When Dementia Patients Become Delusional and How to Respond

It surely is disturbing when a loved one, having dementia, suddenly becomes suspicious towards you. For example, your father might forget that you’ve been dealing with his money matters for years and may suddenly assume that you are trying to steal his money.

However, these are some of the familiar scenarios which Alzheimer’s caregivers have to face on a daily basis. Dementia affects how the patient perceives the world. One of the common side effects of dementia is patients exhibiting delusional behavior and, in some cases, the affected individuals even experience hallucinations.

Firstly, it is important to understand what delusion and hallucination are. While delusion involves suspicion and false beliefs, hallucination is a false perception that can even be sensory in nature. In the earlier stages of the disease, the patient can recognize that this is a figment of their imagination. But, as the disease worsens over time, they may be unable to distinguish between fantasy and reality.

According to a research, almost 40% of Alzheimer’s patients are prone to delusions and suspicious behavior. This is why caregivers should know how to handle this type of behavior at a practical level because it can be very hurtful to both parties if they respond emotionally.

So, what is your best weapon to deal with such behaviors? Knowledge and a practical approach. Here are some coping strategies that can help you handle the situation much more effectively.

Tips for responding to delusions

As difficult as it may sound, try not to let your loved one’s suspicious behavior get under your skin. Explain the process to your family, friends and other caregivers. Help them understand that their suspicion and aggressive behavior is not a reflection of them. Remember, it is the disease talking and not them. Remind yourself that this behavior is due to the decline in brain health and the changes happening within.

Secondly, try to maintain a regular routine for your loved one suffering from dementia. A consistent and predictable schedule will reassure the person and may help prevent delusions and anxiety.

Here are some more effective ways to manage delusions:

1. Employ the 3 R’s (Reassure, Respond, and Refocus)

Remain calm and resist any urge to correct or explain things to your loved one. Don’t try to prove that what they are experiencing is not real, it will only confuse them further.  Just respond to their needs with empathy and reassure them that you are there to listen. Respond appropriately by acknowledging their fear. Try to shift their focus from the problem causing topic. This doesn’t mean that you should agree with your loved one when they are delusional. Be honest while respecting them. An example of a reassuring yet validating statement might be,“It must be scary to think someone is in the house with you.”

2. Investigate

Sometimes, the immediate environment plays a role in triggering fear and delusion within the patient. Investigate your surroundings and look for a cause that might have caused the unsettled behavior. If they are seeing something that you aren’t, find out where and what it is. Is it because of the lighting through the window creating a shadow?

Once, you have identified the underlying pattern behind the problem, try to minimize it by shifting to another room during those hours, or by closing the drapes at that specific time.

3. Distract

Whenever you find your loved one on the verge of being delusional, try to divert their attention by using distraction as a technique. Too much screen time, especially violent or upsetting shows, can make them more prone towards anxiety and meltdowns. Think about other activities that they like. Common distractions are taking a walk around the block, solving puzzles, playing cards and looking at old photographs.

Here are 6 stimulating activities that can improve the lives of dementia patients.

4. Duplicate any lost items

If your loved one tends to lose things repeatedly and then keeps on searching for that particular item, consider keeping duplicates. For example, if your mother loses her wallet and assumes it’s stolen, purchase two or more similar wallets, and offer it to her when she loses it the next time.

5. Look for support

Never say no to help and become a part of a support system that offers a safe haven for caregivers, family, and friends of persons with dementia. Being a part of a support group is an empowering experience that can help you feel prepared to cope with difficult situations.

Read brain health blogs where people share their response strategies and get more ideas from other caregivers.

6. Evaluate for other medical causes

Sometimes, there can be other medical reasons that trigger delusions and suspicious behavior. Consult with your loved one’s physician to rule out any other underlying medical issue like dehydration, urinary tract infections, kidney or bladder infections, or pain- all of which can cause hallucinations or delusions.

If your loved one has started a new medication, report behavioral changes to the doctor immediately as it can also be a side effect of the medicine.


The bottom-line is that no matter who we are, we just want to feel understood. Whether it is a toddler who hasn’t developed his vocabulary or an adult experiencing delusion related to dementia, or any other medical issue- the way to deal with it remains the same. After all, every human being wants others to respond to their feelings and acknowledge what they are experiencing.

Photo by Alexandre Debiève on Unsplash