Alzheimer’s and Hallucinations, Delusions, and Paranoia

Due to complex changes occurring in the brain, people with Alzheimer’s disease may see or hear things that have no basis in reality.

• Hallucinations involve hearing, seeing, smelling, or feeling things that are not really there. For example, a person with Alzheimer’s may see children playing in the living room when no children exist.
• Delusions are false beliefs that the person thinks are real. For example, the person may think his or her spouse is in love with someone else.
• Paranoia is a type of delusion in which a person may believe—without a good reason—that others are mean, lying, unfair, or “out to get me.” He or she may become suspicious, fearful, or jealous of people.

If a person with Alzheimer’s has ongoing disturbing hallucinations or delusions, seek medical help. An illness or medication may cause these behaviors. Medicines are available to treat these behaviors but must be used with caution. The following tips may also help you cope with these behaviors.

Hallucinations and Delusions

Here are some tips for coping with hallucinations and delusions:

• Discuss with the doctor any illnesses the person with Alzheimer’s has and medicines he or she is taking. Sometimes an illness or medicine may cause hallucinations or delusions.
• Try not to argue with the person about what he or she sees or hears. Comfort the person if he or she is afraid.
• Distract the person. Sometimes moving to another room or going outside for a walk helps.
• Turn off the TV when violent or upsetting programs are on. Someone with Alzheimer’s may think these events are happening in the room.
• Make sure the person is safe and can’t reach anything that could be used to hurt anyone or himself or herself.

In a person with Alzheimer’s disease, paranoia often is linked to memory loss. It can become worse as memory loss gets worse. For example, the person may become paranoid if he or she forgets:

• Where he or she put something. The person may believe that someone is taking his or her things.
• That you are the person’s caregiver. Someone with Alzheimer’s might not trust you if he or she thinks you are a stranger.
• People to whom the person has been introduced. He or she may believe that strangers will be harmful.
• Directions you just gave. The person may think you are trying to trick him or her.

Paranoia may be the person’s way of expressing loss. The person may blame or accuse others because no other explanation seems to make sense.

Here are some tips for coping with paranoia:

• Try not to react if the person blames you for something.
• Don’t argue with the person.
• Let the person know that he or she is safe.
• Use gentle touching or hugging to show you care.
• Explain to others that the person is acting this way because he or she has Alzheimer’s disease.
• Search for things to distract the person, then talk about what you found. For example, talk about a photograph or keepsake.

Also, keep in mind that someone with Alzheimer’s disease may have a good reason for acting a certain way. He or she may not be paranoid. There are people who take advantage of weak and elderly people. Find out if someone is trying to abuse or steal from the person with Alzheimer’s. For more information, visit Elder Abuse.

Coping with Agitation and Aggression in Alzheimer’s Disease

People with Alzheimer’s disease may become agitated or aggressive as the disease gets worse. Agitation means that a person is restless or worried. He or she doesn’t seem to be able to settle down. Agitation may cause pacing, sleeplessness, or aggression, which is when a person lashes out verbally or tries to hit or hurt someone.

Causes of Agitation and Aggression

Most of the time, agitation and aggression happen for a reason. When they happen, try to find the cause. If you deal with the causes, the behavior may stop. For example, the person may have:

• Pain, depression, or stress
• Too little rest or sleep
• Constipation
• Soiled underwear or diaper
• Sudden change in a well-known place, routine, or person
• A feeling of loss—for example, the person may miss the freedom to drive
• Too much noise or confusion or too many people in the room
• Being pushed by others to do something—for example, to bathe or to remember events or people—when Alzheimer’s has made the activity very hard or impossible
• Feeling lonely and not having enough contact with other people
• Interaction of medicines

Look for early signs of agitation or aggression. If you see the signs, you can deal with the cause before problem behaviors start. Try not to ignore the problem. Doing nothing can make things worse.

A doctor may be able to help. He or she can give the person a medical exam to find any problems that may cause agitation and aggression. Also, ask the doctor if a medicine is needed to prevent or reduce agitation or aggression.

Tips for Coping with Agitation or Aggression

Here are some ways you can cope with agitation or aggression:

• Reassure the person. Speak calmly. Listen to his or her concerns and frustrations. Try to show that you understand if the person is angry or fearful.
• Allow the person to keep as much control over his or her life as possible.
• Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
• Build quiet times into the day, along with activities.
• Keep well-loved objects and photographs around the house to help the person feel more secure.
• Try gentle touching, soothing music, reading, or walks.
• Reduce noise, clutter, or the number of people in the room.
• Try to distract the person with a favorite snack, object, or activity.
• Limit the amount of caffeine, sugar, and “junk food” the person drinks and eats.

Here are some things you can do:

• Slow down and try to relax if you think your own worries may be affecting the person with Alzheimer’s.
• Try to find a way to take a break from caregiving.

Safety Concerns

When the person is aggressive, protect yourself and others. If you have to, stay at a safe distance from the person until the behavior stops. Also, try to protect the person from hurting himself or herself.