Lewy Body Dementia: How to Manage Hallucinations [Video]

  • Hallucinations are common among people with Lewy body dementia (LBD).
  • In most cases, being honest about a patient’s hallucinations can help manage their symptoms.
  • Antipsychotic medications may be life-threatening for people with LBD. 

Compared to people with Alzheimer’s or vascular dementia, people with Lewy body dementia (LBD) are more likely to experience hallucinations. They may also have this symptom earlier, which may serve as the first warning sign of the disease. 

Visual hallucinations affect about 80% of people with Lewy body dementia. Often, these hallucinations are recurrent and very detailed, and may commonly include seeing adults, children, or animals.

According to research, there’s a correlation between elevated amounts of cognitive impairment in LBD patients and having hallucinations. Hallucinations in LBD have also been found to decrease quality of life. People with LBD and their caregivers may benefit from being aware of how to respond to these hallucinations. 

Responding to Hallucinations

Responding to Lewy body dementia hallucinations can be challenging. These hallucinations often occur in the early stage of the disease, and some patients respond well when gently oriented with reality and reassured that the hallucination isn’t real. With Alzheimer’s disease, it’s not recommended to try to persuade the patient that what they’re seeing or hearing isn’t real. But in LBD, the method can be used as an initial response since people with LBD usually have fewer cognitive deficits when they’re having hallucinations.

Experts recommend answering truthfully if your family member directly asks you if you see the person that he sees across the room, and to acknowledge that although you don’t see her, you know that the patient does. Some family members have reported that when LBD patients have caught them lying, the patients became angry and agitated.

If the hallucination makes the patient feel very upset and distraught, use caution and distance yourself a little from him. A distressed LBD patient could mistake you for his hallucination, or have a catastrophic reaction and become aggressive. Reassure him and ask for his permission before entering his space.

You can also use validation therapy in which you ask the patient what the person looks like, how long the person has been there, and what makes them go away.

Another option is to distract the patient by taking them to a different room or for a walk outside, playing some music, talking about a game they like, or calling a pet over for some therapy.


Treating dementia hallucinations is similar across all types of the disease, but in Lewy body dementia, the use of antipsychotic medications can cause severe and life-threatening reactions. 

About 50% of LBD patients are extremely sensitive to typical antipsychotic medications, like Haldol. While atypical antipsychotics may be less likely to trigger a serious reaction, it’s crucial to proceed with caution. 

It’s also important to note that the medicine Sinemet, which is often used to treat the movement challenges of LBD, can worsen hallucinations in some people with the disease. 

Research has revealed that cholinesterase inhibitors benefit some LBD patients who experience hallucinations. The US Food and Drug Administration has approved this medication to treat Alzheimer’s disease and other dementias. 


Like other dementias, Lewy body dementia can affect the whole family. Caring for someone with the disease can be physically and emotionally draining. If you need help, consider joining a support group or looking into other ways to provide the best care for your loved one.


Source: Very Well Health

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