When Someone with Dementia Sees or Hears Things

Seeing, hearing, smelling, tasting or feeling something that others do not notice can feel real to the person. It may be frightening, or it may not upset them. Start with how the person feels and whether anyone is unsafe, rather than trying to prove what did or did not happen.

An experience may be a hallucination, but it may also be a misperception or misidentification. A shadow could look like a person; a familiar person could be mistaken for someone else. You do not have to decide which is happening. Describe what the person says and what you notice, and ask a clinician if you are concerned.

What should I do in the moment?

Stay calm, ask how the person feels, and offer reassurance without arguing. The Alzheimer’s Association advises assessing whether the experience is distressing or dangerous. If the person is comfortable and safe, there may be no need to interrupt.

• Acknowledge the feeling. You might say, “I don’t see anyone, but I can tell this is frightening. I’m here.” This is honest and lets the person know you are taking them seriously.
• Keep your words short. A long explanation or repeated correction can raise stress. Let the person describe what they notice if they want to.
• Offer, do not force, a change. Ask whether they would like to sit somewhere else, turn on another light or listen to a familiar song. Moving to a well-lit, familiar room may help; stop if the person does not want to move.
• Stay close if they want you there. Do not touch the person suddenly. Ask before offering a hand or a hug.

If the experience is harmless and not upsetting, follow the person’s lead. Do not turn the moment into a test or ask them to prove what they saw.

Some people find an experience comforting or familiar. If the person is calm and safe, there may be no need to change the subject or take them somewhere else. Ask what they would like; do not turn every such moment into a medical discussion. If they are frightened, respond to that feeling even when you cannot see the same thing.

Could something in the room be mistaken for a person or sound?

Check the setting with the person if they welcome that help. The Alzheimer’s Society distinguishes hallucinations from misperceptions, where a real object or pattern is seen incorrectly.

• Improve the light. Turn on a lamp and check for shadows or reflections from mirrors and windows.
• Check common sounds. A television, fan or appliance may sound like a voice or footsteps. Turn it down or off only if the person is comfortable with that.
• Look at patterns. A busy carpet, curtain or wallpaper may be mistaken for movement or an object. Ask whether the person would like to look from another place or change the view.
• Check sensory aids. If the person uses glasses or a hearing aid, ask whether they would like help checking that it is available and working as usual.

If the experience happens in the same place, look for a repeatable feature: a reflection in glass, a strong floor pattern, a television heard from another room or low light at dusk. Check for a real sound or object before treating it as a perception change. If you try an environmental change, explain it and ask whether it feels better.

Try one small change at a time. Do not rearrange the person’s belongings or remove something they value without asking. A familiar routine and a calm, well-lit space may feel easier.

When should I contact a doctor?

Contact the person’s doctor about experiences that are new, repeated, prolonged or upsetting. Changes in eyesight or hearing, illness, medicines and other factors can contribute. A clinician can assess what may be happening and whether any follow-up is needed. The Dementia Australia guide also recommends checking for physical, sensory, medication and environmental factors.

A sudden change is different. The NHS says sudden confusion needs immediate medical help, and the Alzheimer’s Society advises immediate medical help when hallucinations involve more than one sense. Contact local urgent medical services if the person suddenly becomes confused or the hallucination involves multiple senses. If someone is in immediate danger, use local emergency services.

Do not start, stop or change a medicine on your own. Ask the prescriber or pharmacist to review recent changes and all medicines the person uses, including over-the-counter products. Our doctor-visit guide can help prepare questions.

What details may help at an appointment?

If the person agrees, write down brief observations to share with the care team:

• what they said they saw, heard or felt, using their words when possible;
• when and where it happened, and about how long it lasted;
• whether the person seemed frightened, calm or at risk;
• what the room was like, including light, shadows, sounds and who was nearby;
• any recent illness, sensory change or medicine change you know about.

Use the person’s own words and describe what you noticed. For example, note “said a person was by the window” rather than labeling the event. Share notes with the person’s agreement when possible.

These notes do not diagnose the cause. If the experience starts suddenly with confusion or a major change in alertness, seek urgent help instead of waiting to collect a record.

The guide to late-day restlessness covers evening lighting and routine. For accusations about missing items, see when someone with dementia is suspicious.