Hallucinations vs delusions in dementia


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Let’s talk about a question that I get a lot, one that I hear as a part of another question, which is what is the difference between a hallucination and a delusion? Sometimes people don’t actually ask this as much as I can tell that when they’re describing something to me, they are confusing the terms. So a delusion is a fixed, false idea. Everyone living with dementia has delusions. Actually, we all have delusions really, but a delusion is a fixed, false idea. A hallucination is when you’re sensing something that’s not there. You’re seeing, hearing, smelling, tasting, and feeling something that’s not there. And the best way to describe the difference between these is probably this example. A delusion would be if I told you I saw my grandmother yesterday, okay. I did not see my grandmother yesterday. She passed away years ago.

A hallucination would be that my grandmother is standing right here. Can you see the difference? So a hallucination would be me actually actively seeing something and telling you about it. Now it gets confusing because if I were to say to you, I saw my grandmother yesterday, technically you could not be sure if that was a hallucination or a delusion, right? Because maybe I did actually think that I saw her. Like I actually was talking to her and I thought she was standing right there. But generally speaking with dementia, if someone does say something like that, you can pretty much consider it a delusion. Now the most common hallucinations are where someone is hearing or seeing something – typically, children or animals. Those are really common hallucinations that someone will see. And if you hear my cat yelling, this is one more reason that I do my videos in the car, but here we are, so a hallucination is when you’re seeing or hearing or smelling, tasting something that’s not there.

If that is happening, if that is not a normal part of their disease process, such as they have dementia with Louis body Parkinson’s disease dementia, and you’re not normally experiencing them having a hallucination, this would be a great time to make sure we don’t have something else medical going on, such as a urinary tract infection or something that could cause hallucinations, regardless of if something medical is causing it. And, you know, even as we’re looking into what the cause of the hallucination might be, we still want to treat the hallucination as real, just as we would with the delusion. We still want to, as I say, embrace that person’s reality. We want to do what is true for them, even if it doesn’t make sense to us.

So if mom is saying, “You know, oh, I look at those kids over there. They think they need to get on the school bus.” And there aren’t any kids, we’re not going to say, no mom, there aren’t any kids there, forget about it. We’re going to say, oh, you’re right. You know what? The school bus must be late. I’ll go outside and see what’s going on. Right? We want to still solve the emotional problem, not the physical one, AKA arguing about whether or not that hallucination is real. I hope this video helped you out a little bit. I know these things are kind of confusing sometimes, and we just want to make sure we’re using the right language when we’re describing a symptom of dementia. Thanks.

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1 thought on “Hallucinations vs delusions in dementia”

  1. Is there anything you can do for delusions other than embrace their realty. My wife has early onset Alzheimer’s. She has had delusions for the last 18 months.

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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