Understanding and Responding to Challenging Behaviors in Alzheimer’s Disease

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Hallucinations and Delusions and Alzheimer's

Some people with Alzheimer's may experience hallucinations or delusions. Not everyone with Alzheimer's will be affected in this way and not everyone who has these problems has Alzheimer's. This advice sheet looks at ways of handling these experiences.

A person with Alzheimer's may sometimes experience hallucinations. They may see, hear, smell, taste or feel things which are not really there. The most common hallucinations are those which involve sight or hearing.

The reaction of the person with Alzheimer's to the hallucinations may vary.

• They may realize that their imagination is playing tricks with them and pay no attention to the hallucination.
• They may find it difficult to decide whether or not the hallucination is real. In this case they may like you to go with them to look at the place where they thought they saw something. Or it may help if you check the room where they thought they heard voices or other noises. You can then confirm for them that nothing is there.
• As the Alzheimer's becomes more severe the person may become convinced that what they are hearing or seeing is real. They can find this very frightening. Try to let them know that, although you are not sharing their experience, you understand how very distressing it is for them. Distracting the person may help. There is absolutely no point in arguing about whether or not the things that they are seeing are real.
• Hallucinations are less likely to occur when the person is occupied or involved in what is going on around them.
• Not all hallucinations are upsetting. Sometimes it may be better to go along with the person rather than distract them. It depends on the situation.

If the hallucinations persist or the person with Alzheimer's becomes distressed by them, speak to the GP. Medication can sometimes help but, if prescribed, should be regularly reviewed by the doctor.

Visual hallucinations and Alzheimer's

Visual hallucinations are the most common type in Alzheimer's. The person may see people, animals or objects. Sometimes these involve quite complicated scenes or bizarre situations.

Such hallucinations can be the result of the person’s brain misinterpreting everyday objects. They may believe, for example, that they see faces in patterns on fabrics, that pictures on posters are real people or animals, or that their reflection in the mirror is another person.

Many people with Alzheimer's who experience visual hallucinations only experience them occasionally. However, sometimes they are more persistent and troublesome.

Possible causes of visual hallucinations include:

Illness. Hallucinations can result from physical illness such as infections. They can also be side-effects of some types of medication. A doctor should be able to help rule out these possibilities.

Eyesight. Visual hallucinations may be due to poor eyesight. This cannot always be improved but you should:

• Arrange regular eye checks and encourage the person to wear their glasses if they need them
• Check that any glasses worn are clean and that the prescription is correct
• If cataracts are the cause of poor sight, discuss whether they should be removed with the GP
• Make sure that the lighting in the home is good.

People with Alzheimer's with Lewy bodies often have a mixture of the symptoms found in Alzheimer’s disease and Parkinson’s disease. People with this form of Alzheimer's are more likely to have persistent visual hallucinations together with stiffness and slowing of movement and marked fluctuations in their abilities. In these cases, antipsychotic medication, which is sometimes prescribed for hallucinations, can make the stiffness worse. It should, therefore, only be prescribed in small doses, if at all, and reviewed regularly.

continue: Delusions and Explaining Odd Behavior to Others

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Reviewed: 03/2006