Hallucinations, Delusions and Misperceptions

Sometimes dementia can cause a person to experience a different reality to our own, this may include seeing, hearing, tasting or smelling something that isn’t present (hallucinations), inability to recognise objects, people, tastes or sounds (misperception) and/or having a fixed belief that is not true (delusions).

Hallucinations are more common in Lewy body dementia (LBD) and Parkinson’s disease dementia, (although they can occur in Alzheimer’s disease and other types of dementia also). They may see animals or people that aren’t there and this may happen only occasionally or more frequently, sometimes daily see Professor Suzanne Reeves

Your loved one’s reality is different to your own at this moment in time and they will have a fixed belief that what they are experiencing is real. This is usually caused by damage to the area of the brain affected by the dementia and/or changes in their neurochemicals in the brain. Sometimes characters from television may appear very real and appear to be in the room with your loved one. It may be difficult for them to work out what is real and what is virtual from televisions and screens. This may or may not frighten your loved one, but if it does, I would suggest turning off the television and reducing the sensory overload (voices from the radio may also apply here).

What do I do if I think the person is having an hallucination?

If your loved one appears to be experiencing hallucinations, then the first thing to do would be to ask yourself, are they upset by this?  Is their behaviour being affected by them? Are they at risk? Are they frightened? Sometimes, people may not be concerned by them, but if they are, try and stay calm, breathe slowly and try and feel their emotion.  Finding the Light in Dementia  offers tips and approaches that may help.

What may seem as a hallucination may possibly be more of a misperception, such as mistaking one object for another or mistaking who they are seeing. Sometimes your loved one may not recognise their older self in the mirror and this can be quite frightening. If a reflection in a mirror causes distress, cover the mirror or get someone to help you attach a blind to it, so that you are still able to use it, but that it is not visible to cause your loved one distress.

If they have poor eyesight, make sure they have an up to date appointment with an optician (and a hearing test also) for a check-up. Maybe suggest moving into a different room, declutter the space and change the lighting as sometimes shadows, dark rooms and patterns can cause misperceptions.

Sometimes your loved one may communicate an idea that is false which may appear bizarre and may sometimes be paranoid such as believing that family members are stealing from them. This is a fixed belief and can be very upsetting for family members/friends. Try not to take this personally, avoid challenging the belief or trying to reason, because what is felt is a true reality for your loved one. Once again offer reassurance and try to distract from the delusion, as mentioned above.

People can be mistaken for other members in the family such as a son may be perceived as his father. There may be times when you may want to attempt to bring your loved one back to your reality and sometimes earlier on in the condition it may be possible. But be aware and avoid confrontation and upsetting them. As the condition progresses it may be better to let it go and not correct them.

Try and stay in the moment, your loved one needs to feel that they are safe and cared for. Following these approaches, however difficult and upsetting it can be, will help you too.  If you struggle with this, I would suggest talking to your doctor about getting some counselling to help you and to point you in the direction of local support groups and Alzheimer’s Society/Association. See friends and family and try not to isolate yourself. If you are getting good support, you are in a better position to care for your loved one.

If these hallucinations and/or delusions continue over time or if they involve a number of senses it is important that you consult your doctor as they may also be caused by other physical complaints such as infections, pain or even side effects to some medication.



For more help and support read Chapter 10 Altered States: Hallucinations, Delusions and Misperceptions, Try new approaches to avoid distress in Finding the Light in Dementia, a Guide for Families, Friends and Caregivers