Dementia Hallucinations: A Complete Guide

Medically Reviewed By Nicole Washington, DO, MPH

People with dementia may experience hallucinations due to the damage it can cause in the brain. While dementia hallucinations are often visual, some may involve sound, touch, smell, and taste. Dementia is a set of symptoms affecting memory, thinking, language, and behavior. Many conditions cause dementia due to brain damage, such as Alzheimer’s disease and Lewy body dementia.

Sometimes, dementia-related brain damage can lead to hallucinations. However, treatment approaches such as personal care and medication can help manage symptoms.

This article explains dementia hallucinations, including their types and symptoms, causes, treatment, and prevention.

Types and symptoms of dementia hallucinations

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Hallucinations are false perceptions involving the senses.

With hallucinations, you may perceive sensory information that is not really there, such as a smell.

Any of the five senses can be involved in hallucinations, such as:

  • Visual hallucinations: Visual hallucinations involve sight. For example, you may see a person who is not there.
  • Auditory hallucinations: Auditory hallucinations involve hearing. Examples of auditory hallucinations include hearing voices or footsteps.
  • Olfactory hallucinations: Olfactory hallucinations involve smell. You may smell things that are not really there, such as food or smoke.
  • Tactile hallucinations: Tactile hallucinations involve touch. Examples include feeling bugs crawling on your skin or someone touching you.
  • Gustatory hallucinations: Gustatory hallucinations involve taste. For example, you may experience tastes that are not real, such as metallic taste.

Dementia hallucinations can be very realistic. People may engage with the hallucinations, such as replying to a voice they hear. Depending on what the person perceives and how others respond, hallucinations can range from being distressing to pleasant.

Hallucinations often start in the later stages of dementia but do occur Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source in the early stages for some people.

Like other dementia symptoms, hallucinations may worsen over time. For example, they may become more frequent or involve more senses.

How to tell they are hallucinations

It can be hard to know for sure whether someone is experiencing hallucinations or other symptoms.

Sometimes, hallucinations are confused with delusion.

Both hallucinations and delusions are an altered sense of reality. However, while hallucinations relate to false sensory perceptions, delusions are false beliefs. For example, someone with dementia who is experiencing delusion may believe that they are in a different place.

Other times, someone can appear to have hallucinations, but another factor or condition is responsible, such as:

  • Misperception or misidentification: Sometimes, people misperceive or misidentify something real rather than experience hallucinations. For example, someone may say they see a person in their house but have mistaken a hanging jacket for a human figure. Listen to what the person with suspected hallucinations describes, and check whether any real sensory information could be contributing to these perceptions. If the perceptions stop after removing what could be responsible, they may not be hallucinations.
  • Hearing problems: If you or someone you care for has auditory symptoms, they may be due to a hearing problem rather than hallucinations. Arrange a hearing test for any hearing symptoms, and if you use a hearing aid, make sure it is working properly.
  • Taste or smell disorders: Some factors and health conditions can lead to Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source distortions in taste or smell, such as infections, nerve damage, certain medications, and oral problems. Speak with a dentist or ear, nose, and throat doctor for any symptoms relating to taste or smell.

Other conditions apart from dementia can also cause or contribute to hallucinations, such as:

Some of these factors can contribute to hallucinations alongside dementia. For example, having an infection may trigger or worsen dementia symptoms.

Causes of dementia hallucinations

Dementia occurs due to Trusted Source National Institute on Aging Governmental authority Go to source complex changes and damage in areas of the brain. Sometimes, this damage may affect brain areas that control sensory processing, leading to hallucinations. However, researchers are still trying to understand exactly what causes dementia in the first place.

Hallucinations can happen with all causes of dementia. However, they tend to occur more often in people with Lewy body dementia and Parkinson’s disease dementia.

Learn more about dementia, including its types, causes, and treatment.

How to manage dementia hallucinations

Approaches that might help you manage hallucinations safely and support the person having them include Trusted Source National Institute on Aging Governmental authority Go to source :

  • Assessing risk: Assess whether or not the situation is dangerous, and react calmly and quickly. Keep the person safe and away from anything they could use to hurt themself or others.
  • Reassurance: If the person is upset or afraid, reassure them with kind, comforting words, and let them know you will care for them. Ask if you can hold their hand or whether there’s anything you can do to help them feel better.
  • Validation: Try not to argue that what someone is hallucinating is not real, as it is real to them, and this can be distressing or confusing. Instead, recognize their emotions and reassure them that they are safe. Still, you may not need to go along with dementia hallucinations to validate their experience. For example, you can say, “I know you hear something, but I don’t hear it.”
  • Avoid misperceptions: Try to help the person avoid distressing or confusing input, such as violent programs on TV or unrecognizable sounds.
  • Distraction: Try distracting the person with a change of scenery or a soothing activity, such as going for a walk. Being in a well-lit, comfortable space or around other people may also help provide reassurance.

Treatment for dementia hallucinations

Dementia medications can help treat hallucinations, especially those due to Lewy body dementia.

One medication that may help with dementia hallucinations, in particular, is a type of acetylcholinesterase inhibitor called rivastigmine (Exelon). Acetylcholinesterase inhibitors can help nerve cell communication in the brain.

If other dementia medications do not help, your doctors may recommend taking an antipsychotic medication for severe or distressing hallucinations.

Learn more about dementia medications.

Antipsychotic medications for hallucinations include:

  • aripiprazole (Abilify, Aristada)
  • clozapine (Clorazil, FazaClo ODT, Versacloz)
  • haloperidol (Haldol)
  • olanzapine (Zyprexa)
  • quetiapine (SEROquel)
  • risperidone (Risperdal, RisperDONE)
  • ziprasidone (Geodon)

Talk with a doctor about the pros and cons of each antipsychotic medication and whether they may be appropriate for you. The Food and Drug Administration (FDA) adds boxed warnings to these medications due to their safety concerns, as they are linked to an increased chance Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of stroke and death in older adults with dementia.

People may also react differently, and more research is needed to understand how effective each antipsychotic is for dementia.

Preventing dementia hallucinations

Not all hallucination episodes are preventable. However, some steps may help make them more manageable or less frequent.

Follow your doctor’s treatment recommendations to help manage dementia symptoms. If hallucinations are due to a certain medication, adjusting that medication’s dosage with a doctor’s guidance may help.

Physical issues, such as dehydration and constipation, can contribute to hallucinations. Ensuring the person is comfortable, well, and has their needs met, such as hunger and thirst, may reduce the chance of hallucinations.

When to see a doctor

Speak with a doctor about any suspected hallucinations, as another condition that requires treatment may be responsible.

Consider keeping a symptom diary to help describe hallucination episodes and know when they happened. Also, be sure to inform the doctor about any other illnesses the person has or medications they are taking.

Summary

Dementia hallucinations involve sensing or perceiving things that are not really there, such as seeing a person, smelling an unpleasant smell, or hearing a voice. They occur due to damage in the brain caused by dementia.

Treatment with personal care and support, dementia medications, and antipsychotic medications may help reduce or manage hallucinations.

Speak with a doctor promptly if you or someone you care for experiences hallucinations.

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Medical Reviewer: Nicole Washington, DO, MPH
Last Review Date: 2024 Feb 8
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