Have you ever had your loved one tell you there’s a cat in the room when there clearly isn’t? Or maybe they’ve heard voices, or seen people outside the window who aren’t really there? If you’ve experienced this, you’re not alone—and you’re not crazy for wondering what’s going on.

Hallucinations are actually pretty common in people with dementia, especially in certain types like Lewy Body or later stages of Alzheimer’s. These can be visual—like seeing people, animals, or shadows—or even sounds, like music playing or people talking. And while it may seem “off the wall” to us, to the person with dementia, it feels very real. They’re not pretending. Their brain is simply working differently now.

And when it happens, it can be scary, confusing, or just plain frustrating—for both of you. You might feel like you need to snap them out of it or explain that it’s not real. But most of the time, that only makes things worse. The truth is, these aren’t just “weird moments.” They’re windows into a brain that’s trying to make sense of a world that no longer makes sense.

Let me share a story from years ago when I worked in a nursing home. It’s one that still sticks with me.

John and the Fire

John was a tall, strong farmer with dementia. One afternoon, he was sitting in the sunroom with six other residents when he suddenly shouted, “Fire!”

I rushed in and saw John standing in the middle of the room, panic written all over his face. He truly believed the room was on fire. And to him, that fire was just as real as the floor I was standing on.

Now, I could’ve told him, “John, there’s no fire. You’re seeing things.” But that would’ve only made him more upset—and honestly, that fear could have turned into anger. He was a big man, and if he thought I was ignoring a real danger, I could’ve been hurt.

So instead, I stayed calm and said, “Oh my goodness, John—thank you for letting us know! I’ve called the fire department, and they’re on their way. We need to get everyone out of here.” And that’s exactly what we did. I moved everyone to another room, and once we were away from the “fire,” John began to calm down.

I didn’t argue with him or try to correct him. I validated his fear and redirected him. And it worked.

Now, let me tell you about Bob and his wife, Maggie.

Maggie was a firecracker of a woman—always on the go, sharp as a tack, loved gardening and telling stories. But after a few years of living with dementia, things started to shift. One night, she calmly told Bob that there were children hiding under their bed, giggling.

Bob laughed at first, thinking she was joking. But when Maggie got upset and asked him to go check, he realized this was no joke to her—it was real in her mind.

He didn’t know what to do. Should he correct her? Should he pretend? Should he call the doctor? Like so many caregivers, Bob felt caught off guard and unsure what to do.

But over time, Bob learned something really important: Maggie’s brain was seeing and hearing things differently. Maybe it was shadows on the wall or the hum of the fan—her brain was trying to fill in the blanks, and that’s what led to the hallucinations.

Once Bob stopped trying to “fix” the moment and started focusing on how Maggie was feeling , things got easier. He learned to gently reassure her, sometimes peek under the bed just to help her feel safe, and then redirect her with something soothing—her favorite tea, a little soft music , or a cozy blanket.

He also made their room more comforting. He added a nightlight, took away mirrors that reflected strange shapes, and made sure there weren’t any dark corners that could confuse her.

And you know what? Things got better. Not perfect, but better .

With the right understanding and a few simple tools, Bob was able to create a safe space for both of them. He felt more confident, and Maggie felt more at peace.

Both John’s and Maggie’s stories remind us of something important: when someone with dementia experiences a hallucination, we need to adjust—not them. Trying to correct or explain usually backfires. But if we stay calm, validate their feelings, and gently redirect them, we can help bring their fear down and their comfort up.

Hallucinations are one of the many complex symptoms of dementia that can be puzzling and distressing for both the person with dementia and their caregivers. These false perceptions can vary from seeing things that aren’t there to hearing voices or even feeling things that don’t exist. Understanding what hallucinations are and how to handle them is an essential part of dementia caregiving.

Hallucinations in dementia refer to when a person experiences sensory perceptions that aren’t real. These could involve seeing things that aren’t there, hearing voices, or feeling things like insects crawling on their skin. While hallucinations can occur with any type of dementia, they are especially common in Alzheimer’s disease and Lewy Body Dementia.

Many people confuse hallucinations with delusions, but they are different. Delusions are false beliefs, such as thinking someone is stealing from them or that people are plotting against them, while hallucinations involve sensing things that are not physically present.

Types of Hallucinations in Dementia

1. Visual Hallucinations: The most common type in dementia. A person might see people, animals, or objects that aren’t there. For example, they might see a person sitting in a chair when no one is there.
2. Auditory Hallucinations: These involve hearing sounds, voices, or music that don’t exist. The person may hear voices calling their name or hear conversations when no one is around.
3. Tactile Hallucinations: These are less common but involve the sensation of something physical, such as the feeling of insects crawling on the skin or the sensation of being touched.

It’s important to remember that each individual may experience hallucinations differently, and they may vary from day to day or even hour to hour.

Hallucinations occur due to changes in the brain caused by dementia. As the disease progresses, certain brain areas responsible for processing information and reality perception are damaged, which can lead to misinterpretation of sensory input.

Several factors can contribute to hallucinations:

• Brain changes: The brain changes that happen in dementia can affect how the brain interprets sensory signals.
• Medications: Some medications, like antipsychotics, sedatives, or even certain antidepressants, can trigger hallucinations.
• Environmental factors: Things like unfamiliar places, poor lighting, or clutter can confuse the person with dementia, leading to hallucinations.
• Stress and anxiety: Being in unfamiliar or stressful situations may also trigger hallucinations, especially if the person feels anxious or unsafe.

When a person with dementia experiences hallucinations, it’s important to respond with patience, reassurance, and understanding. Here are some tips for handling these situations:

1. Stay Calm and Reassuring: It’s essential to remain calm when responding to hallucinations. A soothing, gentle tone can help the person feel safe and less anxious.

2. Avoid Arguing: Arguing with someone about what they are seeing or hearing will only increase their distress. Instead, validate their feelings. For example, you can say, “I understand that you’re seeing that, but I don’t see it.”

3. Use Distraction: Redirect their attention to something else they enjoy, like listening to music, watching a favorite show, or even a simple activity like a walk. This can often shift their focus away from the hallucination.

4. Provide Comfort: Offer reassurance and physical comfort, like a hug or holding their hand. This can help calm them down and give them a sense of security.

5. Assess the Environment: Make sure the room is well-lit and free from anything that could trigger hallucinations, like shadows or clutter. A well-organized and calm environment can help reduce confusion.

6. Medication: If hallucinations are frequent or troubling, talk to the doctor. It may be necessary to adjust medications or explore alternative treatments to reduce the symptoms.

7. Know When to Seek Help: If the hallucinations become more frequent, disturbing, or difficult to manage, it might be time to seek guidance from a healthcare professional. Keep track of when the hallucinations occur and any patterns that might help your doctor better understand the situation.

It’s important to monitor the frequency and intensity of hallucinations. If they’re causing significant distress or are becoming more frequent, consulting with a doctor or dementia specialist is recommended. They may suggest adjusting medications or trying new strategies to manage the symptoms more effectively.
Hallucinations that appear suddenly or are accompanied by other symptoms like confusion or disorientation may require urgent medical attention to rule out other underlying causes.

Conclusion: 

Dementia-related hallucinations can be a confusing and challenging experience, but with patience and the right approach, they can be managed effectively. Caregivers who respond with calm reassurance and adapt to the person’s needs can help minimize distress. Remember that each person’s experience with dementia is unique, so be flexible and creative in finding solutions that work for both you and your loved one.
If you’re struggling with hallucinations or any other dementia-related symptoms, don’t hesitate to reach out for support. There are plenty of resources available to help you through this journey such as my Understanding Dementia Course and the Alzlog Caregiver’s Notebook, which can assist you in managing the daily challenges of dementia care.