Understanding Hallucinations and Delusions in Alzheimer’s

Alzheimer’s disease causes memory deficits and makes it hard for people afflicted with it to stay in the current moment. But, as caregivers and family members know very well, providing effective care to someone in the middle of a suspicious hallucination or delusion may require every ounce of energy you have. Here’s a closer look at what we know about the hallucinations and delusions Alzheimer’s patients experience.

Understanding Hallucinations and Delusions in Alzheimer's

Because there’s an important distinction between a hallucination and a delusion, let’s start by defining our terms.

Hallucinations

A hallucination can be understood as a sensory experience that is imagined. In other words, it’s something a person sees, smells, hears, tastes, or feels (or any combination of those). When someone with Alzheimer’s has a hallucination, they see, hear, smell, taste or even feel something that isn’t really there.

While a hallucination may be frightening in nature – for instance, a person may feel and see bugs crawling up their legs – it can also involve visions of the past and the sense of reliving old experiences. In our interview with Dr. Stephen Hoag, author of A Son’s Handbook: Bringing Up Mom with Alzheimer’s/Dementia, he describes how when he took his mother, a former vaudeville performer, to the big grocery store in town, “Mom would see all these people as an audience and say, ‘You’re on next!’ So I’d take it away, singing and dancing with her and entertaining everyone.” This is an endearing example of the hallucinations that accompany Alzheimer’s – and indeed, that specific one happened often enough that the locals still tell Dr. Hoag how they miss he and his mother’s spontaneous supermarket performances. “And if on another day Mom thought I was her boyfriend from high school,” he says, “that’s who I became. There’s no way to deal with it rationally or directly. You don’t reason it out.”

Delusions

Meanwhile, as alz.org explains, a delusion is not the same thing as a hallucination. The primary distinction is that, unlike a hallucination, a delusion involves a set of false beliefs. An Alzheimer’s patient suffering a delusion may be overwhelmingly suspicious of the people around them, believing that family members or caretakers are trying to trick them and steal their possessions, or that the government or police are following them, or any number of highly paranoid scenarios.

One challenge for caregivers and family members is to keep in mind that the disease is causing these delusional behaviors. Just as with hallucinations, delusions are not rational; you can’t reason with a dementia patient who’s experiencing a delusion, because reason doesn’t enter into it. For caregivers, the only good way forward is, as Dr. Hoag puts it, to “Lead with your love.”

What Causes Hallucinations and Delusions? 

These false perceptions are caused by changes within the brain that result from Alzheimer’s, usually in the middle to later stages of the disease. Memory loss and other cognitive problems that cause confusion—such as the inability to remember certain objects or recognize faces—can contribute to these untrue beliefs. It’s important to bear in mind that people with Alzheimer’s continually struggle to make sense of the world in the face of their declining cognitive function, and it’s a profoundly lonely and isolating experience.

Do They Get Worse as the Disease Progresses?

It’s also important to note that medication side effects can masquerade as dementia. Indeed, many seniors are prescribed medications by different specialists, with no one doctor responsible for tracking how all the drugs interact together. Even on their own, certain anti-anxiety medications (like Xanax and Valium) have the potential to create side effects that strongly resemble dementia, including short-term memory loss and hallucinations.

The Role of Memory Care

For a person with middle-to late-stage Alzheimer’s who suffers from hallucinations and dementia, the best caregiving solutions may be what’s called memory care. A memory care community is an assisted living environment that has the staff and setup to prevent wandering and give individuals the daily assistance they need. They may also include therapies–such as art therapy, music therapy, group reminiscence therapy, and even pet therapy–that are designed to reduce anxiety and improve mood. If you’re looking for memory care, Senior Living Advisors at A Place for Mom can guide you in your search.

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Please leave your thoughts and comments

  • annabelle

    How do you deal when they accused your daughter n boyfriend in having affair n when they accused my daughter for looking at them dirty look.

  • Godschild

    It helps to read the book “The 36 hour Day”. It has helpful hints for every aspect of the disease.

  • Sydney Thapelo

    what is painful between

    a. Anxiety
    Vs. OCD

    b. Hallucinations
    Vs. Delusions

    c. Epilepsy
    Vs. Mental Retardation

    d. Depression
    Vs. Puerperal Psychosis

    and why

  • Melisa

    this is only helpful for definitions. and if your lived one can still talk and move. hallucinations continue past this stage. What and how do you comfort someone that cant talk but it is obvious they are having some sort of hallucination. Has anyone else ever experience this?

    • schnoodle

      Mine can still talk but it takes several occurrences and “conversations” before I think I’ve figured out the issue. Quite frankly, the explanation doesn’t help much ( “they are laughing at her” and “they locked her in her room and she couldn’t get out” neither of which are true). So – I think the suggestions still apply. Acknowledge how this must be scary, frustrating, worrisome – whatever you can think of that they might be feeling and then keep offering reassurance. Doesn’t always work for me and it truly is tiring but I know she can’t help it.

  • carol

    How do you keep them in bed at night and from sleepwalking, doing dangerous things, walking out the door in winter?

    • schnoodle

      I’m starting to experience this and I’m opting for deadbolts that are operated with a key. Naturally I’ll have the key (and keep one by the door, close by in case of fire). Right now she’s not opening the patio door but … I’ll cross that bridge if/when that happens. At least that door, she doesn’t like going out because there’s no handrail. Her wandering so far – the only dangerous thing has been opening the front door w/o my knowing and it STAYED OPEN while we slept.

      • kc

        we added an alarm system announces when a door is open to know if someone is entering or leaving .

    • Mamma’s girl

      Our Mom was pretty mobile up to the last 6 months. My brother posted a sign on the door that read ‘Patty, please stay inside with John (her husband)”. She liked to read so she would read it, go look for John, and stay inside. We all went to tell Dad/John, when we were going out of the house. We’d say, “Ok, Patty, let’s tell John that we are going outside”. She would do that on her own when she wanted to go out for the mail and Dad would say ‘Ok I’ll wave to you from the window’ and watch and wave. As things progressed we went to door alarms. Further on, we went to chain locks placed up hire up on the doors. Actually, Mom liked being in the familiarity of the house, with music playing, her art work on the walls, and watching the birds. She did ask frequently, when she was going home, though. We would just say that the paintings on the walls were hers, that she sewed the beautiful drapes, so this must be the home she made for herself and her husband – then guide the conversion to telling her stories about the family. “One time, my mother….” She would smile.

    • Stephanie

      I use a “fall monitor” which is a large pad placed on the floor. When my father steps on it, it sounds an alarm on my monitoring station. I place the pad in the doorway out of my father’s room and I’m alerted as soon as he tries to leave his room. Thus, no wandering.

  • kc

    my mom doesn’t remember when she ate last and is overeating a lot of unhealthy snacks how do I manage her eating habits better she has gained 10 lbs in last 6 months.

    • oolonmcc

      I suspect the same with my mum too. (It’s mum, not mom, where I come from 🙂 )
      I’d be interested to know the same thing because she only seems to eat if I arrive at meal times, and can’t remember what she had the previous meal.

  • bruce campbell

    bruce
    my wife no longer recognises me as her husband – she thinks i am her father and tells everyone who i am. i cared for her for 8 years but it has now become too much with the continual hallucinations and delusions which she suffers, this also brought on fits of aggression as she failed to understand what was happening. she is now in full time care and seems quite happy in her surrounds.

  • Dannies E Travis

    My husband has become aggitated and “acting out” more and more lately. My hope was for our family unit to stay together as long as we could. His disease has become commonplace for our granddaughter. She knows that he has Alzheimer’s, he is in denial. I refer to them as “the kids” when talking to our daughter.

    His yelling scares her, she’s 5 years old. Our daughter displays signs of dementia in that she lives like a sloth; forgets all the time, is morbidly obese (her words to me), and should be psychologically/neuropsychologically be assesed. Together we can be playful, conversational, and then things change….

  • Debbie

    My father dementia has been getting worse, he’s started having hallucinations and he’s now staring at the ceiling. I asked him about the ceiling but I haven’t been able to understand his answer. He won’t even watch TV anymore. Has anyone experienced this?

    • Mary Susan Wairimu

      T.V may be traumatizing especially if the programs are noisy or violent….. music will help to relax…. soft cool music…

  • Wendy

    My sister in-law don’t even let her children talk to me, I love them so much from the day they were born, she was okay back then, but now she thinks that i will steal her children from her.

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