Hallucinations and false ideas in dementia
People with dementing illnesses sometimes suffer from a range of conditions in which they do not experience events as they are. Although delusions and hallucinations are imaginary, they seem very real and can cause extreme anxiety, even panic.
Some conditions which people with dementia may experience
Paranoia
Paranoia is characterised by unrealistic beliefs, usually of either persecution or grandeur. People with dementia can 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 that someone is trying to take their possessions. A 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.
Hallucinations
Hallucinations are sensory experiences that cannot be verified by any one 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 simply not there. Voices may be heard, people may be seen who are not present, or strange and frightening noises may be heard.
Delusions
Delusions are ideas which are not based on reality but which are thought to be true by the person. Their content can often be centred on people stealing money or other possessions and can be manifested as fixed ideas about people intending harm.
Damage to the brain
Dementia may cause the person to lose the ability to recognise things because the brain becomes incapable of interpreting the information which it has received. Examples of this are failure to recognise a spouse or the house in which the person lives.
Problems with memory which occur in dementing illnesses 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 live in a world with no memory of recent events—where things 'disappear', explanations are forgotten or misunderstood and conversations do not make sense.
Physical or medical factors which can cause or exacerbate problem behaviours
- Sensory defects such as poor eyesight, poor hearing.
- Medication.
- Psychiatric illness.
- Physical conditions such as infections, fever, pain, constipation, anaemia, respiratory disease, malnutrition, dehydration.
Environmental factors which may also play a part
- Unfamiliar environment.
- Unfamiliar caregivers.
- Disruption of familiar routines.
- Inadequate lighting which make visual cues less clear.
- 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.
Some ways to cope
- Do not try to argue. It is better to acknowledge that the person may be frightened by the delusions and hallucinations.
- Do not scold the person for mislaying objects or hiding things.
- Investigate suspicions to make sure they are not founded on fact.
- Attempt to distract them if possible.
- Try to respond to the underlying feelings which may be at the bottom of statements which the person makes e.g. person's statement: 'My mother is coming to pick me up.' (The mother has been dead for years) Response: 'You must miss your mother. Tell me about her.'
- Distractions which may help are music, exercise, activities which the person can cope with, conversation with friends, looking at old photos or pets.
- Physical contact may be reassuring but be sure that the person is willing to accept this.
- Have a medical check-up to eliminate the presence of other physical or psychiatric problems and to check on the effects of medication.
- Have vision and hearing tested.
- Increase lighting in the environment and use night light.
- Try to improve nutrition and make sure the person is getting enough liquids.
- Try to maintain a familiar environment. If the person has to move, take some familiar things from the previous residence.
- Try to maintain consistent caregivers.
- Try to maintain a familiar routine.
- Try to learn the person's favourite hiding places.
- Keeping a diary or log 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 things which are often mislaid such as keys, purse, etc.
- Some hallucinations or false ideas may 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.
Last Reviewed: 09 March 2001
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