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Hallucinations and delusions

Changes in mood


If my husband addresses remarks to someone he thinks is sitting beside him, I don’t laugh or say there’s no-one there. I take it calmly and say, “Are you sure there’s someone there? Isn’t it the pattern on the curtains?”

My sister told me that a man passes nearly every day and tries the handle of our front door. One day just after the postman had delivered a letter, she told me it had happened again and was quite worried. I reassured her that the man was not a thief, but she did not seem convinced. So as I knew the postman well, he kindly agreed to ring the bell and give me the mail rather than just putting it through the letterbox. My sister still keeps an eye on him but seems to be less anxious.

A hallucination is something that someone hears, smells or feels that does not actually exist and which is usually unpleasant. A paranoid delusion, on the other hand, involves someone believing something of a persecutory nature that is not true, e.g. that the postman is deliberately withholding important letters. Unfortunately, due to communication problems, the person with dementia tends to feel increasingly isolated and have little chance to reflect on and exchange ideas with other people. People with dementia often suffer from delusional misidentifications. The most frequent types of misidentification include the misidentification of relatives or carers as being impostors, the belief that imaginary visitors are living in their home, the inability to recognise their own mirror image or misidentifying it as someone else, shock at seeing the reflection of an old person (this may also be due to problems with memory) and the misperception of people appearing on the television as being real. Furthermore, as a result of brain damage, someone with dementia might also confuse or wrongly interpret what they hear, feel and taste. For example, they might complain that a sweet dessert tastes salty, that soft music is loud or that it is freezing cold outside in the brilliant sunshine.

Hallucinations and delusions can provoke intense fear and even lead to aggressive behaviour. The person with dementia is faced with a situation that they do not understand and cannot control. At first you may be shocked and feel helpless or frustrated at not knowing what to do. However, you can help by the way you handle the situation, by providing reassurance and by taking measures to reduce the likelihood of the problem reoccurring.

How to prevent hallucinations or delusions from occurring

Consult a doctor

Hallucinations can sometimes be caused by an infection or may be a side effect of medication. It is important to contact a doctor in order to rule out these two possibilities. The doctor may be able to stop or change the medication. Medication to stop hallucinations should only be used as a last resort because of possible side effects.

Try to discover the cause and alter the environment

Sometimes, something in the environment can cause a hallucination, e.g. a mirror, dark corners, shadows, statuettes or ornaments of animals and paintings, etc. Finding out what has triggered a hallucination will help to prevent it from reoccurring. For this reason, it is a good idea to try to take away objects which are not really necessary, taking care not to make too dramatic a change at once. Otherwise, the person with dementia might miss personal belongings, think that someone has stolen them and feel disoriented as the room or building will have become unfamiliar. Alternatively, it might be possible simply to cover mirrors and draw the curtains. Ensuring that there is adequate lighting may prevent the person from seeing things that do not exist, e.g. interpreting shadows as holes in the floor.

How to cope with hallucinations and paranoid delusions

Provide explanations and reassurance, without challenging the belief

Although you should not go along with false beliefs, you can nevertheless provide reassurance that everything is all right and under control. For example, a delusion that someone is stealing spoons may be causing the person with dementia some distress. Without challenging this belief, you could reassure the person that you have more than enough spoons. If they experience hallucinations, they will really believe that what they see, hear or feel exists. It is pointless trying to persuade them that it is not the case. Insisting will only lead to frustration and discourage the person from trying to communicate what they are experiencing. You can help by providing reassurance and comfort. Touching and talking in a calm and reassuring way may bring the person back to reality. You should be careful that your touch is not interpreted as a form of restraint. Another approach is to explain that you cannot hear or see what they can, but that you understand how they must feel.

Try to create a distraction

Distracting someone who is hallucinating or suffering from paranoid delusions can be a useful technique, particularly if the person is experiencing a strong emotion such as fear or anger, and if reassurance has not worked. But this is not always possible. In such cases, you should give the person enough space, so you do not put yourself in physical danger.

Avoid using physical restraint

It is best not to restrain someone with dementia if they are hallucinating because it is not clear how this will be interpreted. Also, they may offer strong resistance, feeling that someone is trying to prevent them from escaping from a dangerous situation. This would be the case with hallucinations involving fire or gas leaks. It might be possible to reassure the person that everything is under control and calm them down. You may occasionally feel that restraint is necessary. In this case, be careful to look after your own safety too.

Don’t automatically dismiss beliefs

Try not to automatically dismiss claims made by the person with dementia that someone is stealing. The fact that someone suffers from hallucinations and delusions does not necessarily mean that everything they say is untrue. Like anyone else, they may be taken advantage of. Accusations of theft should be tactfully investigated. If you feel it necessary to approach the people concerned, you should be careful to reassure them (unless they are guilty!) that the accusations being made by the person with dementia are a consequence of the disease and should under no circumstances be taken personally.



Last Updated: Thursday 06 August 2009