Dementia Hallucinations: Why They Happen and What to Do About Them

It’s quite common for dementia to cause hallucinations. As brain cells degenerate due to the progression of dementia, the brain can misfire and create the experience of receiving stimuli from the body’s sensory systems, resulting in hallucinations.

Hallucinations can present in many ways:

• Visual: Seeing things that aren’t there
• Auditory: Hearing things that aren’t there
• Gustatory: Phantom tastes
• Olfactory: Phantom smells
• Tactile: Sensations on the skin

Certain types of dementia are more likely to include hallucinations as a symptom than others. The stages of dementia in which hallucinations occur and the type of hallucination experienced may depend on the type of dementia a person has.

• Alzheimer’s disease. Alzheimer’s patients can experience hallucinations; however, they are not particularly common. Hallucinations associated with Alzheimer’s disease are generally auditory or tactile. If a person with Alzheimer’s disease experiences hallucinations, they typically occur in the later stages of the disease.
• Parkinson’s disease. Parkinson’s disease can also cause hallucinations. As with Alzheimer’s,  those with Parkinson’s may experience hallucinations in the later stages, and the hallucinations are more commonly auditory or tactile. Not every person with the disease will experience hallucinations.
• Vascular dementia. Vascular dementia is typically the result of a stroke, and those with this dementia can experience tactile, auditory, or visual hallucinations. These hallucinations most commonly occur in later stages of the disease.^[01]
• Lewy body dementia. Perhaps the most common type of dementia to cause hallucinations is Lewy body dementia. In this form of dementia, hallucinations are an earlier stage symptom.^[02] Most commonly, individuals with Lewy body dementia experience vivid visual and auditory hallucinations. As the disease progresses, hallucinations will usually taper off ^[03], while other symptoms, such as trouble with balance, will become more severe.

Hallucinations in individuals with dementia can be tricky to identify. Sometimes people with dementia talk to themselves, but it’s important to certain that your loved one is addressing an unseen individual and not themselves. Try to be sure if your loved one is explicitly indicating they see or hear something that you do not. And, before assuming your loved one is hallucinating, it is always best to eliminate other possibilities.

If your loved one sees an intruder or smells smoke, of course you should check to make sure these threats are not real. If your loved one continues to insist that these threats or other hallucinations persist, it may be time for a physician’s input. Sometimes a physical problem, such as damage to an auditory or or optic nerve, can be a culprit. For instance, a taste-related hallucination may indicate that your loved one has a dental issue that needs attention.

In general, if there’s no physical explanation for what your loved one is experiencing, it’s possible that they are hallucinating. However, always keep in mind that they could be experiencing another type of misperception associated with dementia. Keep track of your observations, discuss them with your loved one’s physician if possible, and do your best to look out for environmental triggers.

Other types of misperception dementia patients may experience

People with dementia often experience a few types of misperceptions that can’t always be classified as hallucinations, though they may present similarly.

• Delusions are beliefs that are not based in reality yet remain fixed in a person’s mind as if they were facts. Unlike hallucinations, delusions don’t need a misfiring of the senses. The person experiencing delusions may become fixated on an idea that has no evidence, such as their spouse having an affair.

  Delusions can, however, have some overlap with hallucinations. Somatic delusions are beliefs that the person is experiencing a sensation, which they may believe to be caused by a malady they don’t actually have. Somatic delusions can be a form of tactile hallucinations, and to a caregiver, they can be indistinguishable from one another.^[04]

• Paranoia is a common type of delusion in dementia patients in which the person experiencing it believes that someone is out to harm them. A person living in a care home, for example, may be convinced that the staff are taking things from his room. Or, a person may believe that someone is watching her through hidden cameras.

• Time shifting is a misperception that is more specific to dementia than the previous ones mentioned. In the progression of most types of dementia, short-term memory begins failing before long-term memory. As short-term memory lapses, the brain fills in the blanks with long-term memory in order to give more context to whatever situation the person is in. A person with dementia experiencing time shifting may believe his daughter is his wife at a younger age. Someone else may think she still has to be on time for a job she hasn’t worked in years.

Let our care assessment guide you

As with most symptoms of dementia, there are a few techniques you can use to support your loved one through hallucinations and hopefully minimize their distress.

Identify patterns and triggers

Like most dementia symptoms, hallucinations don’t follow a schedule. However, also like most dementia symptoms, hallucinations may be more likely in the evenings with sundowning. Dementia hallucinations are also common at night when the person with dementia is especially fatigued.

If you’re with your loved one regularly, you may begin to notice a time of day when hallucinations are more likely to occur, and you may also begin to have a sense of what triggers them. Changes to environment, routine, diet, and medications can all be contributors. Take some notes on the circumstances around your loved one’s hallucinations in order to identify their specific triggers.

Eliminate your loved one’s hallucination triggers

Hallucinations can keep your loved one from getting enough sleep, which in turn exacerbates dementia symptoms.^[05] Keeping your loved one’s routine consistent with familiar caregivers, eliminating caffeine and cutting back on sugar later in the day, and getting plenty of activity in the afternoon can help your loved one stay regulated and get sufficient sleep.

Additionally, reflective surfaces and unfamiliar shadows can contribute to hallucinations, particularly after dark. Close curtains and remove mirrors from the areas where your loved one spends their evenings, and keep their bedroom well-lit before bed.^[06]

Remove safety hazards from your loved one’s environment

Hallucinations can be a source of danger for dementia patients. If they’re prone to wandering or sleepwalking, make sure doors are locked and staircases are blocked to prevent falls. You can also install a monitoring system so you and other caregivers will be alerted if your loved one wanders at unusual times.

Of course, it’s also important to keep medications, knives, weapons, and other hazardous items in locked cabinets so your loved one won’t find them in a moment of hallucination or confusion.

Respond with compassion when your loved one with dementia is hallucinating

If your loved one is hallucinating, there are a few things you can do to alleviate their distress and help them through it.

• Refrain from arguing with your loved one. It may be tempting to try to convince your loved one that what they’re seeing or experiencing isn’t real. However, this is more likely to make them feel invalidated and lead to agitation.
• Offer reassurance. Remind your loved one that they’re in a safe place. If they’re convinced that something is in the closet, shine a light on it and show them that everything is okay.
• Redirect. Simply moving to another room can help dissipate the hallucination. Then, try to get your loved one engaged in an activity, such as a puzzle or a game of dominoes. If they’re not feeling particularly active, try having a snack and some music or a comforting show.^[06]

Some medications may help alleviate hallucinations in dementia patients. However, more often, medications can contribute to the problem. In fact, some medications prescribed for Parkinson’s disease are known to have hallucinations as a side effect.

If the hallucinations are severe, antipsychotic medications may help, but sometimes the side effects can be more problematic than the symptom the drug is treating.^[07] Antipsychotics prescribed to dementia patients can cause drowsiness, confusion, and worsening of memory impairment, as well as increased risk of blood clots, infections, and strokes.^[08]

Often, the most effective treatment for dementia-related hallucinations is managing symptoms through routine and environmental adjustments. Talk to your loved one’s doctor to determine the best treatment plan for your loved one.

Talk with a Senior Living Advisor

If your loved one’s hallucinations are especially frequent, or are causing significant distress, this may be an indicator that their dementia is becoming more advanced. However, before you make any big decisions about the future, it’s best to schedule an appointment with your loved one’s primary care physician to eliminate other causes.

Make a list of the medications or other substances your loved one is on. Note the circumstances of the hallucinations, the time of day, the type, and the frequency, and share this information with your loved one’s doctor so that they can better determine the cause of the hallucinations.

If your loved one’s doctor doesn’t see any additional cause for the hallucinations, and if they continue to progress, it may be time to consider memory care. A Senior Living Advisor at A Place for Mom can help you explore options for your loved one’s continued care.