Seeing things, confusion & not recognising you

A hallucination is an experience created by the brain, with nothing outside causing it. Seeing things is the most common kind in dementia. It might be a person, a child, an animal, or a parent who died long ago.

Other senses

• Feeling: like insects on the skin
• Hearing: voices or footsteps
• Smelling: smoke or perfume
• Tasting: a strange or metallic taste

A delusion is a strongly held belief that isn’t based in reality, such as “Someone is stealing from me” or “My husband is seeing someone else.” When the belief is that others mean harm, it is often called paranoia.

Delusions often grow out of memory gaps. The brain links pieces of information in the wrong way and reaches a false conclusion that feels completely real.

Here the brain misreads something that is really there. A reflection in a window becomes an intruder. A coat on a door becomes a person. Dark blue floor tiles look like water.

The person may have trouble recognising particular faces or objects. They may mistake their daughter for their wife, or their son for their husband. They may not know their own reflection.

In Capgras syndrome, a person believes someone close to them has been replaced by an impostor. They may recognise the face but not believe it is really you.

As recent memories fade, a person may rely on older ones and feel they are living years ago. They may ask to pick the children up from school, or ask for their mother.

This can explain why they don’t recognise you. They may be expecting their grown child to look like a little boy or girl, or expecting to see a much younger face in the mirror.

The person may say a friend visited today, when it never happened or happened months ago. They are not lying. Their brain is filling in a gap without them knowing.

Dementia can damage the back of the brain, which processes what the eyes see, and the areas that recognise faces and objects. The eyes may work fine, but the brain misreads the picture.

Vivid, realistic visual hallucinations are most common in dementia with Lewy bodies, and can appear early. In Alzheimer’s, hallucinations are more common in later stages. Delusions become more likely as dementia progresses.

The Types of dementia explained guide covers Lewy body dementia in more depth.

Worsening eyesight can cause visual hallucinations on its own. Hearing loss can turn ordinary sounds into voices. A busy carpet pattern can look like insects to tired eyes.

Infections (such as bladder or chest infections), dehydration, constipation and intense pain can all trigger hallucinations. So can delirium, a sudden state of intense confusion that is common in people with dementia.

Hallucinations and false beliefs can sometimes be caused by treatments, or by combinations of them. Tell their clinical provider about anything new or changed, and ask for a regular review.

If a person forgets where they put their purse, the only explanation that makes sense may be theft. If they forget their partner went shopping, they may think he is with someone else.

• “I don’t see it, but I believe you see it. Let’s go to the kitchen together.”
• “I’m here. I’ll keep you safe.”
• “That sounds scary. Tell me about it.”
• “You seem worried. Let’s sit by the window for a bit.”

• Arguing that “nobody is there”
• Laughing, even kindly
• Long explanations of how the brain works
• Quizzing: “Don’t you know who that is?”

Trying to convince them they are wrong tends to increase distress. They may feel you are dismissing their fears.

If they find it soothing, hold their hand, sit close, or gently stroke their arm. Frightening hallucinations often fade in a well-lit room with other people around.

Some people enjoy what they see, like children playing or a cat on the bed. If it isn’t upsetting or dangerous, you may simply let it be and stay warm and present.

Make sure the person can’t reach anything they could use to hurt themselves or someone else. If they become frightened and aggressive, step back to a safe distance and speak softly.

Try this

• Agree set places for keys, purse and wallet, so you know where to look first
• Keep spares of things that often go missing, like glasses or a second identical wallet
• Learn their usual hiding spots
• Look together rather than insisting it was misplaced

The person may recognise your face but be sure you are a stranger pretending to be you. This is a brain change in how faces connect with feelings. It does not mean your love has stopped reaching them.

Things families try

• Give it time: step away briefly, then come back calmer with a fresh hello
• Offer a different activity together to shift their focus
• Say your name warmly each time you come in
• Stay calm and don’t argue about who you are

They may not recognise a friend who visits, or a new care worker, and feel a stranger is in their home. They may also believe their home isn’t theirs, perhaps after new furniture or unfamiliar people arrive.

Try this

• Ask visitors and care workers to say their name and why they’re here each time
• Avoid unnecessary changes to furniture and layout
• Check for reflections in dark windows at night and close the curtains

If they forget you went to the shop, their brain may fill the gap with something worse. Try not to take offense or defend yourself at length.

Try this

• Give a short, simple answer: “I was at the store. I’m back now.”
• Reassure with warmth: a hug, a hand, “I’m here with you”
• Switch focus to a shared activity or a small chore

A person with dementia who says they are being stolen from or mistreated may really be a victim of abuse or financial exploitation. Look into it carefully before deciding it is a false belief.

The Elder abuse & financial exploitation guide explains the signs and where to report concerns.

Testing someone’s memory usually brings embarrassment or fear. Don’t insist they have forgotten you. To them, what they see is real.

If they mistake you for your dad, it may be because you now look like he did at your age, and they are living in that time. If they are content, correcting them may not help.

Gentle options

• Ask about the person they think you are: “What was he like?”
• Join the memory: talk about that time and place
• Say your name again later, without pressure

Emotional memories are often easier to hold onto. A warm, calm, friendly connection can still bring comfort, even when your name is gone.

Ways to connect without words

• Holding hands or a gentle hand massage
• Looking through photos together
• Music they loved when they were young
• Simple shared tasks, like folding towels

Keep photos of them and close family at different ages around the house. It can help them recognise the time they are living in, and connect the adult in front of them with the child they remember.

Someone living in an earlier time may expect to see a much younger face, and think the older person in the mirror is an intruder. Covering or removing mirrors at eye level can ease a lot of distress.

• Close blinds or curtains when it gets dark outside
• Cover mirrors, or turn them to face the wall
• Cover shiny surfaces at eye level if they cause upset

• Reduce clutter that casts odd shapes
• Turn lights on early, before daylight fades
• Use night lights in hallways and the bathroom
• Watch for glare and pools of light on shiny floors

Move objects that could be mistaken for a person, especially in the bedroom and in view of the bed at night.

Busy patterns on carpets, curtains or bedding can look like insects or moving shapes. Plain, contrasting colours are easier to read.

• Avoid sudden loud noises like fireworks or party poppers
• Check for sounds that could be misread, like an air conditioner
• Turn off violent or upsetting programmes, including the news
• Turn off background TV or radio when you talk

Avoid moving furniture or changing where things are kept. Keep familiar appliances, like an old radio or TV, as long as they work, since new ones can be confusing.

The Daily care & safety at home guide has more ideas for a safer, calmer home.

When someone is physically present but psychologically absent, there is no clear ending to grieve. Many caregivers find this uncertainty harder than the illness itself. Naming it can help: the illness causes this, not you and not them.

It is common to grieve again as the illness progresses: the first time they forget your name, the first time they call you a stranger. Grieve in your own way and time.

The Anticipatory grief: grieving before a loss guide goes deeper on this.

Being called a thief or a cheat by someone you are caring for is painful. Talk it through with another caregiver or a counsellor. It is okay to step away briefly, make a drink, and come back when you feel calmer.

• Accept offers of help, and take breaks
• Join a caregiver support group, in person or online
• Keep up one or two things you enjoy
• Talk with someone you trust, or a grief counsellor

The Caring for yourself as a dementia carer guide has much more on rest, respite and stress.

Answer questions simply: “Grandma has an illness that makes it hard for her to remember things.” Let them know no one caused it. Older kids may feel embarrassed, so make it easy for them to talk to you.

The Sharing dementia care: family, kids & care staff guide has more on helping children.

Knowing the person’s life story, jobs, routines and important people helps staff understand who they are looking for and what they are reacting to. A one-page profile, such as the Alzheimer’s Society’s “This is me” form, is useful in hospitals and care homes.

Caregiver support groups, and the Alzheimer’s Association’s free online community ALZConnected, let you share what has worked with hallucinations and false beliefs, with people who truly understand.

Faith communities, social groups and neighbours can be part of your support network: a visit, a meal, an hour so you can rest. A written plan of who helps when keeps the load shared.

Talk with a real person about a hard moment, get local resources and emotional support. Help is available in more than 200 languages. Callers who are deaf or hard of hearing can dial 711 for relay.

The National Institute on Aging’s Alzheimer’s and related Dementias Education and Referral Center answers questions by phone and email and refers families to local and national resources.