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    Dementia Symptoms & Caregiver Strategies: Management of Hallucinations in Cognitively Impaired Adults

    When a person 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. 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.

    Possible causes include:

    • Alzheimer's and other dementias
    • Schizophrenia
    • Physical problems, such as kidney or bladder infections, dehydration, intense pain, or alcohol or drug use and withdrawal
    • Eyesight or hearing problems
    • Medications (side effects and/or interactions)
    Coping strategies
    When responding to hallucinations, be cautious. First, assess the situation and determine whether the hallucination is a problem for the person or for you. Is the hallucination upsetting for the person? Is it leading the person to do something dangerous? Is the sight of an unfamiliar face causing them to become frightened? If so, react calmly and quickly with reassuring words and a comforting touch. If the behavior is not dangerous, there may not be a need to intervene. When hallucinations or illusions do occur, don’t argue about what is real and what is fantasy. Discuss your loved one’s feelings relative to what they imagine they see or feel. Respond to the emotional content of what he or she is saying, rather than to the factual/fictional content.

    Offer reassurance
    • Respond in a calm, supportive manner. You may want to respond with, "Don't worry. I'm here. I'll protect you. I'll take care of you."
    • Gentle patting may turn the person's attention toward you and reduce agitation.
    • Acknowledge the feelings behind the hallucination and try to find out what the hallucination means to the individual. You might want to say, "It sounds as if you're worried" or "I know this is frightening for you."

    Modify the environment
    Since hallucinations are often the result of failing senses, unidentifiable sounds, shadows, and highly contrasting colors all can become the basis for fantasy. There are certain things you may be able to do to reduce the frequency of hallucinations in your loved one:
    • Check for sounds that might be misinterpreted, such as noise from a television or an air conditioner.
    • Decrease the number of things in the environment that can be misinterpreted as something else, such as patterned wallpaper or bright, contrasting surfaces or objects.
    • Look for lighting that casts shadows, reflections or distortions on the surfaces of floors, walls and furniture. Turn on lights to reduce shadows.
    • Cover mirrors with a cloth or remove them if the person thinks that he or she is looking at a stranger.
    • Maintaining sameness in the environment may also help reduce hallucinations.
    Use distractions
    • Suggest a walk or move to another room. Frightening hallucinations often subside in well-lit areas where other people are present.
    • Try to turn the person's attention to music, conversation or activities you enjoy together.
    See the Doctor
    If a person begins hallucinating, it's important to have a medical evaluation to rule out possible causes and to determine if medication is needed. The first line of treatment for these behavioral symptoms is non-drug approaches, but if these strategies fail and symptoms are severe, medications may be appropriate. Medications can sometimes help to reduce hallucinations, so seek professional advice if you are concerned about this problem.

    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.

    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: