Hallucinations and dementia can be distressing for both the person living with dementia and the people supporting them. Seeing, hearing or believing things that are not there can feel frightening, confusing and emotionally overwhelming, especially when symptoms begin unexpectedly or worsen over time.
While hallucinations are not experienced by everyone living with dementia, they are relatively common in certain types of dementia and can occur at different stages of the condition. Understanding why hallucinations happen, how they may present, and how families can respond calmly and compassionately can make a significant difference to someone’s wellbeing and quality of life.
At Lapis Care, we understand how complex dementia care can become as symptoms progress. Our compassionate, person-centred approach supports individuals and families through every stage of the dementia journey, helping people remain safe, comfortable and supported within familiar surroundings.
What Are Hallucinations in Dementia?
Hallucinations occur when a person sees, hears, smells, tastes or feels something that is not actually present. In dementia, visual hallucinations are the most common, although auditory hallucinations and dementia can also occur together.
For example, a person may:
- See unfamiliar people or animals in the room
- Hear voices or music
- Believe someone is entering the home
- Feel sensations on their skin
- Misinterpret shadows, reflections or objects
Hallucinations are different from memory loss alone. They are changes in perception caused by the brain processing information differently.
In some cases, hallucinations may be mild or occasional. In others, dementia hallucinations and delusions may become more frequent and distressing over time.
According to Alzheimer’s Society, hallucinations can affect multiple senses and may be linked to changes in how the brain processes information. The charity also explains that visual hallucinations are particularly common in certain forms of dementia.
When Hallucinations Come with False Beliefs
Many families also encounter delusions and hallucinations in dementia together. Delusions are strongly held false beliefs that may not be based in reality.
Examples can include:
- Believing belongings have been stolen
- Thinking a spouse is being unfaithful
- Feeling unsafe in their own home
- Believing strangers are living in the property
Dementia UK explains that changes in perception, delusions and hallucinations can often become distressing for both the individual and their loved ones, particularly when the person fully believes what they are experiencing is real.
Why Symptoms Often Worsen in the Evening
Many carers notice dementia and hallucinations at night becoming more pronounced. This is often linked to “sundowning”, where confusion and distress worsen later in the day.
Contributing factors may include:
- Tiredness and fatigue
- Reduced lighting and shadows
- Changes in routine
- Increased confusion
- Loneliness or anxiety
A calm, familiar environment with good lighting and reassurance can often help reduce distress during the evening hours.
Which Types of Dementia Cause Hallucinations?
Hallucinations can occur in several forms of dementia, although they are more common in certain types.
Dementia with Lewy Bodies
Hallucinations are particularly common in dementia with Lewy bodies and may appear early in the condition.
The NHS guide to Dementia with Lewy Bodies notes that vivid visual hallucinations are one of the more common symptoms associated with this form of dementia.
Frontotemporal Dementia: A Less Common Link
Frontotemporal dementia and hallucinations are less common than in Lewy body dementia, but behavioural and personality changes may sometimes include unusual beliefs or altered perceptions.
Vascular Dementia: How Brain Changes Play a Role
Vascular dementia and hallucinations may occur depending on which parts of the brain have been affected by reduced blood supply or strokes.
Alzheimer’s Disease
Hallucinations can also occur in Alzheimer’s disease, particularly in later stages.
When in the Journey Do They Tend to Start?
People often ask at what stage in dementia do hallucinations occur?
The answer varies from person to person. Some individuals may experience hallucinations in the earlier stages, especially with Lewy body dementia, while others may only develop symptoms in moderate or later stages.
Rather than focusing solely on stages, it is often more helpful to monitor:
- Changes in behaviour
- Increased confusion
- Distress levels
- Safety concerns
- Sleep disruption
- Emotional wellbeing
UTI and Dementia Hallucinations
A sudden increase in confusion or hallucinations should always be assessed by a healthcare professional.
UTI and dementia hallucinations are commonly linked, particularly in older adults. Urinary tract infections can sometimes trigger rapid changes in cognition, confusion and unusual behaviour in someone living with dementia.
Families should seek medical advice if hallucinations:
- Appear suddenly
- Become significantly worse
- Are accompanied by fever or pain
- Lead to distress or unsafe behaviour
When Perception Changes Affect Behaviour
In some cases, dementia and sexual hallucinations or inappropriate beliefs may occur due to changes in the brain affecting judgement, perception and behaviour.
These experiences can be upsetting for families, but it is important to remember they are symptoms of the condition rather than intentional behaviour. Compassionate support and professional guidance can help families navigate these situations sensitively and safely.
How Should Families Respond?
When someone experiences hallucinations, arguing or correcting them may increase distress.
Instead, families can often help by:
- Remaining calm and reassuring
- Avoiding confrontation
- Gently redirecting attention
- Checking for environmental triggers
- Improving lighting
- Reducing background noise
- Maintaining familiar routines
If the hallucination is not causing distress or danger, reassurance may be more beneficial than attempting to challenge what the person believes they are experiencing.
If suspicion or false beliefs are also part of what you’re noticing, our guide to dementia and paranoia covers that in more depth. And if you’re earlier in the journey and exploring what support might look like, dementia care at home is a good starting point.
The Importance of Specialist Dementia Support
Supporting someone with dementia hallucinations and delusions can become emotionally exhausting for families over time. Professional home care can provide reassurance, consistency and practical support while helping individuals remain safely at home.
At Lapis Care, our dementia care team understands the emotional and behavioural challenges that dementia can bring. We provide compassionate, person-centred care tailored to each individual’s needs, routines, and preferences, guiding you through every step of the journey.
FAQs
Are hallucinations common in dementia?
Yes. Hallucinations can occur in several types of dementia, particularly dementia with Lewy bodies and later-stage Alzheimer’s disease.
What causes it?
Hallucinations are caused by changes in the brain affecting perception and processing. Infections, medications, poor sleep and environmental factors may also contribute.
What is the difference between hallucinations and delusions?
Hallucinations involve sensing something that is not there, while delusions are strongly held false beliefs.
Can a UTI be the cause?
Yes. UTI and dementia hallucinations are common in older adults and can lead to sudden increases in confusion and behavioural changes.
Are hallucinations worse at night?
For many people, dementia and hallucinations at night can become more noticeable due to fatigue, shadows, anxiety and sundowning symptoms.
Should you correct someone experiencing hallucinations?
Usually, calm reassurance is more helpful than arguing or correcting the person, especially if the hallucination is not causing harm or distress.
Which type of dementia is most associated with this?
Dementia with Lewy bodies is particularly associated with vivid visual hallucinations, often appearing earlier in the condition.
When should families seek medical help?
Medical advice should be sought if hallucinations appear suddenly, worsen significantly, cause distress or are accompanied by signs of illness such as a possible infection.