Use careArticle link

Redirecting Hallucinations in Lewy Body Dementia: A Step-by-Step Guide

When your loved one with Lewy body dementia sees or hears things that aren't there, it can be frightening for both of you. Hallucinations are a common symptom of this disease, but you don't have to argue or feel helpless. This guide offers concrete, gentle steps to redirect their attention, reduce distress, and restore calm. You'll learn what to say, what to do, and how to adapt your approach for different situations. Remember, you are not alone, and there are practical tools that work.

Key points

  • Hallucinations in Lewy body dementia are real to the person experiencing them. Arguing will only increase distress.
  • Validate their feeling first, then gently redirect to a new activity or environment. This builds trust and reduces fear.
  • A change of scenery—moving to a different room or going outside—can often make a hallucination fade.
  • Bright, even lighting reduces visual hallucinations. Check for shadows, flickering bulbs, or dim rooms.
  • If the hallucination is not upsetting, leave it alone. Not every hallucination needs a response.
  • Always rule out physical causes (infection, medication side effect, sensory issues) before assuming it is just the dementia.

What Is Happening in Lewy Body Dementia?

In Lewy body dementia, the brain's ability to interpret sensory information is disrupted. Hallucinations—seeing, hearing, smelling, tasting, or feeling things that aren't there—are especially common and often vivid. These are not a sign of psychosis or a mental health crisis; they are a direct result of the disease process affecting the brain's visual and sensory processing centers. The person experiencing the hallucination is not lying or confused in a way you can reason them out of; their brain is genuinely perceiving something that is not present in the external world. This is why arguing or trying to 'correct' them usually backfires, causing more agitation and distress.

Why Redirection Works for Lewy Body Hallucinations

Redirection is a powerful tool because it works with the brain's changing abilities rather than against them. People with dementia often lose the ability to sustain focus on one thing for long periods. If you can gently shift their attention to a different activity, environment, or topic, the hallucination may fade or disappear on its own. This is especially true for visual hallucinations, which often subside in well-lit areas or when the person is engaged in a calming, familiar activity. The key is to validate their experience first—let them know you hear them and take them seriously—before you try to move them into a new focus. This builds trust and reduces the fear that can make hallucinations worse.

When to Be Concerned About a Sudden Change

While hallucinations are common in Lewy body dementia, a sudden increase or a new type of hallucination can signal an acute medical problem. Up to 90% of sudden behavioral changes in dementia are caused by something like a urinary tract infection, medication side effect, or other infection. If your loved one's hallucinations become more frequent, more frightening, or are accompanied by confusion, fever, or a change in mobility, contact their doctor immediately. Do not assume it is 'just the dementia getting worse.' Always rule out a physical cause first, especially in Lewy body dementia, where people are sensitive to many medications.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Stay calm and take a slow breath. Your loved one can sense your anxiety. Speak in a soft, low tone. Do not raise your voice or show alarm. Your calm presence is the first step to reducing their fear.

  2. Acknowledge and validate their experience. Say something like, 'I can see you're upset. Tell me what you're seeing.' Do not say 'There's nothing there.' Instead, join their reality briefly. For example, if they say there is a man in the room, you can say, 'I see you're worried about that person. Let me take care of it.'

  3. Use a 'therapeutic fib' to gently change the narrative. If they see bugs crawling on them, say, 'Oh, I see them. Let me help brush them off.' Then physically brush their arm or clothing. This acknowledges their feeling without lying about the reality of the bugs. Then say, 'There, they're gone now. Let's go sit in the kitchen.'

  4. Move them to a different room or environment. A simple change of scenery can break the hallucination. Say, 'Come with me to the kitchen—I need your help with something.' Walk with them, holding their hand or guiding them gently. The act of walking and the new visual input can help the hallucination fade.

  5. Offer a familiar, calming activity. Once you are in the new space, engage them in something they enjoy: looking at a photo album, folding towels, listening to music, or petting a stuffed animal. The activity should be simple, repetitive, and soothing. Avoid anything that requires complex thinking or new instructions.

  6. Turn on lights or open curtains. Hallucinations often worsen in dim or shadowy environments. Bright, even lighting can reduce visual misperceptions. If it's nighttime, use a nightlight or lamp rather than a bright overhead light that might cast shadows.

  7. Check for unmet needs. Hallucinations can be triggered by hunger, thirst, pain, or the need to use the toilet. Gently ask, 'Are you hungry? Would you like a cup of tea?' or 'Do you need to use the bathroom?' Addressing a basic need can sometimes resolve the hallucination entirely.

  8. If the hallucination is not distressing, let it be. If your loved one is calmly talking about a person or thing that isn't there and is not upset, there is no need to intervene. Trying to redirect a non-distressing hallucination can actually cause confusion. Simply listen and nod. If they ask you about it, you can say, 'That sounds interesting,' and then gently change the subject.

  9. Use a simple, one-step command to redirect. Instead of saying, 'Let's go to the kitchen and make some tea,' say, 'Come with me.' Then, once they are moving, say, 'Let's sit down.' Break tasks into tiny steps. This reduces cognitive load and makes it easier for them to follow your lead.

  10. If redirection fails repeatedly and the hallucination is causing severe distress, document what happened and discuss with their neurologist. In Lewy body dementia, antipsychotic medications can sometimes make hallucinations worse or cause severe side effects. Only a doctor can decide if medication is appropriate, and it should be a last resort after behavioral approaches have been tried.

What not to do

  • Do not argue or try to convince them the hallucination isn't real. Saying 'There's nobody there' or 'You're imagining things' will only increase their confusion and agitation. Instead, validate their feeling and then redirect to a new topic or activity.

  • Do not use logic or reasoning. The part of the brain that processes logic is damaged. You cannot 'talk them out of' a hallucination. Trying to do so is like trying to convince someone with a broken leg to walk it off. It will not work and will cause more distress.

  • Do not get angry or frustrated. Your loved one is not doing this on purpose. They are experiencing a real sensory event. If you get upset, they will pick up on your emotion and become more frightened. Take a break if you need to—step into another room for a minute to compose yourself.

  • Do not leave them alone in a frightening hallucination. If they are scared, your presence is a comfort. Stay with them, speak softly, and guide them to a different space. Abandoning them in that state can make the hallucination more terrifying and erode trust.

  • Do not assume every hallucination needs to be treated. If the hallucination is not bothering them—for example, they see a friendly person who isn't there and are calm—there is no need to intervene. Overreacting can create a problem where there wasn't one.

  • Do not use antipsychotic medications without a doctor's guidance. In Lewy body dementia, many antipsychotics can cause severe side effects, including rigidity, confusion, and even death. Never give any over-the-counter or prescription medication for hallucinations without first consulting the neurologist or pharmacist.

Practical tools

  • The 'Join and Shift' Script

    A simple two-part phrase to use when your loved one is hallucinating. First, join their reality: 'I can see you're worried about that person. Let me take care of it.' Then, shift their focus: 'Come with me to the kitchen—I need your help with the tea.' This validates their experience and then gently moves them to a new activity.

  • The 'Bug Brush-Off' Technique

    If they feel bugs or insects crawling on them, say, 'Oh, I see them. Let me help you brush them off.' Use a soft cloth or your hand to gently brush their arm, shoulder, or clothing. Then say, 'There, they're gone now. Let's go sit over here.' This addresses the tactile hallucination without arguing.

  • The 'Lighting Check' Checklist

    Keep a small checklist near the light switches: (1) Turn on overhead lights, (2) Open curtains or blinds, (3) Turn on lamps in corners, (4) Remove any flickering bulbs. Hallucinations often diminish in bright, even light. At night, use a dim nightlight rather than a bright lamp that might cast shadows.

  • The 'Activity Menu' Card

    Create a small card or list of 3-5 calming activities your loved one enjoys. Examples: looking at a photo album, listening to their favorite music, folding towels, petting a stuffed animal, or doing a simple puzzle. Keep this card in your pocket or on the fridge. When a hallucination occurs, pick one activity and invite them to join you.

  • The 'Sensory Check' Routine

    Before assuming a hallucination is purely dementia-related, check for sensory issues: (1) Are their glasses clean and on? (2) Are their hearing aids working and inserted? (3) Is the room too dark or too bright? (4) Are there any shadows or reflections that could be misinterpreted? Fixing these can sometimes stop the hallucination at its source.

  • The 'Distraction Kit'

    Prepare a small bag or box with items that can quickly redirect attention: a familiar scented lotion (like lavender), a soft textured cloth, a small photo album, a favorite snack, or a simple fidget toy. When a hallucination starts, offer one of these items and say, 'Here, feel this—it's so soft,' or 'Would you like a piece of chocolate?'

Discuss with your clinician

If hallucinations are new, sudden, or accompanied by fever, confusion, or a change in mobility, contact the doctor immediately to rule out infection or medication side effects.

Ask the neurologist: 'Are there any medications that could be causing or worsening the hallucinations? Should we review all current prescriptions?'

If redirection fails repeatedly and the hallucinations are causing severe distress, ask: 'Is there a safe medication option for Lewy body dementia? What are the risks and benefits?'

If your loved one has a history of falls or movement problems, discuss with the doctor before trying any new activity or environment change that might increase fall risk.

Ask about a referral to a geriatric psychiatrist who specializes in dementia-related hallucinations and can offer non-medication strategies.

Related guides

Sources