Understanding Delusions in Dementia Care

A person living with dementia accuses us of stealing their money, tells you someone is coming into their room at night to rummage in their closet, or says they are being targeted by a staff member.

These are all common examples of delusional thought patterns that a person living with dementia may experience. Delusions can create significant concern for loved ones of persons living with dementia because it can be hard to know what is real and what is fantasy. You want to validate their emotions and protect them, but did these things really happen?

Delusions are a well-documented symptom of dementia. Research has found that, “Delusions and hallucinations are generally observed in about 1 in 4 to 1 in 3 patients with Alzheimer disease (AD), with reported frequencies of delusions as high as 94% and hallucinations as high as 69.5%.”

Alzheimer’s Disease11-17%10-39%
Vascular Dementia5-14%14-27%
Lewy Body Dementia55-78%40-57%
Parkinson’s Disease32-63%28-50%
Frontotemporal Dementia1.2-13%2.3-6%

Hallucinations vs. delusions

It’s important to recognize that hallucinations and delusions are NOT the same thing!

HALLUCINATIONS involve hearing, seeing, smelling, or feeling things that are not really there.

Example: You’re sitting outside with your loved one and they tell you how nice it is to see the children playing! However, you look where they are looking and see an empty snowy field.

DELUSIONS are firmly held beliefs in things that are not real

Example: Your loved one tells you that a staff member is tunneling under the ground to sneak into their room and steal their money.

Caregiver tips

It’s important to remember that not every delusion is harmful or upsetting to our loved one. Some can actually be enjoyable!

Though delusional statements can make us worried or uncomfortable, we must also recognize that our loved one is trying to make sense of the world around them.

When it comes to dementia and delusions, we have to pay closer attention to the feeling behind the delusion, not only the content of it.

As always, remember to take care of yourself physically and emotionally. You can’t pour from an empty cup!


    Prevalence of delusions and hallucinations in patients with dementia, Alzheimer’s disease, Parkinson’s disease, dementia with Lewy bodies—Pimavanserin: Potential Treatment For Dementia-Related Psychosis (Cummings et al. 2018)