A person with Alzheimer’s may become suspicious of those around them, even accusing others of theft, infidelity or other improper behavior. While accusations can be hurtful, remember that the disease is causing these behaviors and try not to take offense.
What to Expect
Delusions (firmly held beliefs in things that are not real) may occur in middle- to late-stage Alzheimer’s. Confusion and memory loss — such as the inability to remember certain people or objects — can contribute to these untrue beliefs. A person with Alzheimer’s may believe a family member is stealing his or her possessions or that he or she is being followed by the police. This kind of suspicious delusion is sometimes referred to as paranoia.
Although not grounded in reality, the situation is very real to the person with dementia. Keep in mind that a person with dementia is trying to make sense of his or her world with declining cognitive function.
A delusion is not the same thing as a hallucination. While delusions involve false beliefs, hallucinations are false perceptions of objects or events that are sensory in nature.
When a person with Alzheimer’s or other dementia hallucinates, he or she may see, hear, smell, taste or feel something that isn’t there. Some hallucinations may be frightening, while others may involve ordinary visions of people, situations or objects from the past.
Understanding Hallucinations
Hallucinations are false perceptions of objects or events involving the senses. These false perceptions are caused by changes within the brain that result from Alzheimer’s, usually in the later stages of the disease. The person may see the face of a former friend in a curtain or may see insects crawling on his or her hand. In other cases, a person may hear someone talking and may even engage in conversation with the imagined person.
Alzheimer’s and other dementias are not the only cause of hallucinations. Other causes include: Schizophrenia; Physical problems, such as kidney or bladder infections, dehydration, intense pain, or alcohol or drug abuse; Eyesight or hearing problems; Medications.
If a person with Alzheimer’s begins hallucinating or are having severe delusions and there is a fear of self-harm or caregiver harm, or if the delusion or hallucination is extremely troubling to the person, it’s important to have a medical evaluation to rule out other possible causes and to determine if medication is needed. It may also help to have the person’s eyesight or hearing checked.
The first line of treatment for the behavioral symptoms of Alzheimer’s is non-drug approaches, but if these strategies fail and symptoms are severe, medication may be appropriate. While antipsychotic medications can be effective in some situations, they are associated with an increased risk of stroke and death in older adults with dementia and must be used carefully. Work with the doctor to learn both the risks and benefits of medication before making a decision.
Learn more: Medications for Behavioral Symptoms, Alzheimer’s Association Statement on Challenging Behaviors (PDF)
How to Respond
- Don’t take offense. Listen to what is troubling the person, and try to understand that reality. Then be reassuring, and let the person know you care.
- Don’t argue or try to convince. Allow the individual to express ideas. Acknowledge his or her opinions.
- Offer a simple answer. Share your thoughts with the individual, but keep it simple. Don’t overwhelm the person with lengthy explanations or reasons.
- Switch the focus to another activity. Engage the individual in an activity, or ask for help with a chore.
- Duplicate any lost items. If the person is often searching for a specific item, have several available. For example, if the individual is always looking for his or her wallet, purchase two of the same kind.
Share your experience with others. Join ALZConnected, an online support community and message boards, and share what response strategies have worked for you and get more ideas from other caregivers.
Mayo Clinic 2023 Conference on Brain Health and Dementia – Paths to Emotional Wellness
November 4, 2023
This course offers Live (in-person) and Livestream (virtual) attendance options.
This special conference provides attendees the opportunity to explore emotional wellness for oneself and the knowledge to positively impact wellness for those living with dementia. Emotional wellbeing is examined from personal, cultural, and diverse perspectives. The impressive slate of conference presenters and facilitators include those living with dementia, care partners, healthcare professionals, artists, advocates, and researchers who are all dedicated to this topic.
The Alzheimer’s Association® is a worldwide voluntary health organization dedicated to Alzheimer’s care, support and research. Our mission is to lead the way to end Alzheimer’s and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Their vision is a world without Alzheimer’s and all other dementia.