Picture this: you are in the middle of the meeting and receive the phone call that starts, ‘She thinks someone strange is in the house.’ It’s your sister on the phone, explaining the terrifying incident the mother described to her moments before. Hearing this, you might feel distressed and even check whether the call was from your home or if someone called you by mistake.
While you might be aware of your mother’s dementia condition, you might still wonder, why does my mother see people who aren’t there? Bewildered by the incident your sister just described, you may contemplate whether it was a case of hallucination, delusion, or paranoia. Let’s find out in this blog.
We’ll cover what hallucinations in dementia are, how delusions or paranoia differ from them, and how an expert dementia care community handles these and other distressing behaviors that families often face.
Three Things Families Confuse
How do you calm someone who is frightened by something that isn’t there? This is what most families Google after experiencing an incident just like yours. But they often conflate all behavioral challenges, thinking they’re all the same. In reality, all three of these are different issues that stem from brain changes in dementia, making it hard for families to understand what each issue means.
Here’s a breakdown of what each behavior means for the individual with dementia.
Hallucinations
It’s a behavior issue that causes the individual to experience false sensory perceptions. They happen when the brain misinterprets sensory input, causing the person to see, hear, smell, taste, or feel something that isn’t there. While the family may think these experiences are completely imaginary, they are very real for the senior experiencing them. The individual might talk to someone who isn’t there or even swat at bugs on the wall. Based on severity, some hallucination instances can be too frightening as well.
Delusions And Paranoia
Both delusions and paranoia are linked, as paranoia is a form of delusion that dementia patients develop. A delusion is a strong belief that is completely untrue. Despite clear proof, they may believe otherwise. An example of this would be the mother believing that their family members are stealing from them. Paranoia is a specific type of delusion where the individual develops a fear or suspicion of harm. They may become intensely afraid that others are trying to cheat, harm, steal from, or spy on them.
Misidentification
Misidentification and Capgras in dementia often coexist, as Capgras is a specific type of misidentification. Misidentification is a specific symptom of memory loss and visual agnosia that causes the individual to misidentify people, places, or objects. For instance, Capgras syndrome may cause the person to think that their daughter is a sister/stranger, which often triggers delusions.
Why The Brain Produces Them
Seeing a parent accusing family members of stealing in dementia is sure to cause distress among the family members. Before understanding how to respond to dementia delusions, the family should understand what actually causes these episodes. The main reason behind these behavioral issues is physical damage to the brain that alters a person’s ability to process sensory input, form memories, and reason through daily life. Progressive damage to brain tissue disrupts how the mind organizes and interprets signals from eyes, ears, and other senses. Memory loss, cognitive decline, and underlying medical issues like UTI, dehydration, severe pain, or medication side effects can abruptly trigger these distressing behavioral challenges.
Rule Out First – What Can Look Like Dementia Symptoms
Many families think of hallucinations, delusions, and paranoia as direct signs of dementia and its progression. However, it’s never right to jump to conclusions without evidence, since these issues can also result from underlying medical conditions. The symptoms of these conditions can resemble hallucinations, delusions, paranoia, and misidentification, causing the family to think that they are caused by dementia. A doctor must rule out acute, treatable, or external conditions that resemble cognitive decline.
Here are details on what can look like dementia symptoms:
Infection And Delirium
An acute infection can cause sudden confusion, hallucinations, and paranoia, all of which closely mimic progressive dementia. But families must know that this is actually delirium and requires immediate medical attention. In older adults, urinary tract infections (UTIs) and pneumonia are frequent culprits that trigger symptoms that look like dementia. Delirium can also be caused by dehydration, severe pain, lack of sleep, and low electrolyte levels, which again can cause hallucinations, paranoia, and delusions.
Medication Side Effects And Interactions
Certain medications can also induce behavioral challenges that look like dementia symptoms. Commonly, these are caused by new drugs, dose changes, or interactions between multiple prescriptions and OTC products. The combination of these can frequently trigger psychotic symptoms. Common medication types that may cause these issues include sedatives, anticholinergic drugs, and antihypertensives. Those undergoing certain Parkinson’s treatments may also face these symptoms that may look like dementia. The fix is to request a complete medication review with a primary care provider or pharmacist to evaluate drug interactions.
Vision And Hearing Loss
Certain older adults also have vision and hearing loss that may cause sensory misinterpretation that leads to hallucinations, paranoia, and false beliefs that mimic dementia. Poor eyesight can cause the brain to misinterpret shadows or shapes, leading to visual hallucinations. Likewise, worsening vision can cause the brain to perceive images that are not real. An individual’s inability to hear clearly can cause them to miss parts of conversations, leading them to suspect others are whispering, plotting, or talking about them (paranoia). Misinterpretation occurs when sights or sounds are unclear, and one’s brain tries to fill in the gap with false conclusions, which closely resembles cognitive decline.
Families themselves shouldn’t conclude whether the behavioral concerns are due to dementia or the above-mentioned reasons. They must know that new or sudden symptoms warrant a medical evaluation within the same week and shouldn’t be ignored.
Which Dementias Cause Them Most Often (And Why Lewy Body Is Different)
Dementia is an umbrella term for a group of symptoms that cause a loss of memory, thinking, and reasoning skills. However, not all dementia types affect an individual the same way. Some bring intense symptoms early on, while others may not cause any behavioral issues until the moderate stages. Because the right response differs for each person, it’s important to know which type of dementia causes the most behavioral concerns.
Here are details on which types of dementia cause psychotic symptoms most often.
- Dementia with Lewy Bodies (DLB): Visual hallucinations and paranoia are quite common, and they start near the very beginning of the disease.
- Alzheimer’s Disease: Delusions and hallucinations appear in the middle or late stages as memory and brain damage worsen.
The reason Lewy body dementia is considered unique is that the intense behavioral symptoms appear in the earliest stages due to specific visual and frontal brain damage. This damage brings early visual problems, fluctuating awareness, and Capgras syndrome due to the formation of abnormal protein clumps.
How To Respond In The Moment – Rules That Work
Understandably, it’s natural for family members to feel overwhelmed seeing their parent exhibit problematic behavioral symptoms like hallucinations, delusions, and paranoia. But in these moments, what matters is staying calm and thinking before reacting. They need to focus on the person’s emotions rather than arguing about what’s real or correcting the loved one.
Here’s what they can do in these circumstances.
Don’t Argue, Don’t Play Along – What To Do Instead
While delusions in dementia are common, it never means they can’t be managed. Family members must stay calm, acknowledge their emotions, and gently change the subject. Arguing causes distress; to the person, their reality feels completely true, and hearing anything to the contrary increases their anger. If you play along and agree with the hallucination, it can make them more upset later. Your agreement would turn their fear into something true and permanent.
Stay calm and keep your voice soft while validating their feelings. Lead with comfort: “I am right here with you,” or “You are safe in this house.” Redirect their focus by gently moving them into a new room or engaging in a new activity. Check for shadows, loud noises, or a busy TV show that might trigger fear.
Responding To Accusations Without Defending Yourself
What to do when a parent with dementia accuses you of stealing? First, don’t defend yourself or argue; instead, stay calm and comfort their feelings. Know that the reason behind their confusion and accusation is dementia. Since logic doesn’t work, acknowledge their feelings by saying things like, “You look worried,” or “It is hard to misplace things.” As they calm down, gently redirect them to another subject or activity.
When Fear Is The Real Symptom
When a person with dementia acts out strangely and experiences hallucinations, delusions, or paranoia, you should respond to their underlying fear and emotions rather than trying to argue with them or correct their false perceptions. Use calm, comforting statements to validate their emotions and gently redirect them to another activity.
Environmental Changes That Reduce Episodes (Light, Mirrors, Noise, Television)
Reducing environmental triggers plays a prominent role in managing hallucinations, delusions, and paranoia in dementia.
Here’s what the family can do to make environmental changes:
- Maintain good lighting throughout the house during the day to prevent shadows that can look like scary shapes.
- Use a soft nightlight so the room doesn’t get pitch black, which can cause misinterpretations when waking up.
- As reflections can cause fear or agitation, it’s best to remove or cover the mirror.
- Turn off loud radios and keep household sound low.
- Talk with the person in a calm, low, and gentle voice.
- Choose what they consume on the TV.
- Play familiar, happy music or gentle nature videos to help them relax.
The Medication Conversation—Questions For The Prescriber
Preparing for a medical appointment to discuss hallucinations, delusions, or paranoia in a person with dementia requires a focused list of questions to ensure a safe and effective treatment plan.
Here are some questions that the family can ask the prescriber:
- Could an underlying physical illness or pain be causing or worsening these symptoms?
- Could any current prescription drugs, OTC products, or recent medication changes be triggering this behavior?
- Do we need a vision or hearing check?
- What environmental or routine changes can we try at home to reduce the triggers and anxiety?
- Is it safe to give the person antipsychotic medications?
- How frequently is monitoring and follow-up needed?
How Trained Memory Care Teams Respond Differently
A trained memory care team manages hallucinations, delusions, paranoia, and related behavioral challenges through non-drug approaches first, using medication only as a last resort for severe distress or safety risks.
They investigate the root cause of agitation, anger, confusion, or accusations. Instead of just redirecting, they first validate feelings, then adjust the environment as needed. These professionals use medications cautiously and usually at the lowest dose for the shortest possible time.
FAQ
- What is the difference between a hallucination and a delusion?
In simple terms, a hallucination is a false sensory perception, while a delusion is a fixed false belief.
- Why do people with dementia see or hear things that aren’t there?
It’s because damage to their brain cells causes the brain to misinterpret or incorrectly process sensory information.
- Should I correct my parent or go along with it?
Don’t correct or argue with them, but avoid fully playing along with false realities. Instead, validate their feelings and redirect their attention.
- What do I say when my parent accuses me of stealing?
Never argue or try to prove them wrong. Instead, validate their point and offer to look for the missing item together.
- How do memory care teams respond differently?
As professionals, memory care teams understand that the resident’s brain has sustained significant damage due to disease progression, which has caused distressing behaviors like hallucinations, delusions, and paranoia.
Willow Falls – Compassionate Dementia Care Services That Assure Comprehensive Wellness
At Willow Falls, we understand how distressing hallucinations, delusions, and paranoia can be for an older adult with dementia. These aren’t just behavioral symptoms of the disease but experiences that cause fear, frustration, and even extreme anger.
It’s never easy for a family to manage these overwhelming situations. They may lack professional guidance on how to handle these concerns. But they don’t have to manage it alone; they can choose professional support from our trained memory care staff.
At Willow Falls, we offer holistic dementia care, tailored to residents’ individualized care needs and lifestyle preferences. Frightening symptoms are easier to manage in an environment built for them. Contact us and schedule a visit to learn more about our staff’s expertise and our community.