​Behavioural changes in persons living with dementia can occur as a result of changes in their brain.

The Department of Psychological Medicine from Changi General Hospital (CGH), a member of the SingHealth group, explains the common symptoms displayed by persons with dementia and offers caregivers tips on how to better manage these behaviour changes when caring for their loved ones with dementia.

Hallucinations in persons with dementia

Hallucinations are experiences where a person smells, tastes, feels, hears or senses something that does not exist. This may be a result of the changes in the brain caused by dementia.

‘Visual mistakes’ such as illusions and misperceptions are not hallucinations, although they are sometimes mistaken as such. Visual mistakes can result from poor vision and any form of damage in the visual system including the brain.

8 Tips to manage hallucinations in persons with dementia

1. Consult a doctor to find out if the hallucinations could be caused by other reasons besides dementia

When the person with dementia newly experiences hallucinations, arrange for a medical check-up to rule out the presence of other physical or psychiatric problems as well as to check for side effects of medications.

2. Sympathise with the person when he/she is experiencing a hallucination 

Acknowledge that they may be frightened by the hallucinations, and do not argue with them as what they experience is very real to them.

3. Be patient when explaining to your loved one what he/she is experiencing isn't real

Explain the real situation calmly. If your loved one does not accept it, repeat it when they are calmer and rested.

4. Provide sufficient lighting for the person with dementia

Ensure adequate lighting to lessen shadows when it is dark, which could trigger a hallucination in a person suffering from dementia.

5. For persons with dementia, it is important to keep them occupied

Distracting them with activities such as music, exercise or even conversations with friends may help.

6. For hallucinations that are harmless, it is okay to ignore

Some hallucinations can be ignored if they are harmless and do not cause the person to become agitated.

7. Don't be afraid to seek help

If the hallucination episodes are causing distress to your loved one with dementia and to you as a caregiver, discuss the issue with your loved one's primary physician.

8. Make a record when the person with dementia experiences a hallucination

Take accurate notes or observations about:

  • What the person saw or sensed during the hallucination

  • When did the hallucination occur (the time of day) and what was he/she doing when it occurred (e.g., during a nap, meal, exercise)

  • Where the person was when the hallucination occurred (details of exact location)

  • Duration of the episode, and whether the episode is intermittent or a regular occurrence

  • Words that your loved one used to describe what they think they saw, heard, sensed, tasted or smelled

  • Name of the current and NEW medications (including self-prescribed) that the person is on and the dosage taken 

  • Recent bereavements experienced by the person

This information may facilitate the primary physician in deciding whether treatment for hallucinations is necessary.

Possible reasons for a person with dementia experiencing hallucinations

  1. Disease progression of dementia

  2. Medical conditions such as stroke, infection, pain, fever and dehydration due to medications or medical conditions

  3. Clarify if the hallucinations are new and not caused by medical conditions or medications

  4. Lack of sleep

  5. Sudden change in environment (e.g., attending a new day care centre, rotating to another person’s home)

About BPSD (Behavioural and psychological symptoms of dementia)

Behavioural and psychological symptoms of dementia (BPSD) are neuropsychiatric symptoms and behaviours displayed by persons with dementia.

These symptoms constitute a huge aspect of dementia irrespective of its subtype, and they demonstrate a strong correlation with the degree of functional and cognitive impairment.

Learn how to manage anger and aggressionclick here.

Learn how to manage apathyclick here.

Learn how to manage inappropriate (disinhibited) behaviours, click here.

Learn how to manage paranoia and delusionclick here.

Learn how to manage repetition (repetitive behaviour), click here.

Learn how to manage sundown syndrome, click here.

Learn how to manage wandering behaviour, click here.

Ref: H24