What's the difference between Alzheimer's hallucinations and delusions?

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Q: The doctor told me that my elderly father was having hallucinations and delusions while in the hospital. What’s the difference?

A: A hallucination is experienced through one of the five senses: so a person may see, hear, smell, taste, or feel things that seem real but aren't. A delusion, on the other hand, is something a person thinks something they strongly believe to be true, which is not. Because Alzheimer's hallucinations and delusions seem so real to the person experiencing them, it is often impossible to convince them otherwise.

Both of my parents had Alzheimer's simultaneously. They had numerous hallucinations and delusions, but I realized that if they weren't harmful or hurtful to them, just relax and go with the flow. I'd ask them to tell me more about it and tried to calm their fears. I learned to live in their reality of the moment, rather than cause confusion and make them feel bad all the time by telling them that their minds weren't working properly anymore. Unfortunately, when a hallucination or delusion caused fear, it was so much harder for them—and for me—to deal with.

I cried often during my first year of caregiving before I learned what to say when my father woke me up at 4:00 a.m. "Ohhh my goodness, really Dad? You know what? I think you might have had a real vivid dream. You've been sleeping, and I know my dreams can seem so real to me, sometimes, too. You trust me, don't you? I promise there isn't anyone else in the house, but let's lock all the doors together again so you feel safe, OK?" I can't even describe to you the look of relief and thanks on my father's face.

Then a few years ago, it was so interesting when I experienced my own amazing hallucination while I was in the hospital nine days from breast cancer complications. Initially, I didn't want heavy pain medication, but the pain was so severe I begged my doctor to try everything. Pills, shots, patches, drips, you name it, we tried it. Finally, my doctor sighed in exasperation, "I just don't know what else to give you Jacqueline, we've thrown the hospital at you!"

So, as I lay there in la-la land, I happened to look down to see thousands of ants crawling on the floor and up my hospital bed. I was stunned and frightened, but then amazingly my rational mind somehow thought, "OK, wait a minute here—what are the odds of that many ants being in a brand new hospital?"

I buzzed for my nurse. "Ummm, I'm sorry, I think I may have dropped some of my lunch on the floor and I just saw a few ants—do you see them there now?" She looked down carefully studying the floor (as I'm seeing thousands of black swarming ants) and says, "No, I can't find any now, but I'll have the floor mopped right away."

I thought, hummm, very interesting—I'm having one of those hallucinations that I always lecture about! I kept looking and blinking harder and harder and I could still see thousands of them—so vivid, so real! And then when the door started warbling back and forth with thousands of ants on it, I thought, "Dang, I should have done drugs in my youth, then I'd probably be able to enjoy this more!"

I find it fascinating that as soon as I realized that my mind was playing tricks on me, because of the pain meds, I was able to relax and just enjoyed the show. But I can just imagine how confusing and frightening it would be if I didn't understand that. And that is the case for people with dementia. It would be so infuriating to watch thousands of creepy-crawly ants coming toward me, while being told by everyone that they just weren't there. I swear, when I first saw the "ants" I would have bet money that they were real!

Isn't it interesting that my caregiving experience with my parents, and my own illness, has given me a deeper understanding of hallucinations and delusions—and even more compassion for the victims of dementia, as well as their heart-broken families.

Jacqueline Marcell is a former television executive who was so compelled by caring for her elderly parents (both with early Alzheimer's not diagnosed for over a year) she wrote "Elder Rage." She is also an international speaker on elder care and host of the popular Internet radio program "Coping With Caregiving."

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