Your mother tells you there are children playing in the backyard, but the yard is empty. Your father insists a man is standing in the corner of the bedroom at night. Moments like these are unsettling, and many families don't know whether to play along, correct their parent, or call the doctor.
Dementia hallucinations are common, especially as the disease progresses, and they can be managed2. Vivid visual hallucinations are an early hallmark of Lewy body dementia. This guide explains what they are, what can cause or worsen them, how to respond in a calm and caring way, and when to get medical help. The goal is to keep your parent safe and comforted, not to win an argument about what is real.
What are dementia hallucinations?
During a hallucination, a person sees, hears, smells, tastes or feels something that isn't there. For example, your parent may see their own mother in the room even though she died years ago1. Some hallucinations are frightening, like insects crawling on the skin. Others are pleasant or ordinary, such as visions of familiar people or scenes from the past2.
Hallucinations vs. delusions
A delusion is different. It's a false belief the person holds as true, such as thinking a spouse is unfaithful or that someone is stealing from them. Hallucinations involve the senses; delusions involve beliefs31. Paranoia is a type of delusion. If your parent accuses family of taking things, read our guide to dementia and accusations of stealing.
Which types of dementia cause hallucinations
In Alzheimer's disease, hallucinations are caused by brain changes and usually appear in the later stages2. In Lewy body dementia, vivid visual hallucinations are common and can appear earlier in the disease4. People with Parkinson's disease may also develop hallucinations; our guide to Parkinson's care covers that condition.
Causes to rule out first
Dementia is not the only cause of hallucinations. Before assuming the disease is worsening, check for other problems the doctor can treat21:
- Infections. A urinary tract infection can cause sudden confusion and hallucinations in older adults. See UTIs in the elderly.
- Dehydration. Not drinking enough can cause confusion. See dehydration in the elderly.
- Pain. Intense pain your parent can't describe may show up as distress or strange perceptions.
- Medicines. New prescriptions, dose changes and some over-the-counter drugs can trigger hallucinations.
- Vision and hearing loss. Poor eyesight or hearing can make shadows look like people or sounds seem like voices. See hearing loss in the elderly.
- Alcohol. Alcohol use, or stopping suddenly, can cause hallucinations.
How to respond in the moment
Start by asking yourself whether the hallucination is a problem. Is it upsetting your parent? Is it leading them to do something dangerous? If not, there may be no need to step in2. If your parent is frightened, try these steps:
- Stay calm. Your tone matters more than your words. Speak softly and slowly.
- Don't argue. Telling your parent it isn't real usually increases distress. Don't argue about what they see or hear1.
- Acknowledge the feeling. Say something like, "That sounds frightening. I'm here, and you're safe."2
- Offer comfort. Gentle touch, holding a hand or sitting close can redirect attention to you2.
- Distract. Move to another room, go for a short walk, play familiar music or start a simple activity1.
- Keep everyone safe. Make sure your parent can't reach anything they could use to hurt themselves or others1.
You don't need to agree that the person is real, but you also don't need to deny it. Responses like "I don't see him, but I can tell you're worried" are honest and kind.
Hallucinations at night
Many families notice hallucinations get worse in the evening or at night. Low light, shadows and tiredness can all play a part, and late-day restlessness is common in dementia. Frightening hallucinations often ease in well-lit areas where other people are present2.
- Keep lights on. Use night lights in the bedroom, hallway and bathroom.
- Check for shadows and reflections. Cover mirrors or dark windows if your parent sees 'people' in them.
- Turn off upsetting TV. Someone with dementia may believe violent scenes on TV are happening in the room1.
- Keep a calm routine. Regular bedtimes, less caffeine and quiet evenings help.
Our guide to sundowning explains more ways to make evenings easier.
Make the home less confusing
Small changes in the environment can reduce what triggers hallucinations2:
- Good lighting. Bright, even lighting reduces shadows that can look like people or animals.
- Fewer patterns. Busy wallpaper, rugs or curtains can look like moving shapes.
- Quiet spaces. Reduce background noise from TVs and radios that could be mistaken for voices.
- Glasses and hearing aids. Make sure they are clean, working and worn.
- Familiar objects. Photos and keepsakes help your parent feel oriented and safe.
Learning the patterns helps too. Keep a simple log of when hallucinations happen, what your parent describes and what was going on around them. Patterns can point to a trigger, like a certain time of day, a room, or a medicine, and the log is useful to share with the doctor. Bring it to every appointment, along with a current list of all medicines and supplements.
What to say: examples that help
Finding the right words in a tense moment is hard. These examples show the general approach: stay calm, acknowledge the feeling, offer safety and redirect.
- If your parent sees a stranger in the room: "I don't see him, but I believe you're scared. I'm right here. Let's go to the kitchen and have some tea."
- If your parent sees a loved one who has died: "You're thinking about Mom. Tell me about her." Talking about the person often brings comfort without arguing about whether they're present.
- If your parent feels bugs on the skin: "That must feel awful. Let me help you wash your hands and put on some lotion." Then check the skin for a rash or dryness the doctor should see.
- If your parent hears voices: "I hear the TV in the other room. Let's turn it off so it's quieter."
Avoid joining in with the hallucination in ways that make it bigger, like pretending to chase away an intruder. And try not to take it personally if your parent doesn't believe you. Their brain is trying to make sense of what they experience, and your calm presence is what helps most.
When a hallucination is harmless or even comforting
Not every hallucination is a crisis. Some people with dementia see a pet that died years ago, or children playing, and feel happy about it. If the experience isn't upsetting and isn't putting your parent at risk, you may not need to do anything2.
In these moments, it's usually kinder to let the experience pass than to correct it. Watch for changes, though. A harmless hallucination can become frightening, and new or more frequent hallucinations are worth mentioning to the doctor. Keep noting them in your log so you can see whether they are changing over time.
It can also help to share what you've learned with others who spend time with your parent, such as siblings, home care aides or adult day staff. When everyone responds the same calm way, your parent feels safer, and you're not the only one carrying the load. Our guide to dementia anger and aggression covers what to do if fear turns into lashing out.
When to talk to the doctor
Tell your parent's doctor about any hallucinations or delusions, including what illnesses your parent has and what medicines they take1. A medical evaluation can rule out other causes and decide whether treatment is needed. It may help to have your parent's eyesight and hearing checked as well2.
About medication
Non-drug approaches are the first line of treatment for behavior symptoms in dementia. If those fail and symptoms are severe, medication may be considered. Antipsychotic drugs can help in some situations, but they are linked to a higher risk of stroke and death in older adults with dementia, so they must be used carefully23. People with Lewy body dementia can have serious reactions to some antipsychotics, which is one more reason the diagnosis matters4. Ask the doctor about the risks and benefits before agreeing to any new medicine. If a medicine is started, ask how you will know whether it is working, what side effects to watch for, and when it will be reviewed or reduced.
Caring for yourself
Hallucinations are hard on caregivers too. Being woken at night, or being treated as a stranger, wears you down. Explain to friends and relatives that the behavior comes from the disease, so they can respond kindly1. Take breaks, accept help and connect with other caregivers. Our guides to caregiver burnout and respite care can help.
If hallucinations and other behaviors become more than you can safely manage at home, a memory care community with trained staff may be the right next step. Our guide to choosing memory care explains what to look for, and person-centered dementia care describes the approach good programs use.
