Hallucinations, Delusions and Paranoia Related to Dementia

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Watching an elderly person experience hallucinations and delusions can be difficult when you're trying to offer the best care to someone you love so much.

Caregivers want to help loved ones know that these troubling behaviors are not real, but that natural instinct can be wrong.

"You can't argue or rationally explain why something happened. That doesn't help. It just frustrates the person. The person somehow knows that you are talking down to them, not taking them seriously, treating them in an undignified manner," 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.

Major psychiatric symptoms of Alzheimer's disease include hallucinations and delusions, which usually occur in the middle stage of dementia, according to the Alzheimer's Foundation of America. About 40 percent of dementia patients experience delusions, while hallucinations occur in about 25 percent of cases.

Understanding the Differences and Why

Hallucinations, delusions and paranoia are not symptoms of age, but of disease. Caregivers can't prevent them, but how you respond can help someone deal with the reactions, such as aggression, agitation and violent outbursts. As Alzheimer's advances, the responses may become more dangerous as people try to act on the delusions or hallucinations.

Hallucinations are:

  • A sensory experience – visual, auditory, and/or tactile – that often occurs when someone wakes up.
  • A false perception of something they see, hear or feel that cannot be corrected by someone telling them it is not real.

Delusions are:

  • A fixed false belief not supported by reality, and often caused by a faulty memory.
  • Often blaming caregivers for theft and infidelity.

Paranoia is:

  • Centered around suspiciousness.
  • A way an elderly person projects hostility and frustration onto caregivers.

Coping with Hallucinations

"Go to their reality," says Dr. Marion Somers, author of "Elder Care Made Easier: Doctor Marion's 10 Steps to Help You Care for an Aging Loved One." "Otherwise, you're going to aggravate them, and you don't want to increase the level of agitation. You want to calm the situation."

Reassure them in the moment by saying, "I see you're scared. I would be scared if I saw those things too." Tell them you will stay with them and they are safe with you.

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 what they are seeing.

Realize that some hallucinations, such as seeing or hearing children in the house, can be comforting. If the individual is reassured by a hallucination, caregivers don't need to do anything to stop it, Gwyther says. "You need to respond to the things that are scary or disruptive or keep the person from getting adequate care," she says. "If these symptoms escalate and threatening behavior toward a family caregiver, then you have to do something about it."

Other causes of hallucinations can be:

  • Eyesight or hearing problems
  • Medications
  • Physical problems, such as dehydration and kidney or bladder infections
  • Schizophrenia
  • Alcohol or drug abuse

Severe hallucinations may warrant anti-psychotic medication, but Gwyther says medication can present a risk for dementia patients. She recommends first changing the way you communicate by reassuring them, and changing the activity and environment.

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.
  • Listen for any sounds, such as TV or air conditioning noise, that could be misinterpreted.
  • Remove mirrors or cover up mirrors, if it could cause someone to think they are seeing a stranger.

Dealing with Delusions

Delusions among dementia patients typically are mild and result from memory problems. Individuals fill a hole in a faulty memory with a delusion that makes sense to them because they don't remember where they last saw an object, Gwyther says. Recognize that the elderly individual is living in a world that doesn't make sense and is scared. Don't take any accusations personally or respond by saying, "Why would I take that?"

Instead, reassure the person, without asking questions. If they are looking for an item, tell them you will help them find it. You also may want to keep a spare set of items commonly lost, the Alzheimer's Association recommends.

Then you can try to distract them, by saying something such as "But before we look, why don't we take a break and have some ice cream."

If a caregiver spouse is being confronted with delusions of infidelity, realize that the elderly person is afraid of being abandoned. Here's one possible response: "I'm a one-woman man. We're in this together and we're going to see each other through it."

Responding to Paranoia

Paranoia is least likely of the three behaviors, but just as troubling when it's out of character for someone. When paranoia occurs, caregivers can assess the problem by considering these questions, according to the Alzheimer's Association:

  • What happened right before the person became suspicious?
  • Has something like this happened before?
  • Was it in the same room or the same time of day?

If someone is experiencing paranoia, it is important to discuss their medications (prescribed and over the counter as well as vitamins) with their doctor, says Somers, who has more than 40 years of experience as a geriatric care manager and caregiver.

"Sometimes they're overmedicating themselves," she says. "That can bring on paranoia."

Recognizing the causes for all three behaviors and understanding the mindset when someone is enduring hallucinations, delusions and paranoia can help you keep calm as a caregiver.

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65 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 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.
We are just starting to deal with our mother's paranoia and this information is a good starting point. The big issue I see right off is how do you get the elderly person to go see a doctor about these problems when they refuse to believe it is their problem and not people plotting against them? Any ideas on how to convince them to go to the doctor?