Dementia - hallucinations and false ideas

People with dementia sometimes suffer from a range of conditions in which they do not experience events as they really are. Although hallucinations and delusions are imaginary, they seem very real and can cause extreme anxiety or even panic.

Hallucinations
Hallucinations are sensory experiences that cannot be verified by anyone other than the person experiencing them. Such experiences may include any of the senses, but the most common are visual and auditory hallucinations - the person sees or hears something that is not there. Voices may be heard, people may be seen who are not present, or strange and frightening noises may be heard.

Paranoia
Paranoia is characterised by unrealistic beliefs, usually of either persecution or grandeur. People with dementia may believe that others are out to get them, or that they have superhuman powers.

People with dementia sometimes become quite suspicious, accusing others of stealing things and hoarding or hiding things because they believe that someone is trying to take their possessions. Another common accusation is that the person's partner is being unfaithful. Such ideas may lead the person with dementia to become fearful and resistant to attempts to care for them.

Delusions
Delusions are ideas which are not based on reality but which are thought to be true by the person with dementia. Their content can often be centred on people stealing money or other possessions, or they may have fixed ideas about people intending to harm them.

Misidentification
People with dementia can misidentify other people. Sometimes they do not recognise their husband or wife as being the person they have known. At other times, they may think their reflection in the mirror is a real person and become frightened of it, or think that voices on the radio or television are from people in the room with them.

Causes of hallucinations and paranoia
Dementia may cause the person to lose the ability to recognise previously familiar things because the brain can no longer interpret the information which it has received. Examples of this include failure to recognise a partner or the house in which the person lives.

Problems with memory which occur in dementing illnesses may lead to suspiciousness, paranoia and false ideas. If people with dementia are unaware that their memory is poor, they will often create an interpretation in which someone or something else is blamed. This is understandable when they often live in a world with no memory of recent events - where things 'disappear', explanations can be forgotten and conversations do not always make sense.

Factors which may cause or make behaviours worse:
Sensory defects, such as poor eyesight or poor hearing.
Side effects of some medications.
Psychiatric illness.
An unfamiliar environment.
Inadequate lighting, making visual cues less clear.
Physical conditions - such as infections, fever, pain, constipation, anaemia, respiratory disease, malnutrition or dehydration.
Unfamiliar caregivers.
Disruption of familiar routines.
Misinterpretation of environmental cues because of such things as forgetting to use a hearing aid or glasses.
Sensory overload because of too many things going on at once.

Where to begin
Arrange for a medical check-up to eliminate the presence of other physical or psychiatric problems and to check the effects of medication.

Treatment
Medication will sometimes help to control delusions or hallucinations in people with dementia and, occasionally, will help to control misidentification syndromes. However, many of the anti-psychotic medications used to treat these disorders have side effects and may cause stiffness, shakiness, drowsiness or falls. Newer anti-psychotic medications have fewer side effects than the older drugs, but can still cause sedation. Sometimes, where delusions and hallucinations are causing a major problem, a trial of a drug treatment may be appropriate.

Things you can try
Do not argue - it is better to acknowledge that the person may be frightened by the delusions and hallucinations.
Do not scold the person for losing objects or hiding things.
Investigate suspicions to make sure they are not founded on fact.
Attempt to distract the person if possible.
Try to respond to the underlying feelings which may be at the bottom of the statements that the person makes.
Distractions that may help include music, exercise, activities which the person can cope with, conversation with friends and looking at old photos.
Physical contact may be reassuring but be sure that the person is willing to accept this.
Try to maintain a familiar environment - if the person has to move, take some familiar things from the previous residence.
Increase lighting in the home and use night lights.
Try to maintain consistent caregivers.
Try to maintain a consistent routine.
Identify the person's favourite hiding places.
Keep a diary - it may help to establish whether these behaviours occur at particular times of the day or with particular people. Identifying such causes may help the carer to be able to make changes to overcome the difficulties.

If possible, keep a spare set of the things that are often mislaid - such as keys, purse or glasses.
Some hallucinations and false ideas can be ignored if they are harmless and do not cause the person to become agitated. Do not take accusations personally and be aware that the person is not able to control this behaviour.

Support for carers
Dealing with these behaviours day in, day out is not easy. It is essential that the carer seeks support for themselves from an understanding family member, a friend, a professional or a support group.

Twice Blessed,

My folder/file is getting quite fat! I have read at least ten books on AD, but nothing is as complete and concise as these postings.

Thank you, again.

Barb

Thank you for this info. My mom is convinced I have left my husband and having an affair with her ex-boyfriend. I kind of lost it the other day trying to convince her all this is not happening.She is sure I am running the bars.
A couple of times she said we were trying to kill her.
Now I know this is just part of it that comes and goes and try not to waste energy. IT still hurts even if not true.

Yup - my mom saw an elephant on our back porch. She was convinced it was an elephant. We have a lot of animals (dogs, cats, chickens, ducks and horses) but no elephants. She quickly snapped out of it, but it did leave me a little unnerved for a bit.

Betsy, I can imagine!

TB,
your posts are SO timely, thanks. my niece watched my dad this weekend so my husband and i could get a little (much needed and appreciated) respite. my niece said my dad was hallucinating and also a little paranoid (that people were going to come and kill him). reading your post may explain some of that. no incidents since he is back at my house of which i am grateful. thanks again for all your wisdom!

My mother's condition is deterioting fairly rapidly and the hallucinations is the worst problem. Does anyone know if a geriatic psychiatrist would be effective in helping these problems?

I would certainly think so. You are fortunate to have one in your area!..And welcome to our forum!

Twiced Blessed, thank you for posting this. My mom has had hallucinations and she also gets very upset with me most mornings as I am getting ready to go to work (stay home with me, you don't need to work) and I feel so guilty. I try to remind myself that it's just the alz but it's hard.

The gentleman I take care of is quite bad during dusk. The lights from outdoors and indoors will reflect on flat surfaces or glass. They bend the light and with their poor eyesight it can be awfully confusing. If you can close shades or curtains at this time of day, or later when they will see their own reflection in a sliding glass door this may help. Good luck!

ttt

Thank for posting this! My mom recently told me that my dad had been talking to his reflection in the mirror and believed it was another person. he kept trying to introduce her to the person!

I also think dehydration intensified his hallucinations. It's extremely important to make sure the LO is hydrated and their electrolytes are in balance.

Thank you for sharing your experiences. My mother is 91 and has, mostly, in good heath for her age. 3 days ago she was hospitalized for fainting and falling down. She was supposed to be released today, but I noticed some unfamiliar symptoms today. She started experiencing auditory and visual hallucinations, seeing and hearing things that the rest of us could not confirm. When we informed the doctor, he cancelled her release, and my mother will be examined by a neurologist to find the cause of her hallucinations. These posts is giving me some general information that it may be early symptoms al alzhermers??

Thank you for sharing your experiences. My mother is 91 and has, mostly, in good heath for her age. 3 days ago she was hospitalized for fainting and falling down. She was supposed to be released today, but I noticed some unfamiliar symptoms today. She started experiencing auditory and visual hallucinations, seeing and hearing things that the rest of us could not confirm. When we informed the doctor, he cancelled her release, and my mother will be examined by a neurologist to find the cause of her hallucinations. These posts is giving me some general information that it may be early symptoms al alzhermers??

Thank you so much for this information. It explains a lot to me about what is going on with my husband. This is not an easy journey and but with God's help we will make it.

oldie but goodie...ttt
zerotears