People with dementia can experience hallucinations that may be visual, auditory, tactile, gustatory, or olfactory. Adaptations to their space, along with certain therapies, may help.

Dementia is a term for a decline in brain function that is severe enough to affect a person’s daily life. Over time, it usually causes changes in:

  • memory
  • thinking (cognition)
  • ability to understand and use language

People with dementia may experience hallucinations that make them see, hear, feel, taste, or smell things that are not there. They may also experience false beliefs, known as delusions.

Progressive, neurodegenerative disease may cause both dementia and hallucinations.

Hallucinations affect one in five people with Alzheimer’s disease and more than half of people with Parkinson’s disease dementia and Lewy body dementia.

Keep reading to learn about the symptoms and treatment of hallucinations in dementia, why they happen, and how to help a loved one cope with them.

Visual hallucinations, in which a person sees things that aren’t there, may be the most common type of hallucination among people with dementia. Visual hallucinations can be:

  • Simple: They may involve seeing lights or shadows that aren’t there.
  • Complex: They can involve seeing people, animals, or situations that aren’t there.

People with dementia may also experience other types of hallucinations. These can include:

  • auditory hallucinations, or hearing sounds that aren’t there, such as familiar voices, music, incoherent noises, or footsteps
  • olfactory hallucinations, or smelling things that aren’t there, such as smoke, burnt smells, chemicals, or foods
  • tactile hallucinations, or physical sensations that aren’t there, such as bugs or creatures crawling on the skin (formication), burning, electric shocks, or prickling feelings
  • gustatory hallucinations, or tasting things that aren’t there, such as having a metallic taste in their mouth that isn’t caused by something they ate or drank

Hallucinations may also occur with delusions and paranoia in some people with dementia. Delusions are false beliefs that result from distrubances in thinking while paranoia refers to an irrational suspicion or distrust of others.

These three symptoms may be referred to as dementia-related psychosis.

Hallucinations, delusions, and paranoia due to dementia are typically associated with more severe neurodegenerative disease and increased atrophy of the temporal and parietal lobes, parts of the cerebral cortex. Dementia affecting this part of the brain may be referred to as cortical dementia.

The temporal lobe is commonly associated with memory and auditory processing, while the parietal lobe helps the brain process and integrate physical sensation and spatial information, including size, distance, and shapes.

Hallucinations can occur with dementia that results from different types of neurodegenerative disease, including:

  • Alzheimer’s disease is a neurodegenerative disease that destroys cells in the brain, known as neurons. This damage results in the brain shrinking and losing volume. Over time, a person with Alzheimer’s may experience various symptoms, including hallucinations.
  • Lewy body dementia causes abnormal clumps of a protein called alpha-synuclein, known as Lewy bodies, to collect within nerve cells.
  • Parkinson’s disease dementia is dementia that occurs with Parkinson’s disease, a neurodegenerative disease that leads to the loss of dopamine-producing brain cells. Parkinson’s typically causes difficulties with movement.

Other causes of hallucinations in people with dementia

Hallucinations may occur in people with dementia but result from other causes.

It’s important to rule out other causes of hallucinations to ensure the person gets appropriate treatment. Other causes can include:

  • Worsening eyesight: Dementia often occurs with vision problems. This may be because both tend to occur in older adults.
  • Physical illness: Illnesses and fever can cause hallucinations. These are typically short-lived and go away when the illness has improved.
  • Medications: Some medications may cause hallucinations.

The first line of treatment for dementia-related psychosis, which includes hallucinations, involves managing the symptoms without medication. This can include:

  • Behavioral and psychosocial interventions: This may include interventions like cognitive rehabilitation therapy programs that help train people with dementia in key activities of daily living.
  • Reminiscence therapy: This type of therapy involves using photographs, videos, and music that are associated with the person’s past. While it doesn’t reduce hallucinations, this therapy may improve mood, cognition and behavior.
  • Validation therapy: This involves validating the experiences, feelings, and reality of an individual with dementia. It doesn’t reduce hallucinations, but may encourage cooperation and safety.
  • Adjusting the environment: Among residents in a long-term care facility, individual privacy and personalization of one’s room to be more home-like along may help reduce dementia-related psychosis. If you’re caring for a loved one with dementia in your home, helping personalize their space to make it more familiar may help them.
  • Sensorial approaches: These approaches include playing music and ambient noise, improving lighting, and providing walkways for exercise. They may reduce the risk of dementia-related psychosis.
  • Hearing and visual aids: Providing hearing aids and correcting for visual disability with glasses or cataract surgery can also decrease paranoia associated with dementia.
  • Other interventions: Other interventions like incorporating routine activities, removing the person from environmental triggers, providing cues for orientation, and redirection may help reduce hallucinations and other symptoms.

Sometimes, doctors may recommend medication to help with hallucinations if the above interventions do not help. However, medications can have side effects and some medications may not be safe for older adults.

Treatment may include antipsychotic medications. These medications may reduce the hallucinations. Options may include:

It’s important to talk with a doctor about the potential benefits and risks of new medications for people with dementia. Some antipsychotic medications can increase the risk of severe side effects, including stroke.

If a loved one is experiencing hallucinations from dementia, you can help them by:

  • providing comfort if they are afraid
  • applying strategies for navigating difficult moments with dementia, such as staying calm, avoiding raising your voice, and not arguing about what they see or hear (know that it feels very real to them)
  • distracting them by moving to another room or going outside
  • avoiding upsetting or violent TV programs or movies
  • making sure they are safe by removing items that can cause injury
  • illuminating dark spaces to reduce shadows that may result in visual disturbances
  • decluttering the home to make it easy to navigate the space and reduce visual stress
  • planning walks or simple tasks or activities to help keep them occupied
  • creating and following daily routines

While being a caregiver for someone with dementia can be rewarding and affirming, it can also affect your emotional and physical health. It’s important to take steps to safeguard your own health and avoid caregiver burnout.

Some ways to take care of yourself as a caregiver include:

Some people experiencing dementia may also experience hallucinations, delusions, and paranoia. Collectively, these symptoms may be called demenia-related psychosis.

These symptoms can result from neurodegenerative changes in the brain and typically indicate worsening dementia.

Hallucinations are more common with Lewy body dementia and Parkinson’s disease dementia but can also occur with Alzheimer’s disease.

While some antipsychotic medications may help reduce hallucinations, there are risks involved with with using these medications in people with dementia. Doctors typically recommend non-medication interventions, such as adapting the person’s space, distracting or comforting them, or therapies such as cognitive rehabilitation or remiescence therapy.

If a loved one has dementia, it’s important to consider their care options and take advantage of available resources to help.