ALL ABOUT ALZHEIMER'S: Hallucinations & Delusions      By Betty Weiss

So many things about Alzheimer’s are disturbing to our senses--surprising, frightening, unexpected, bewildering. You walk into the bathroom to find your husband is laughing and talking to his reflection in the mirror. He turns to tell you ‘that’s sure a nice fellow I’ve been talking to’ and your heart sinks. He can no longer recognize himself in a mirror, nor you if you are standing next to him, so he talks to the nice man.

It scares you when he yells at someone you can’t see, or has a conversation with a figurine. Your first reaction, naturally enough, is to tell your loved one that there is no one to yell at, the figurine is not real—and in return, he is likely to tell you that it is real, because to him it is--as real as the things you yourself see.

Hallucinations are things an individual will see, hear, smell, taste or feel through his senses and they are absolutely real to him. But it’s all a false perception caused by changes in the brain. It does no good to tell him otherwise. He may agree for the moment, but it will happen again and again. The changes in the brain cannot be reversed and restored. If the hallucinations are not frightening to the patient, and if you can get your mind around the idea that they are not frightening to you either, then it is good to just agree, to go along with whatever your loved one is seeing or hearing. Go into his reality for the moment. Tell him that was a nice man (in the mirror), that you are happy he had such a good visit. You can even ask him to tell you all about it. Better to validate the experience; arguing about it will only cause frustrations for both of you.

If your loved one has an hallucination that frightens him, then you have to take a different tack. I have talked directly to something only my husband saw, told it to ‘go away’ to ‘get out of the house.’ It usually worked. You have to reassure your loved one that he is safe and everything is alright. You won’t let anything bad happen. Yes, you are telling a lie to ease the situation, just as you tell a small, frightened child that Mommy will always be here. You can’t guarantee it, but you go with the odds. Again, you can ask him to talk about it, commiserate with things like ‘gee, that really sounds bad, but it’s gone now, let’s have some ice cream.’

Everyone on occasion ‘sees’ a face in a cloud, a curtain, a shadow, but Alzheimer’s patients cannot understand that it is only an illusion. You can try to modify the environment by keeping areas well lit to avoid shadows, cover mirrors, rearrange curtains, and draw shades at night to avoid reflections in the windows. Again, you can try to divert your loved one’s attention with an extra hug, a short walk, music, sorting coins or buttons, hold hands, enjoy the moment and have some hot chocolate.

Delusions are something else and often harder to deal with. These are not things they ‘see’ or ‘hear,’ but ideas that get into their heads and it can be impossible to get them out. They often become suspicious, accuse others of stealing, someone is spying, their food is poisoned. Your loved one may accuse you of not being you, call you an imposter and say that this is not his house. The more you try to reason with him that you are really you and this is his house, the more he will accuse you of lying.

If something has been ‘stolen,’ help him look for it; say it’s been lent to a friend, it’s at the cleaners, whatever works for the moment. My husband accused me of being unfaithful and when I said, ‘but I’m right here with you’ he shot back ‘oh, no, you’re not!’ This was hard to combat because I could not agree and could not deny without escalating things and being called a liar. So I’d try, somehow, to accept responsibility without admitting guilt, and if you think that it’s all impossible, you’re right—it is impossible—it’s Alzheimer’s. 
Betty Weiss is the author of the best selling Alzheimer's Surgery: An Intimate Portrait, and When The Doctor Says, "Alzheimer's:" Your Caregiver's Guide to Alzheimer's & Dementia. She does not give medical advice.                           
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