Caregiver guide
Senile dementia hallucinations, delusions and paranoia: how to respond
Many people living with dementia see, hear or believe things that aren't real, or become convinced someone is stealing from them. Don't argue. Stay calm, comfort the feeling, check for a medical cause, and tell the doctor.
When your person sees things that aren't there
Maybe your mom talks about the children playing in the backyard when no one is there. Maybe your husband is sure the neighbor is coming in at night to move his things. Or maybe your wife wakes you up to ask if you're really her husband.
These moments can be scary and heartbreaking. To your person, they are completely real.
People often search for "senile dementia hallucinations." Senile dementia is an older phrase that doctors don't use anymore. Today we'd say hallucinations in a person living with Alzheimer's or another dementia. Whatever you call it, it's common, and there are calm, kind ways to respond.
What is the difference between hallucinations, delusions and paranoia?
- Hallucinations are when a person sees, hears, smells, tastes or feels something that isn't there. Seeing people or animals in the room is a common example.
- Delusions are firm beliefs that aren't true, such as "This isn't my house" or "My wife is an impostor."
- Paranoia is a type of delusion where the person believes others are lying, stealing or out to hurt them. They may become suspicious, fearful or jealous.
Your person may also misread what's around them. A coat on a chair may look like a person, or a pattern on the rug may look like bugs. Better lighting can help with this.
What stage of dementia has hallucinations?
In Alzheimer's disease, hallucinations and delusions are more common in the middle and later stages, as memory and thinking get worse. Paranoia often grows as memory loss grows.
In some other types of dementia, they can come much earlier. That's why it's important to tell the doctor as soon as they start.
What type of dementia has hallucinations?
Any type of dementia can cause hallucinations. They're especially common in Lewy body dementia and Parkinson's disease dementia, where detailed visual hallucinations, such as seeing people or animals, can be one of the early signs. People with Alzheimer's disease and vascular dementia can have them too.
Learn more about the types of dementia in our Alzheimer's and dementia FAQ.
What do dementia hallucinations look like?
Every person is different, but caregivers often describe:
- Seeing people, children or animals in the house
- Seeing bugs on the walls, bed or skin
- Talking with someone who isn't there, sometimes a loved one who has died
- Hearing voices, music or knocking
- Smelling smoke or something burning
- Believing people on TV are in the room
Some hallucinations are pleasant and don't upset your person at all. If they're happy and safe, you may not need to do anything. If they're frightened, that's when to step in.
First, check for a medical cause
New hallucinations aren't always the dementia. Call the doctor, especially if they come on suddenly. Ask about:
- An infection, such as a urinary tract infection
- Dehydration or not eating well
- Pain or poor sleep
- Side effects of a new medicine, or medicines that don't mix well
- Vision or hearing problems
Bring a list of every medicine and supplement your person takes. Fixing one of these problems can sometimes make the hallucinations go away.
What to do when a dementia patient starts hallucinating
Stay calm
Speak slowly and gently. Your calm helps your person feel safe.
Don't argue
Telling them it isn't real usually makes them more upset. To them, it is real.
Comfort the feeling
Try "That sounds scary. I'm here, and you're safe." A gentle touch or hug can help if your person likes it.
Check what they're seeing
Look for shadows, reflections, patterns or noises that may be causing it. Turn on lights, close blinds or cover a mirror.
Change the scene
Move to another room, step outside for a short walk, or offer a snack or favorite activity.
Turn off upsetting TV
Violent or loud shows and the news can seem like they're happening in the room.
Keep everyone safe
Lock away anything that could be used to hurt someone, including firearms, knives and car keys. If anyone is in danger, call 911.
How to respond to paranoia in dementia
Paranoia often comes from memory loss. If your person can't remember where they put their purse, it can seem like the only explanation is that someone took it. If they forget who you are, they may not trust you.
Try to:
- Stay calm and don't take accusations personally.
- Skip the argument. Say "Let's look for it together."
- Reassure them that they're safe.
- Learn their favorite hiding spots and keep a spare of things that go missing often, like glasses or keys.
- Gently explain to family and visitors that the accusations are part of the disease.
If things keep disappearing, read our guide on why people with dementia hide things.
Sometimes suspicion is right. People living with dementia can be targets for scams and financial abuse. If you notice missing money, new "friends" or unusual bills, look into it. Our Elder Services Helplines page lists places to get help.
Get support for yourself
Being accused, or not being recognized by the person you've loved for decades, is painful. You don't have to carry it alone.
The Alzheimer's & Dementia Resource Center (ADRC) offers free caregiver support groups, in person and online, and free one-on-one Care Navigation to help you plan for these moments.
Hallucinations often show up alongside other changes. See our guides to sundowning and agitation and aggression.
Need to talk now, day or night? Call the Alzheimer's Association 24/7 Helpline at 800-272-3900. In an emergency, call 911.
Dementia hallucinations: common questions
Does dementia or Alzheimer's cause hallucinations?
Yes. Changes in the brain can cause hallucinations in Alzheimer's and other dementias. They're most common in Lewy body and Parkinson's disease dementia. Because infections and medicines can also cause them, always tell the doctor.
Why are dementia hallucinations worse at night?
Tiredness, low light and shadows make it harder to make sense of what's around you. Hallucinations can be part of sundowning. Turn lights on before dark, use night lights, and keep evenings calm.
Is it a dream or a hallucination?
Sometimes people living with dementia wake up and can't tell a dream from real life. If they're upset after waking, reassure them, turn on a light and help them get oriented. If it happens often, mention it to the doctor.
Why does my person think someone is stealing from them?
They may hide things for safekeeping, forget where they put them, and then decide someone took them. Help look for the item, stay calm, and check their usual hiding spots. Don't argue about who took it.
Is there medication for dementia hallucinations?
Sometimes, but doctors usually try other steps first. Some medicines used for hallucinations carry serious risks for older adults with dementia, and people with Lewy body dementia can react badly to some of them. Talk with the doctor about benefits and risks. Never start or stop a medicine on your own.
Are hallucinations a sign that dementia is getting worse?
They can be, but new hallucinations can also come from something treatable like an infection, dehydration or a medicine side effect. Any sudden change should be checked by the doctor.
What is the life expectancy for someone with dementia and hallucinations?
There's no single answer. It depends on the type of dementia, the person's age and other health conditions. Hallucinations on their own don't tell you how much time someone has. Ask the doctor what to expect.
Should I play along with a hallucination?
You don't need to agree that something is there, and you don't need to argue that it isn't. Respond to the feeling: "You seem worried. Let's go sit in the kitchen." If the hallucination isn't upsetting, it's often fine to let it be.
Download the free guide to hallucinations and paranoia
Keep this one-page tip sheet from the National Institute on Aging nearby. This page is based in part on National Institute on Aging guidance.
Free help for dementia caregivers in Central Florida
The Alzheimer's & Dementia Resource Center (ADRC) in Winter Park, Florida, offers free help for caregivers in Orange and Seminole counties. Call (407) 436-7750, Monday to Friday, 8:30 AM to 4:30 PM.