Memory Digest

Hallucinations and Delusions

Why people with dementia may see things that aren't there or believe things that aren't true—like someone stealing from them—and calm, practical ways to respond.

Last reviewed: October 2026

"There's a little girl sitting in the corner." "Someone's been in the house moving my things." "You stole my wallet." Comments like these can be startling and hurtful. They are also common in dementia, and there are good ways to respond.

Hallucinations, delusions and paranoia: what's the difference?

• Hallucinations are false perceptions. The person sees, hears, smells, tastes or feels something that isn't there—such as people, animals or voices. The Alzheimer's Association explains that they are caused by changes in the brain from dementia.
• Delusions are firmly held false beliefs. Common examples: someone is stealing from them, a spouse is unfaithful, they are being poisoned, or they need to "go home" when they are already home.
• Paranoia is a type of delusion involving suspicion—believing others are out to harm, cheat or deceive them.

To the person, these experiences are completely real. They aren't lying or "being difficult."

Why they happen

Brain changes. Dementia damages areas that interpret what we see and hear, and that help us remember and reason. A person who can't remember where they put their purse may logically conclude that someone took it.

Type of dementia matters. Vivid, detailed visual hallucinations—often of people or animals—are a hallmark of Lewy Body Dementia and can occur early in that disease. In Alzheimer's Disease, hallucinations and delusions are more common in the middle and later stages. They also occur in Parkinson's Disease Dementia.

Other causes to rule out (Alzheimer's Association):

• Eyesight or hearing problems—poor vision can turn a coat on a chair into a stranger
• Medications or interactions between them
• Infections, such as urinary tract infections, and dehydration or pain
• Delirium—sudden confusion from an acute illness—see Delirium vs. Dementia

New or sudden hallucinations need a medical checkup to look for these treatable causes.

How to respond

The Alzheimer's Association and NIA offer these strategies:

1. Decide whether it's a problem. Is the experience upsetting the person, or putting anyone at risk? A pleasant hallucination—such as seeing a friendly child or a cat—may not need any action at all.

2. Stay calm and don't argue. Trying to convince someone that what they see isn't real usually increases distress. You might say, "I know you see something, but I don't see it." That's honest without being confrontational.

3. Respond to the feeling. "It sounds like you're worried." "That must be frightening. I'm here, and you're safe."

4. Offer comfort. Gentle touch, a calm voice and your presence can turn attention away from the hallucination.

5. Redirect. Suggest a walk, a snack, music, or moving to another room. Frightening hallucinations often fade in well-lit areas where other people are present.

6. Check the environment.

• Improve lighting to reduce shadows
• Cover or remove mirrors if the person thinks their reflection is a stranger
• Turn off a TV that might be mistaken for real people in the room
• Check for noises (air conditioner, outside traffic) that could be misinterpreted

Handling "someone stole it"

Accusations of theft are among the most common and painful delusions. Try to:

• Not take it personally—it comes from the disease
• Help look for the missing item rather than defending yourself
• Learn hiding places—people often tuck things in the same spots
• Keep spares of important items like glasses, keys or a wallet with a little cash
• Reassure others (family, aides) who may be accused, so everyone understands

When to call the doctor

• Hallucinations or delusions appear suddenly or get much worse
• The person is very frightened, agitated or aggressive—see Agitation and Aggression
• They act on beliefs in unsafe ways (refusing food out of fear of poison, trying to leave home)
• There are other signs of illness such as fever or new confusion

What about medication?

Non-drug approaches are the first line of treatment. If symptoms are severe and other strategies fail, the Alzheimer's Association notes that medication may be appropriate. Doctors sometimes prescribe antipsychotic medicines, but they must be used with great care:

• Antipsychotics carry an FDA boxed warning: older adults with dementia-related psychosis treated with these drugs have an increased risk of death.
• People with Lewy body dementia can have severe reactions to some antipsychotics. Make sure every doctor knows the diagnosis.
• The goal is usually the lowest dose for the shortest time, with regular review.

Treating hearing and vision problems, pain, infections and sleep often helps more than people expect.

Caring for yourself

Being accused or not recognized by someone you love hurts. Talk with other caregivers, use respite care, and lean on support lines—the Alzheimer's Association 24/7 Helpline is 800-272-3900. See Caregiver Stress and Burnout.

Bottom line

Hallucinations and delusions are symptoms of the disease, not choices. Rule out medical causes, stay calm, respond to feelings rather than facts, and adjust the environment. Talk with the person's doctor about any new or distressing symptoms before considering medication.

Sources

1. Alzheimer's Association: Hallucinations
2. National Institute on Aging: Alzheimer's Caregiving: Coping With Hallucinations, Delusions, and Paranoia
3. U.S. Food and Drug Administration: FDA Approves First Drug to Treat Agitation Symptoms Associated with Dementia due to Alzheimer's Disease

Not medical advice. This article is general information, not a diagnosis or treatment plan for any individual. Talk with a doctor about your situation.

Related articles

• Lewy Body Dementia
• Agitation and Aggression
• Sundowning
• Communicating with Someone with Dementia
• Middle-Stage Dementia