Understanding Hallucinations and Delusions in Alzheimer’s

Mark Huntsman
By Mark HuntsmanMay 6, 2014

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.

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


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.”


Meanwhile, as 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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Mark Huntsman

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