations are frequently confused with delusions. Hallucinations are false feelings derived from the senses, and delusions are false beliefs, which often take on the appearance of paranoia.

A person with delusions may believe that particular people are out to harm them, or that others are not being honest with them. People with delusions often become overly fearful and resistant to those that care for them. This is a tough situation for the caregiver but remember that delusional behaviors are typically symptoms of a disease, and your efforts to reason with the dementia patient will be difficult as delusions are not rational.

Tips for Caregivers Dealing with Hallucinations

As the caregiver, hallucinations may add another level of stress to your already difficult list of responsibilities.

Several steps can be taken to help you cope with the hallucinations:

Remain calm and resist the urge to control difficult behavior.

Arguing with your loved one with dementia may worsen their confused state of mind.

Be honest with the person you care for but be respectful. Consider saying, “I do not hear what you hear, but I know that you do, and I know this bothers you. Don’t worry, I’ll take care of you.” This reassures the person with dementia that you have heard their concern and that you are taking care of them, which is calming.

Assess what may be happening.

Try to determine what occurred at that moment that might have prompted the hallucination.

Keep a record of the experience.

Journal details of the behavior and what might have triggered the hallucination.

Journaling will also help you to track the severity and frequency of the hallucinations, as well as help you establish whether the behaviors occur at particular times of the day, around certain people, or after specific environmental changes.

Maintain a familiar environment.

Limit unfamiliar distractions. If you must move the one that you care for, consider moving several familiar objects with them to help him feel accustomed.

Keep familiar objects on hand to hand to the person while having a hallucination. This may bring them back to a sense of familiarity and stop the behavior.

Be prepared to turn on lights, or to shut some off, to return the environment to what the person is accustomed to.

Install a night light to combat any confusion at night.

Consider covering or removing mirrors, which commonly lead to hallucinations, “Who is that person in the mirror? I don’t know them!”

Divert Attention

Divert the person’s attention to music, conversation, or activities that you enjoy sharing together. This may gently return the person’s reality to a sense of calm and familiarity.

Consult with a physician if the one that you are caring for is hallucinating to rule out causes that aren’t directly related to dementia. The doctor may prescribe a drug to help with dementia-related hallucinations if he/she feels medication is necessary, otherwise, the physician will rule out causes of hallucinations such as side effects of prescribed medications, infection, fever, pain, or other physical conditions.