Responding to Alzheimer’s Delusions and Hallucinations

I’m often asked by readers of this blog if people with Alzheimer’s disease or dementia can experience delusions and hallucinations. The answer is “yes.”

While not everyone with these diseases experience delusions and hallucinations, many patients do. For a caregiver or family member, delusions and hallucinations can be a perplexing and frightening experience. I know, my mother had auditory hallucinations and paranoid delusions that were quite spectacular and often violent. She has since been properly medicated and these symptoms have been ameliorated.

I am not a medical doctor and I am not qualified to answer medical questions, but I can provide advice that you might find helpful based on my experiences.

The first step is to contact the patient’s physician and establish that a diagnosis of Alzheimer’s or dementia has been made. There are other diseases that can cause delusions and hallucinations and you need to rule them out.

Next, ask the doctor for a referral to a geriatric psychiatrist. A geriatric psychiatrist specializes in the study, prevention, and treatment of mental disorders associated with old age. Dementia and depression are two areas in this field.

If you are unable to find a geriatric psychiatrist, contact the Alzheimer’s Association for referrals.

My final recommendation is to be prepared for the initial appointment. For a list of questions to ask the doctor, see Alzheimer’s and Talking to your Doctor on my site.

The following article explains about Alzheimer’s delusions and hallucinations and provides suggestions on how to manage them. I hope you find it helpful.

~ Jennifer


Hallucinations and delusions are symptoms of Alzheimer’s disease and other dementias. With hallucinations or delusions, people do not experience things as they really are.

Delusions are false beliefs. Even if you give evidence about something to the person with dementia, she will not change her belief. For example, a person with dementia may have a delusion in which she believes someone else is living in her house when she actually lives alone.

Delusions can also be experienced in the form of paranoid beliefs, or accusing others for things that have not happened. For example, the person with dementia may misplace an item and blame others for stealing it. Some people with dementia may have the delusion that others are “out to get them.” For example, he may believe that his food is being poisoned.

Hallucinations are incorrect perceptions of objects or events involving the senses. They seem real to the person experiencing them but cannot be verified by anyone else. Hallucinations are a false perception that can result in either positive or negative experiences.

Hallucinations experienced by people with dementia can involve any of the senses, but are most often either visual (seeing something that isn’t really there) or auditory (hearing noises or voices that do not actually exist). For example, a visual hallucination could be seeing bugs crawling over the bed that aren’t actually there. Of course, people also make “visual mistakes,” mistaking a housecoat hanging up for a person, for example, because they can’t see the object clearly. This can happen to anyone, and is not considered a hallucination.

Possible causes

  • Different combinations of medications (you may want to speak to a doctor)
  • Unfamiliar people and environments
  • Changes in routines
  • Inadequate lighting
  • Overstimulation of environment (too much noise, too many people, too many distractions)
  • Sundowning, a form of disorientation and confusion that some people with dementia experience in the late afternoon. Learn more about sundowning.

Responding to delusions and hallucinations

  • Try to determine if he has any difficulty with hearing or vision.
  • Make sure that lighting is adequate.
  • Make sure that she is eating a well-balanced diet (malnutrition or dehydration can result in undernourishment of the brain).
  • Try to make the environment comfortable (unfamiliar people or environments may be disruptive).
  • Keep routines and schedules consistent.
  • Try not to change the environment.
  • Check for signs of physical injuries such as bruises or scrapes (a fall that was not witnessed by anyone could cause hallucinations).
  • Determine whether the hallucination or delusion is bothering the person with dementia. (If it is pleasant, you may not wish to address it.)
  • Try to find a way to alleviate the distress. (For example, if the person with dementia says that her necklace has been stolen, help her look for it or distract her with another activity.)
  • Respond to the feelings and not to the issue. Rather than contradict him, acknowledge his concern.
  • Do not get angry with her, and avoid arguing with her. You will not win an argument with a person who is having a hallucination or delusion. Remember, the hallucinations and delusions are very real to her.
  • Investigate suspicions that may be based on fact. It’s possible that he really could be a victim.
  • Use familiar distractions such as listening to music, exercise, playing cards, or looking at photos.
  • Offer her reassurances.
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