Understanding and Responding to Challenging Behaviors in Alzheimer’s Disease

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Auditory hallucinations and Alzheimer's

These occur when the person hears voices or noises although nothing is there. As with visual hallucinations it is important to rule out physical causes such as physical illness and the side-effects of medication. It is also worth checking the person’s hearing and make sure that their hearing aid is working properly if they wear one.

One indication that the person may be experiencing auditory hallucinations is when they talk to themselves and pause, as though waiting for someone else to finish speaking before continuing. However, talking to oneself is very common – not everyone who does this is having an hallucination.

Shouting at people who are not there also suggests the possibility of hallucinations.

People are less likely to hear voices when they are talking to someone real, so company can help.

Delusions and Alzheimer's

A person with Alzheimer's may sometimes become rather suspicious. This is usually because of their failing memory. They may accuse someone of stealing from them when something has been mislaid, for example. However, they are often reassured when the object is found.

With some people this suspicion goes much deeper and they may develop distorted ideas about what is actually happening. The person may become convinced that other people want to harm them, for example, and no amount of evidence to the contrary will persuade them otherwise. This kind of belief is called a delusion and can be very distressing both for the person with Alzheimer's and for those who care for them.

Common delusions that people with Alzheimer's have are:

• Their partner is being unfaithful
• Their partner or close relative has been replaced by an impostor who closely resembles them
• Their home is not their own and they do not recognize it
• Their food is being poisoned
• Their neighbors are spying on them

A person with Alzheimer's has these odd ideas because of the changes that are occurring in their brain. However, sometimes these ideas may be created by hallucinations.

There is little point in arguing with the person as only cause further distress to both of you.

Tips

• Try to reassure the person that you are on their side and want to help them.
• Distract them with other activities.
• Ask for advice from a specialist community nurse who can be contacted through your doctor.
• Medication can sometimes be helpful, particularly if the person is becoming aggressive. This type of medication needs to be reviewed regularly. Ask your doctor.

Explaining behavior

It is important to explain any unusual beliefs or behavior to anyone who comes into contact with the person with Alzheimer's. If they understand the situation they will be more able to reassure or distract the person as appropriate.

continue: Alzheimer's and Aggressive Behavior

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Reviewed: 03/2006