Delusional, paranoid and hallucinatory behavior in Alzheimer’s disease patients


By Micha Shalev

Micha Shalev, MHA CDP CDCM
Micha Shalev, MHA CDP CDCM


Delusional, paranoid and hallucinatory behaviors may be a response to internal or external factors. They most often occur as a result of brain changes in the person with Alzheimer’s disease. They may cause the patient great distress or may be little more than mildly stimulating and even comforting.

Some examples of when these behaviors may cause a problem:

  • Patient believes his food is poisoned and refuses to eat.
  • Patient misplaces items and accuses others of stealing from him.
  • Patient can’t hear well and is convinced others are talking about him and/or conspiring against him.
  • Patient sees, hears or feels persons, bugs, or animals that are not there.

The goals for caregivers are to help the person feel emotionally secure and safe; to reduce or eliminate behaviors or conditions in the environment which may appear threatening or lead to confused thinking; and to reduce physical causes of hallucinatory behavior such as fever, dehydration, impaction and poor nutrition,.

Some suggested approaches for caregivers:

  • Don’t argue or try to rationalize. This will only upset the person more.
  • If the patient is agitated or anxious and believes someone is trying to harm him, try to reassure him or distract him.
  • Try to determine what’s causing the behavior. The patient may be misinterpreting a real situation.
  • Ignore the behavior if it is not causing the patient distress.
  • If the behavior interferes with caregiving, such as refusing to eat or take medicine because it’s “poisoned,” report the situation to the nurse or physician.

Be sure the patient can see and hear as well as he can. Does the individual need glasses or a hearing aid? Loss of hearing or vision may contribute to confused thinking and beliefs because the person cannot interpret correctly what he sees or hears.  This is compounded by memory loss caused by Alzheimer’s disease. Be sure the area is well-lighted. Reducing noise, stimulation, and activity may also help.

Monitor for physical causes – lack of needed nutrition, insufficient sleep. Dehydration and medications may cause or contribute to confused thinking. Extreme lack of stimulation can lead to disturbance in thinking, too. Some behavior which appears hallucinatory may be an attempt at self-stimulation.

When responding to delusions and hallucinations:

  • Try to determine if he or she has any difficulty with hearing or vision;
  • Make sure that lighting is adequate;
  • Make sure that she is eating a well-balanced diet;
  • Try to make the environment comfortable;
  • Keep routines and schedules consistent;
  • Try not to change the environment;
  • Check for signs of physical injuries such as bruises or scrapes;
  • Determine whether the hallucination or delusion is bothering the person with dementia. If not, you may not want to discourage it;
  • Try to find a way to alleviate the distress;
  • Respond to the feelings and not to the issue. Rather than contradict him, acknowledge his concern;
  • Do not get angry, and avoid arguing with them. You will not win an argument with a person who is having a hallucination or delusion. Remember, the hallucinations and delusions are very real to them;
  • Investigate suspicions that may be based on fact. It’s possible that they really could be a victim;
  • Use familiar distractions such as listening to music, exercise, playing cards, or looking at photos;
  • Offer reassurances.

Micha Shalev, MHA CDP CDCM CADDCT, is the owner of Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 Randolph Road in Worcester. He is a graduate of the National Council of Certified Dementia Practitioners program, and a well-known speaker covering Alzheimer’s and dementia training topics. The programs at Dodge Park Rest Home specialize in providing care for individuals with dementia and Alzheimer’s disease. The facility is holding a FREE monthly support group meeting on the second Tuesday of each month for spouses and children of individuals with dementia and/or Alzheimer’s disease. He can be reached at 508-853-8180 or at or view more information online at