Symptoms of Dementia: Hallucinations and Delusions

Dementia is a broad term that describes a range of symptoms that affect cognitive function, including memory, perception, disposition, and conduct. When interviewed by the AARP, individuals diagnosed with dementia discussed the frequent blanks in their memory and difficulty expressing themselves in the early days of their diagnosis. They also conveyed fear about their future, as their condition continued to progress through a series of stages with increasing severity. Likewise, communicating with people with dementia can be difficult for family members, friends, and caregivers as they watch their loved ones gradually lose their memories, undergo drastic personality changes, and need help with tasks that were once simple for them. Two potential symptoms of dementia that can be especially hard to navigate are hallucinations and delusions.

Hallucinations are false sensory perceptions that are only detectable to the individual experiencing them. These perceptions are not actually present in the environment and can encompass any of the five senses. Given how realistic the sensations are to an affected individual, people with dementia can act on their hallucinations, such as by having entire conversations with an imagined person or running out of a building to escape a nonexistent fire. As dementia is caused by damage to the brain, studies have hypothesized that hallucinations originate from sensory misperceptions or “reduced bottom-up sensory drives,” where the brain makes incorrect interpretations of real stimuli in the environment.

Since hallucinations can be distressing, the most effective way for someone to help an affected individual cope is by comforting them. Even without a full understanding of how hallucinations are experienced, especially as they can last anywhere from minutes to days, observers can still attempt to distract an individual from their hallucinations. An observer could initiate a new conversation or bring the person to a different room, removing them from possible distractions, all the while checking for safety. Even though there are no long-term treatments to prevent hallucinations, by taking steps to make the environment safe, such as through covering large mirrors to cover reflections or leaving the lights on to hide offending shadows, one could ensure that the affected person is as comfortable as possible, even while experiencing hallucinations.

Delusions are where a person believes in something that is not true. Unlike hallucinations, delusions are not sensory experiences, and, rather, are ingrained in the person’s thought process. Delusions specifically associated with dementia can manifest as suspicions about other people, or misidentification of familiar objects and people. Studies have found that the delusions are caused by damage to the frontal and temporal lobes of the brain, and the lateralization of damage can predict which symptom is pronounced. Examples of dementia-related delusions are false beliefs that caregivers are trying to harm or steal from them, or that a deceased family member will soon be visiting them. In a study published in the Journal of Neuropsychiatric Disease and Treatment, researchers conducted interviews with patients living with Alzheimer’s disease, a subset of dementia, to explore differences in perception. The researchers found that patients unconsciously altered the passage of time by perceiving it as a combination of past and present events, which potentially explains the manifestation of some delusions.

Delusions can be terrifying experiences for individuals with dementia, so, again, it is best to allow the person to know that they are safe and to support them through the experience. This is because, like hallucinations, there are no medical treatments for delusions. For that reason, instead of attempting to convince the person of the truth, which can exacerbate their doubts, one could gently reassure them that their concerns are valid and offer an alternative explanation. If possible, one should try to remove the offending stimuli from the environment, allowing the affected individual to feel more comfortable.

Hallucinations and delusions can pose obstacles for family members, friends, and caregivers as they navigate the cognitive changes an individual with dementia faces. Experts from the National Health Service suggest that loved ones keep a simple routine, practice active listening while conversing, and address the person’s needs as they arise, while allowing them to maintain a degree of independence. To overcome further communication barriers, it is important to acknowledge and respect the beliefs an individual with dementia holds, and to avoid asking too many questions or dismissing their experiences. As frustrating as it is to watch someone undergo distressing events, it is often equally, if not more distressing, for individuals when they experience a completely different reality from those around them. In such situations, communication is vital, especially practicing attention, empathy, and using open body language, ensuring that the safety and health of the individual with dementia is prioritized at all times.

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