A hallucination is a false perception of objects or events involving the senses. Hallucinations are visual and auditory. When a person with Alzheimer's disease has a hallucination, he or she sees, hears, smells, tastes, or feels something that isn't there. For instance, the person may see the face of a former friend in a curtain or may feel insects crawling on her hand. In other cases, she may hear people talking to her and may even talk to the imagined person. Sometimes the images are frightening and sometimes they are just ordinary pictures of people, situations and objects from the past.

If the hallucination doesn't cause problems for you, the person, or other family members, you may want to ignore it. However, if it is disturbing to you or the patient, it is best to do the following:

Obtain medical guidance

Ask a physician (we recommend seeking the advice of a geriatrician or geriatric psychiatrist) to look for physical disorders that may cause hallucinations, such as kidney or bladder infections, dehydration, intense pain, or alcohol or drug use.

Ask a physician to determine if medication is needed or might be causing the hallucinations.

Have the person's eyesight or hearing checked or make sure that the person wears her glasses or hearing aid on a regular basis.

Offer reassurance

Reassure the person with kind words and a gentle touch. For example, you might want to say: "Don't worry. I'm here. I'll protect you. I'll take care of you," or "I know you're worried. Would you like me to hold your hand and walk with you for awhile?"

Gentle patting may turn the person's attention toward you and reduce the hallucination.

Look for the reasons or feelings behind the hallucination and try to find out what the hallucination means to the individual. For example, you might want to respond with words such as these: "It sounds as if you're worried" or "I know this is frightening for you."

Don't argue with the person about what she sees or hears.

Use distraction

Suggest that the person come with you on a walk or sit next to you in another room. Frightening hallucinations often subside in well-lit areas where other people are present.

Try to turn the person's attention to other features of the room.Use other distractions such as music, conversation, drawing, looking at photos or pictures, or counting coins

Respond honestly

The person may sometimes ask you about the hallucination. For example, "Do you see him?" or "Can you hear the children laughing?" You may want to answer with words such as, "I know that you see something, but I don't see it." In this way, you're not denying what the person sees or hears or getting involved in an argument.

Check out the reality of the situation

Ask the person to point to the area where he sees or hears something. Glare from a window may look like snow to the patient and dark squares on a tiled floor may look like dangerous holes.

Modify the environment

If the person looks at the kitchen curtains and sees a face, you may be able to remove, change or close the curtains.

Check the environment for noises that might be misinterpreted, for lighting that casts shadows, or for glare, reflections or distortions from the surfaces of floors, walls, and furniture.

If the person insists that she sees a strange person in the mirror, you may want to cover up the mirror or take it down. It's also possible that the person doesn't recognize herself.

On other occasions, you may want to turn on more lights and make the room brighter

As a caregiver, you can ease the fears of the person with Alzheimer's disease by using words that are calm, gentle and reassuring. Remember that the hallucination is very real to the individual with the disease.

Please note: A hallucination is not a delusion. A delusion is defined as a false idea, sometimes originating in a misinterpretation of a situation. When an individual has a delusion, she may think that family members are stealing from her or that she's in another place when she's actually still in her own home

Sources: The Primary resource for this fact sheet was Peter V. Rabins, MD, a geriatric psychiatrist, and director of the Price Teaching Service and associate professor of psychiatry at the Johns Hopkins University School of Medicine, Baltimore, MD; Special thanks goes to the following Chapters of the Alzheimer's Association: Indianapolis, Eastern Massachusetts, South Central Michigan, Cleveland, Greater Youngstown, and Greater New Hampshire. Recognition is also extended to the State of New Hampshire Division of Elderly and Adult Services of the Department of Health and Human Services.

David L. Carroll. WHEN YOUR LOVED ONE HAS ALZHEIMER'S. New York: Harper & Row, 1989. Lisa P. Gwyther. CARE OF ALZHEIMER'S PATIENTS: A MANUAL FOR NURSING HOME STAFF. Washington, DC: American Health Care Association, & ADRDA, 1985; Nancy L. Mace and Peter V. Rabins, MD. THE 36-HOUR DAY. Baltimore: The Johns Hopkins University Press, 1991. © 2003 Alzheimer's Disease and Related Disorders Association, Inc. All rights reserved; the Orange County Chapter of the Alzheimer's Association.

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