Do You See What I See? Hallucinations and Delusions in Dementia

How they are different and what you can do to help

By Dan Bulgarelli, Positive Approach to Care

Have you ever witnessed a person living with dementia experience hallucinations or delusions?

While they both deal with a disconnect from reality, they are very different and come from different parts of the brain.

What can cause this, and more importantly, what can you do to help and support a person experiencing them? Let’s take a look at some ideas for steps to take in the moment.

Hallucinations

Hallucinations happen when a person’s brain is either receiving faulty information from the body or the brain is not able to accurately process the data that their body is providing.

Hallucinations can be distressing for the person experiencing them as well as those around them. If a person is hallucinating, their brain is reacting to something that is not there for you.

For the person experiencing the hallucination that bugs are crawling all over their body, their brain is telling them it is all real. In an attempt to help, you may want to orient them, tell them that the bugs aren’t there; but the person can see them, can feel them on their skin, and maybe more. Assuring them that it isn’t real would be akin to me telling you that you aren’t reading this right now. You aren’t holding a phone, tablet, or computer. You aren’t sitting on a chair.

Hallucinations are most often found in Lewy Body Dementia, but can be found with other dementias and certain mental illnesses.

Delusions

Delusions have to do with thinking, not data intake. The brain is accurately processing the data that is coming in, but the thinking process and conclusions are not logical, reasonable or rational.

For example, let’s say a man has a spot where he typically puts his wallet at the end of the day. He is worried that his son that comes over every day is going to take it, so he hides it. The next morning, he doesn’t remember that he hid his wallet, so when he can’t find it, he is very upset knowing that his wallet has been stolen.

Now that you have a better understanding of what delusions and hallucinations are and how they differ, what can you do when someone you love is living with them?

The most important thing to remember is to avoid trying to orient them or arguing with them. Not only are these options not helpful, they can actually hurt your relationship.

When a person is experiencing hallucinations, you could try:

1. Repeating a few of their words

Repeating a few of their words back in the form of a question with genuine curiosity.

By repeating a few of their words back in the form of a question, you’re validating their beliefs. This will make them feel heard, and may make them feel like you’re on their side.

• You’re seeing kids outside your window?

• There’s a dog that keeps sneaking into your room?

• Your food smells bad today?

2. Determine if they feel at risk

Determine if they feel they are at risk or not. If the person does not feel they are at risk, it may be acceptable to just let it be.

If they are feeling at risk, having you there and validating them can make them feel safer, and you can come up with the next steps together.

• Do the kids outside seem like they’re up to no good or just playing?

• Is the dog looking for attention or is he kind of mean?

3. Ask for or provide a separate sensation

If they feel like they are at risk, asking for or providing a separate sensation can help.

By providing another sensation, you are giving the brain something new to focus on, which will likely override the input causing the hallucination.

• There’s a menacing person outside? What are they wearing?

  • This usually creates a need to use their eyes to provide detail, so when they look again the person probably won’t be there.

• There are bugs on your arm? Yuck. Let me see if I can rub them off.

  • At this point, you can have them plant their hand on yours while you rub their arm with the base of your palm. Use deep pressure as you sweep the bugs off.

When a person is experiencing delusions, it is also important to validate their beliefs so they know they have been heard. The easiest way to do that is to repeat a few of their words back in the form of a question. This can be difficult if you are the one they are accusing of having done something, but it allows you to connect in a positive way versus starting with an argument.

• Your wallet is missing? That is frustrating. You think I took your wallet? Hmm, I don’t think I took your wallet, it doesn’t seem like something I’d do. What makes you think it was me?

• You think your husband is cheating on you? Oh no, that’s not good. Why do you think he’s cheating on you? Oh, he took your car keys away and he goes driving without you? Well gee, he doesn’t seem like someone that would do that, but I could be wrong. Would you like me to go talk to him?

As you can see, you can validate without agreeing with the person. Starting the conversation with curiosity allows you to figure out what was triggering the delusion in the first place while also allowing the person to be heard and valued.

While hallucinations and delusions can be scary, knowing how you can try to help can offer you a little comfort during these situations. And by reflecting their words and letting them know that they’re not going through this alone, you give them the opportunity to feel a little more at ease as well.

While there’s no one size fits all solution in dementia care, letting the other person know that you’re by their side may help calm the situation a little bit for both of you.