Hallucinations, Delusions and Paranoia Related to Dementia

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According to the Alzheimer’s Foundation of America, the major psychiatric symptoms of middle stage Alzheimer’s disease and other forms of dementia include hallucinations, delusions and paranoia. About 40 percent of dementia patients experience delusions, while hallucinations occur in about 25 percent of cases. When a senior is experiencing hallucinations and delusions, their caregiver often wants to help them understand that these beliefs and experiences are not real.

“It is not helpful to argue or rationally explain why something happened,” says Lisa P. Gwyther, associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University and director of the Duke Aging Center Family Support Program. “It just frustrates the person. They somehow know that you are not taking their thoughts and feelings seriously.”

While reinforcing reality seems like the logical and kind thing to do, this natural instinct can be wrong. Family caregivers can ensure they’re prepared to handle these challenging behaviors by learning the differences between them and proper coping techniques for each one.

Understanding the Differences

Hallucinations, delusions and paranoia are symptoms of disease and not a normal part of aging. While they may seem similar, they are actually very different.

Hallucinations are false sensory experiences that can be visual, auditory and/or tactile. These perceptions cannot be corrected by telling a patient that they’re not real. Examples include a dementia patient hearing music when none is playing or seeing bugs on a surface where there aren’t any.

Delusions are fixed false beliefs that are not supported by reality. They are often caused by a faulty memory. Examples include accusing caregivers of theft and infidelity.

Paranoia is centered around suspiciousness. Elderly individuals often project hostility and frustration onto caregivers through paranoid behaviors.

Coping with Hallucinations

When it comes to handling a senior’s hallucinations, Dr. Marion Somers, author of “Elder Care Made Easier: Doctor Marion’s 10 Steps to Help You Care for an Aging Loved One,” suggests joining them in their version of reality. Ask them about what they are experiencing as if it is real so that you can more effectively defuse the situation. Refrain from trying to explain that what they are seeing or hearing is all in their head. “Otherwise, you’re going to aggravate them, and you don’t want to increase the level of agitation,” says Dr. Somers.

Reassure them by validating their feelings. Say something like, “I see that you’re upset. I would be upset if I saw those things, too.” Tell them that they are safe with you and you will do whatever you can to help them feel secure.

A comforting touch, such as gently patting their back, may help the person turn their attention to you and reduce the hallucination, according to the Alzheimer’s Association. You also can suggest that they move to a different room or take a walk to get away from whatever may have triggered the experience.

Realize that some hallucinations, such as seeing children or hearing music, can be comforting. If the individual is reassured by a hallucination, caregivers don’t need to do anything to stop it, Gwyther says. “You only need to respond to things that are scary or disruptive or keep the person from getting adequate care,” she says.

In addition to dementia, poor eyesight, hearing loss, certain medications, and physical problems like dehydration and urinary tract infections (UTIs) can contribute to hallucinations. If all other factors are ruled out and a loved one’s hallucinations are disturbing and persistent, then antipsychotic medication may be prescribed to reduce them. However, Gwyther says these medications can present a risk for dementia patients. She recommends first changing the way you communicate during these episodes and changing the activity and environment to remove or reduce triggers.

The Alzheimer’s Association offers these tips to change the environment:

  • See if any lighting or lack of lighting casts shadows, distortions or reflections on walls, floors and even furniture that could contribute to visual hallucinations.
  • Listen for any sounds, such as TV or air conditioning noise, which could be misinterpreted.
  • Remove or cover mirrors if they could cause someone to think they are seeing a stranger.

Dealing with Delusions

Delusions among dementia patients typically result from their cognitive impairment. They occur when a senior tries to make sense of a situation, but their confusion and memory problems make it impossible. “They end up filling a hole in a faulty memory with a delusion that makes sense to them,” Gwyther says. For example, if a loved one cannot find their purse, they may decide that it is missing because someone stole it.

Delusions can be frightening for the person living with dementia, but they can also be very hurtful for caregivers when they are the accused. Recognize that the elderly individual is living in a world that doesn’t make sense to them and is likely scared. Do not take any accusations personally or respond with logical explanations. Instead, reassure the person and avoid asking questions that may cause more confusion. If they are looking for an item, tell them you will help them find it. In cases where a loved one regularly misplaces an item and becomes agitated over the loss, the Alzheimer’s Association recommends purchasing a duplicate of the item to quickly resolve the issue until the original is found.

Distraction is another strategy that dementia caregivers use in response to delusional thinking, but it may not work for every patient or every delusion. If a loved one is experiencing a mild delusion, offering a favorite snack or activity or asking them to tell you about an important experience in their life may be sufficient to redirect their attention. In cases where the person is very upset, reassurance may be the only viable option. Again, it is crucial to avoid rationalizing the situation and stress your commitment to their security and happiness.

Responding to Paranoia

Paranoia is less common than delusions and hallucinations but can still be very troubling. According to the Alzheimer’s Association, when paranoia occurs, caregivers can assess the problem by considering these questions:

  • What happened right before the person became suspicious?
  • Has something like this happened before?
  • Was it in the same room or at the same time of day?
  • Can this trigger be removed or altered to avoid eliciting suspicion?

If someone is experiencing paranoia, it is important to discuss their medications (prescription and over the counter drugs as well as vitamins) with their doctor. “Sometimes medications interact with one another or the dosages are too large,” notes Somers. “That can bring on paranoia, but a doctor can address problems and adjust the senior’s regimen to minimize issues.”

Recognizing the causes for all three behaviors and understanding what a loved one goes through while enduring hallucinations, delusions and paranoia can help you both keep calm and find solutions.

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71 Comments

Getting a proper diagnosis helps. Don't just let a regular GP doctor throw medication at the symptoms. I recently found out my dad has Charles Bonnet syndrome. It's related to brain damage from strokes and compromised vision. He will hallucinate as long as he can see a little. The hallucinations will stop if he goes completely blind, but that's not likely. Also, his condition could easily cause him to suffer dementia before this particular condition resolves. I may never know the exact time or transition from CB to actual dementia.

Sometimes medications can also cause hallucinations, so read the rare side effects. Doctors sometime discount them because they are rare. Something as simple as acid reflux medication and blood pressure meds cause hallucinations in rare cases, so I imagine a mixture would increase the likely hood from rare to less rare.

My point is that aging is natural. Don't kill yourself with worry. You can't solve this in the long run. Just methodically research the condition and work with a geriatric psychiatrist or geriatric neurologist.

Worry more about reassuring your parent they are safe. Ultimately, prayer helps too.

Please rule out systemic infections first! Sometimes elderly folks cannot articulate pain. My dad's dad use to hallucinate with urinary tract infections, but he never complained of pain.
My 89 yr old mother is experiencing all the issues the article points out -- hallucinations, delusions, paranoia. I took her to her physician and she didn't hold back and described same hallucinations, delusions (insisting they were real) to him. He had her evaluated by Neurologist as well. He has put her on Aricept and Namenda - she's been on almost 30 days and then he is to see her again. I don't see any change but she is very frightened that I'm trying to move her out of her home to assisted living. She also refusing outside help. I am learning to just let her tell her story -- delusional or not and I no longer try to correct her as that just frustrates her; I am learning (slowly) to accept her the way she is and accept her stories for what they are and not try to correct her reality. She has accused us of stealing and then she locates the item later. I let it go and luckily have a very understanding husband who makes me laugh about the situation. I'm looking forward to a day when the dr or a situation occurs where she will have no choice but to move into assisted living and be safe. I agree with author to just listen, stay calm and help the loved one stay calm and let them enjoy their "reality" and memories.
My moms hallucinations always involve seeing her parents and or brothers and sisters and talking to them. They all died years ago. She cannot understand where they go and why they don't want her with them. Miserable day for all.