Too often family caregivers get caught up in trying to determine what is “normal” for their loved ones. Normalcy can be used to describe a senior’s mood, behavior, appetite, sleep schedule, symptoms and much more. Establishing a baseline for a loved one’s mental and physical health is very useful for quickly identifying changes but trying to make comparisons with other patients and textbook definitions can be an exercise in futility. This is especially true when it comes to caring for seniors with Alzheimer’s disease and other forms of dementia. “Normal” becomes an ever-changing state that is different for every single patient. In some cases, accepting certain behaviors as normal can actually cause us to overlook important red flags.

Two distressing symptoms that people diagnosed with dementia experience at some point in the progression of the disease are hallucinations and delusions. One of the many ways that these symptoms may manifest is seeing and talking to loved ones who have passed away long ago. Caregivers are often perturbed by these incidents, but they are usually harmless. In fact, people living with dementia may find “seeing” and “speaking with” old friends or family comforting at such a difficult and confusing time.

False perceptions, such as seeing deceased loved ones, often occur in the later stages of the disease. Due to memory loss, a loved one with dementia simply may not remember that this person has died. Further damage to their brain may cause hallucinations of this person’s presence and full conversations or activities with them even though they are not there. These symptoms are most common in seniors with Alzheimer’s disease, Parkinson’s disease dementia and Lewy Body dementia. As dementia progresses, sometimes we have to live in the moment with our loved ones and understand their reality; sometimes we have to recognize when there might be another underlying issue at play.

Because these behaviors may be caused by the disease itself and/or exacerbated by additional contributing factors, it is important to discuss any new or changing symptoms with a doctor as soon as possible. Certain environmental factors, dehydration, lack of sleep, changes in or reactions to medication, and even infections can contribute to hallucinations and delusions. The physician will want to get a well-rounded picture of the patient’s health to rule out other medical issues like a urinary tract infection (UTI) or an adverse side effect of a medication. Doctors who specialize in Alzheimer’s disease and other types of dementia, such as geriatricians, geriatric psychiatrists and neurologists are best equipped to assess and treat a patient’s dementia-related behaviors.

Antipsychotic medications like Seroquel, Risperdal and Haldol may be prescribed if the disease alone is to blame and these delusions are upsetting and interfering with a patient’s quality of life. However, these medications do have side effects and can increase a senior’s risk of stroke and even death. The best initial course of action is to use non-drug approaches to calm a dementia patient who is hallucinating, paranoid or delusional.


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Read: Coping with Hallucinations, Delusions and Paranoia Related to Dementia