Hallucinations, or sensing things that aren’t actually real, can be a symptom of Alzheimer’s disease. Health experts aren’t sure how common this symptom is in people living with Alzheimer’s, though estimates range from 7 percent to 35 percent.

Hallucinations can be distressing for caregivers who may not know how to respond in the moment. Here’s what caregivers need to know to effectively care for someone who is experiencing hallucinations.

What Are Hallucinations?

Hallucinations involve the five senses. If your family member is experiencing a hallucination, they will have a false perception that they are seeing, hearing, tasting, touching, and/or smelling something that is not actually there. Visual hallucinations involve seeing things or people that aren’t there. Auditory hallucinations involve hearing voices or other sounds that aren’t real.

Hallucinations can be connected to delusions, which are false beliefs a person holds that have no basis in reality. Paranoia is a type of delusion that is negative and causes a person distress or suspicion that people around them are mean, lying, or out to get them.

What Causes Hallucinations in Alzheimer’s?

The Alzheimer’s Society and the Alzheimer’s Association note several potential causes for hallucinations in people with Alzheimer’s. These include:

• Damage to the brain — This is the most common cause of visual hallucinations. Damage to the brain can affect how it processes sensory information.
• Vision problems — People who lose their eyesight as they age sometimes develop what’s called Charles Bonnet syndrome, which involves seeing visual hallucinations as the brain adjusts to vision loss.
• Hearing problems — Hearing impairments can contribute to auditory hallucinations.
• Physical illness — Fever, seizure, migraine, inflammation, stroke, and infection can all contribute to hallucinations.
• Other physical problems — These may include dehydration, severe pain, or overuse of alcohol or drugs.
• Certain medications — Some drugs may cause hallucinations as a side effect, though this is rare.

Can Other Types of Dementia Cause Hallucinations?

People with other types of dementia may experience hallucinations. For example, visual hallucinations are one of the main symptoms of dementia with Lewy bodies. Parkinson’s disease dementia can also cause hallucinations. People with Parkinson’s can also have hallucinations without dementia. Other types of dementia, like vascular dementia or frontotemporal dementia, may cause hallucinations, but it’s not a common symptom.

What myALZteam Members Say About Hallucinations

At myALZteam, many caregiving members have tried to support their loved ones during hallucinations. One member said, “My husband has had hallucinations. He thought shadows on the barn were people breaking my car windows. Later, he told me not to breathe because the little people had poisoned the air.”

Hallucinations can cause difficulties for caregivers, as one member explained: “Mum has been having hallucinations at night — calling me at all hours, 3 a.m. — she is up and dressed, thinking I am there and have told her to get ready for an appointment!”

Some people temporarily lose functional abilities during hallucinations. One member shared, “Has anyone experienced hallucinations with their loved one? When my mom has them, all her motor skills stop working. She was unable to walk yesterday or feed herself.”

Handling a loved one’s hallucinations can be frustrating and difficult, especially when you’ve tried many ways to help and nothing works. One caregiver explained: “I don’t know how to deal with the hallucinations. No amount of talking seems to help. If I agree, he wants the police called. If I don't see or hear them, I have a problem and just don’t care.”

It’s important that caregivers for people with Alzheimer’s have a plan in place to help their loved ones and themselves navigate instances of hallucinations.

How To Respond to Alzheimer’s Hallucinations

There are several ways you can respond if your loved one with Alzheimer’s is experiencing hallucinations. The following tips can help everyone get through the hallucination safely and keep their quality of life as high as possible.

1. Offer Reassurance

Reassure your loved one that, despite the hallucination, they are not alone and they are going to be OK. Remind them that you are there with them and that you don’t plan to leave anytime soon. Talk them through it, and tell them that you will protect them from things that distress, scare, or worry them.

It may help to touch them gently, though don’t do this if it triggers a more intense response. If you can, talk to them about how they are feeling. Acknowledging their emotions can help them feel better about the situation as they perceive it.

2. Distract Them

Sometimes, you can use distractions to help someone transition out of the hallucination. Keep things they like to do nearby, and try to get them to engage with something other than the hallucinations. Consider:

• Looking at old photographs
• Listening to music they know and love
• Going on a walk
• Doing something else simple that they enjoy

3. Be Honest

Don’t pretend you are experiencing the hallucinations the way they are. You can try to avoid the topic completely by focusing on their feelings and distracting them. You should also avoid interacting with the hallucination or pretending that it’s real.

If that doesn’t work and they ask you about the hallucinations, acknowledge their experience and then speak the truth of yours. Tell them that you know they are experiencing something, but that you aren’t sharing that experience. You don’t have to do this aggressively or even assertively. Simply them that you’re not having the same experience they are.

4. Avoid Argument

It can be tempting to try to convince your loved one that their hallucination is not real. However, this can lead to arguments or even angry outbursts. Remember that, as much as rational persuasion seems like it should help, it is unlikely to make a difference. If telling them that you aren’t experiencing what they are experiencing sparks an argument, redirect the conversation away from these topics until you can find a distraction that takes their mind off the hallucination.

5. Find a Routine and Stick to It

When every day looks relatively the same and your loved one with Alzheimer’s knows what to expect, they may be less likely to experience hallucinations. Creating routines that your loved one follows as much as possible can help reduce the number of hallucinations you and they work through.

Do your best to stick to the same routine every day. On days when the routine may change, be aware and plan ahead how you will deal with hallucinations should they come up.

6. Look for Patterns and Make Changes

Take notes about when and where hallucinations happen, and be sure to note what room you are in, what the light is like, what it sounds like, and any other details you notice. If there are patterns in the causes of hallucinations, try making some changes. These may include:

• Adding more light
• Lowering the noise level
• Moving the furniture

If certain objects seem to trigger the hallucinations, place them where your loved one won’t see them. If the hallucinations seem to happen at a certain time of day, change your routine for that stretch of time and see if that helps.

7. Get Help

If your loved one is experiencing hallucinations, talk to their healthcare provider at the next visit. They may take a look at your loved one’s medication list and remove or change some of the drugs that could be causing the problem.

They will also let you know if you need to look for a cause outside of Alzheimer’s. Other conditions can cause hallucinations, including:

• Kidney infections
• Urinary tract infections
• Bladder infections
• Dehydration
• Uncontrolled pain

Some medications, like antipsychotic medications, can help improve hallucinations. Medications can have side effects, so nondrug approaches may be preferable. Your doctor will go over this with you and help find ways to reduce hallucinations.

Talk With Others Who Understand

On myALZteam, people share their experiences with Alzheimer’s disease, get advice, and find support from others who understand.

Are you caring for someone who has hallucinations due to Alzheimer’s? Let others know in the comments below.