As many caregivers of people living with Alzheimer’s and other types of dementia know, encountering episodes of hallucination and delusion can happen. During these times, caregivers can find themselves frustrated and unsure of how to reassure their loved one and keep them safe. By understanding hallucinations and delusions and the difference between them, caregivers can better know what their loved one is dealing with, how to address their needs, and when expert care is needed.

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Understanding hallucinations and delusions

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.

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, 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 Alzheimer’s is causing these delusional behaviors. Just as with hallucinations, delusions are not rational; you can’t reason with a loved one with Alzheimer’s 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, a Senior Care Advisor can guide you in your search.

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Meet the Author

Angelike Gaunt

Angelike Gaunt is a content strategist at OurParents. She’s developed health content for consumers and medical professionals at major health care organizations, including Mayo Clinic, the American Academy of Family Physicians, and the University of Kansas Health System. She’s passionate about developing accessible content to simplify complex health topics.

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

Understanding Hallucinations and Delusions in Alzheimer's

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