There are bugs on the bed. Someone broke into the house. Animals are in the kitchen.
Except that they’re not.
Seeing or hearing things that aren’t there is a common symptom of Alzheimer’s disease. And while it can be distressing to those with the disease — and their caregivers — it is possible to prevent hallucinations or minimize their effects.
Hallucinations are more common as people approach the middle stage of Alzheimer’s, the same phase where they may have trouble understanding what people are saying to them. They’re related to delusions, which center around a false belief, such as the idea that people are conspiring against you, and to misperceptions, such as believing people on the TV are real.
If someone has a hallucination, it’s best to go along with it. Trying to prove it’s not true is likely to make the person angry or upset, rather than reassured.
“It’s unlikely that they have the insight to understand that there’s anything wrong with them, so more than likely the response would be anger,” says Kathy Hickman, knowledge mobilization expert at the Alzheimer Society of Ontario.
Think of how you would react if someone told you something you saw wasn’t there, she says. You would probably hold firm to your position and get frustrated that they didn’t believe you.
Instead, she advises caregivers to stay calm, acknowledge what the person is feeling and try to distract them.
“You might say, ‘I can see that you’re really upset right now. How about we go have a nice cup of tea, or let’s put on some music,’” Hickman says.
At the same time, a little detective work is in order. “Ask a couple of questions to understand what’s upsetting the person, and get some clues,” Hickman says.
That’s important because hallucinations are often pegged to real things.
“The person might have a bedspread with a pattern on it, and their brain is telling them there are bugs crawling on their bed,” Hickman says.
In turn, you can remove the trigger by changing the bedspread to something without a pattern. Good lighting can also help minimize confusing shadows.
People are also more likely to hallucinate when they’re under stress, caused by an unfamiliar environment, being overwhelmed by too many people or noises, or not sleeping well. Sundowning — where people with Alzheimer’s are disoriented in the late afternoon — can also contribute.
Keeping a regular routine and ensuring the person is eating well and is not dehydrated can also help prevent hallucinations.
More serious causes include: hearing loss or vision problems, medication interaction issues, a fall, or an infection. So it’s important to report any hallucinations to a physician as well.
If your loved one can’t be distracted, or is extremely upset and can’t be calmed down, urgent medical attention is warranted. And it’s worth thinking about whether the hallucinations mean the person poses a safety risk to themselves or others — how they might act if they believe they’re defending themselves, for example.
And, Hickman notes, people also have positive hallucinations. “They might say there’s animals in the house, and they have a pet, or people are coming to visit,” she says. “But if they’re not upset about that — and you’ve made sure there aren’t safety concerns — there’s not harm in it.”
That doesn’t mean it’s not distressing. “Even if it’s not upsetting to the person, caregivers can be upset,” Hickman says. Knowing how to respond — and keeping in mind to not take hallucinations personally — can help.
Vanessa Milne is a health writer based in Toronto, Canada