Dementia and Delusions, Hallucinations and Paranoia

Conditions of the brain such as dementia can drastically affect how a person views and interacts with the world around them. Seniors who are afflicted with dementia undergo a fundamental change in the way they think. The changes in their brain often cause them to experience delusions, paranoia, and hallucinations. Understanding the difference between these experiences will help you to understand their triggers as well as how to manage an episode.

When dealing with seniors who have dementia, it is important to keep in mind that not every episode of delusion or hallucination is upsetting. In most cases, these episodes are a result of the senior's mind attempting to make sense of a situation, memory or conversation.

Hallucinations, Delusions and Paranoia Symptoms in Dementia

Hallucinations are when a senior or any person has an inaccurate perception of events or objects. This phenomenon is sensory in nature and can occur at any time, for various lengths of time. A senior suffering from dementia or Alzheimer’s disease will often hallucinate. During these episodes, they will smell, hear, feel, taste, and even see things or events that are not actually there. These episodes can be minor such as seeing bugs or animals or as dramatic as seeing and interacting with a person who is not present.

Seniors with dementia who experience delusions are those who hold firm to a false belief or idea. Most often, this is due to misinterpreting what has been said or a situation. Delusions can be both positive experiences and negative experiences for the senior. For example, one experiencing a positive delusion may have an idea that they are being called upon to assist with something important where the actual activity doesn’t exist.

Paranoia is a form of delusion that is always negative. Many seniors with dementia that suffer from paranoia imagine that those around them are stealing, harming them, or plotting their demise. It is important to remember that suspicious paranoia is a common side effect of the dementia disorder, but there may be times where their feelings are based on actual experiences.

When a senior suffers from Alzheimer’s disease or dementia, paranoia is a constant companion. Paranoia is mainly caused by the memory loss that is caused by the condition. Dementia patient's paranoia can be triggered when they forget where they placed an item or when they forget who you are. This can result in the assumption that you are a stranger because they don’t recognize you and that people may be stealing their things. Fearful paranoia may cause seniors to feel that people are trying to trick them when they are given directions or that strangers who are introduced to them are going to hurt them.

Why Does Dementia Cause Delusions, Hallucinations and Paranoia?

When healthy nerve cells in the brain begin to degrade and cease to connect with other cells in the brain, the symptoms of dementia that often include delusions, paranoia or hallucinations will begin to appear. In general, people will lose a certain percentage of neurons as they grow older, but seniors who suffer from dementia will suffer a higher percentage of cell loss than normal. Dementia is usually found in seniors, and those aged 85 and up are more likely to have at least some form of the condition. That being said, there are many seniors who live well past the age of 90 and will never experience any form of dementia. A specific form of dementia, frontotemporal disorders, is typically experienced by middle-aged people as opposed to seniors.

Dementia is used as a catch-all term for a series of conditions and diseases that present with an overall decline in certain functions. A decline of language, memory, basic thinking skills, and the ability to solve problems are the main symptoms. Dementia sufferers also often experience what is called Sundowners Syndrome. Memory loss is one of the most notable side effects of dementia, and Alzheimer’s disease is the leading cause of dementia in senior citizens.

There are many different causes of dementia which all depend on the changes that occur in the brain. Neurodegenerative conditions are the most common cause of dementia. Dementia can also be caused by diseases, illness, or even injury to the brain. These disorders cause a permanent loss of brain function and neurons over time. There is no cure for dementia, though the condition can be slowed and its symptoms managed with therapy and medication. The most common form of dementia in seniors is Alzheimer's disease. Dementia can also develop in the form of vascular dementia, frontotemporal disorders, and Lewy body dementia. The majority of seniors will suffer from a combination of dementia types, such as vascular dementia and Alzheimer's disease.

Dementia can also be defined as the loss of cognitive function. This loss will affect how well a senior is able to perform basic activities to live life normally. It can prevent seniors from paying attention or maintaining focus more than a few moments. It can also affect the way a senior perceives visual and verbal information. Often, seniors who suffer from dementia will have trouble controlling their feelings, which can result in emotional outbursts on occasion. The personalities of seniors who suffer from dementia will often change as their condition progresses. The early stages of dementia will start with minor memory loss and difficulty completing tasks. The later stages of dementia will leave a senior almost or fully dependent on a caregiver to help manage every aspect of daily life.

Identifying Causes

If you notice that a senior that you care for is experiencing delusions, paranoia, or hallucinations, the first thing you should do is schedule an appointment with a medical specialist. While these are common side effects of dementia, they may be caused by other unrelated health issues. A doctor will give them a physical examination and perform other tests to determine or rule out certain causes. These symptoms can also be caused by bladder infections, kidney infections, drug abuse, pain, or even due to dehydration.

Certain medications, such as those prescribed for pain may also be the cause of hallucinations, paranoia, and delusions. It is important that you see a medical professional if you notice any side effects such as confusion, tics, tremors or being overly sedated. It is a good idea to have the seniors’ sight and hearing checked on a regular basis. Many seniors will experience a normal decline in their senses as they age, which can often cause a normal misinterpretation of visual or verbal cues.

Treatment Options

Holistic and non-medical intervention is always the best option when managing seniors who suffer from paranoia, delusions, and hallucinations as part of their dementia symptoms. When an episode starts, take a moment to assess the situation before you react. If the episode is not dangerous or disruptive to the senior or those around them, there is no cause for serious concern. Some questions to ask when assessing the episode are:

• Are the symptoms causing the senior to get upset?
• Is the senior becoming frightened when seeing new faces during the episode?
• Are the symptoms causing the senior to react in a way that can cause harm?
• Has the senior’s response to the episode caused them to become ill?

If the answer is yes to any of the above, calmly step in and comfort them with words of reassurance. Some seniors may also be soothed with a gentle touch or hug. When there is no adverse reaction to an episode, ignoring them until the end of the episode is the easiest option. Keep in mind that these episodes will occur randomly and the senior has no control over what they experience. What they hear, see and believe during an episode will feel very real. It is natural to attempt to correct or argue in an attempt to break their train of thought, but this may further exacerbate the situation. Unless they become violent towards themselves or others, intervention should be limited. If you are unable to manage a senior loved one with dementia, professional care such as one from a dementia care community should be considered.

Reassurance & Distraction

Reassurance, often used in validation therapy for dementia, is one of the best ways to comfort a senior who suffers from dementia symptoms such as a hallucination, paranoia or delusion. Offer them soothing words such as: “I’ll take care of you, everything is okay, don’t worry, I’ll protect you.” Talk softly and use gentle touches to help divert their attention and allay their fears. Although these episodes are mostly random, try to determine the trigger behind it. Understanding what upsets the senior may help you to form a specific response that calms them down.

Distraction is another effective way to reduce the length or severity of an episode, especially if it happens to be frightening to the senior. Delusions and hallucinations that are frightening in nature tend to dissolve when the person is in a place with other people or when moved to a room that is well lit. If you notice a senior becoming afraid, ask them to come with you to another room or offer to take a walk with them. Engage them in an activity that they enjoy such as looking at pictures, listening to music, or even sewing if they prefer.

Always answer seniors honestly when they are having a delusional episode. Don’t argue with them about your experience, but respond truthfully. For example, if they are having a hallucination that makes them believe another person is there with them, they may ask you if you can see the person or reply to the person. Instead of saying “there is no one there”, respond in a way that validates their feelings while also being honest. A good reply would be “I understand you are seeing someone/or something, but unfortunately, I don’t see what you do.” This allows you to better normalize the event without playing into their delusion or invalidating their experience.

Environment Modification & Medical Intervention

Changing the environment is another effective way to reduce or even abort an episode of delusion or hallucination. If a person imagines they see people in the window, you can open or close the curtains to modify the environment. Maintaining a well-lit space is another way to reduce fear by eliminating shadows. Some seniors may have trouble identifying themselves during an episode and will claim that a stranger is looking at them through the mirror. Covering the mirror or moving them away from it will help reduce the intensity of their episode. Many seniors who suffer from dementia will feel that people are stealing from them. In actuality, most often items have simply been lost, misplaced, or put away in a new location. Keeping duplicates of commonly lost items on hand can also help arrest an episode.

Most holistic and interactive interventions work well for seniors suffering from dementia, but there are times when medications may be the only option. A medical professional can evaluate the senior to ascertain if medication to reduce delusions and hallucinations is the best option. Seniors who suffer from separate mental illnesses like schizophrenia may be suffering from delusions and hallucinations due to that condition and not dementia. 

Seniors suffering from dementia and its related conditions such as Alzheimer’s disease are unique. The conditions change the brain in complex ways that are not always easy to understand. They will often experience sights, sounds, and ideas that are not based on current events or even on reality itself. If you are a caregiver of a senior who has started experiencing delusions, paranoia or hallucinations, it is important to have them evaluated by a medical professional. Sometimes, these episodes are a result of an illness or a side effect of a medication prescribed for an unrelated illness. There are medications available to help reduce the effects and frequency of these episodes, however non-medical therapy is preferred. Seniors who have been diagnosed with dementia may exhibit these behaviors often and there are many ways to help manage these episodes without the need for medication. Although dementia patients suffer from delusions and paranoia, there are times when seniors have a valid reason for their feelings. It is important not to automatically dismiss seniors' complaints or feelings of danger without checking to be sure no one is taking advantage of them.