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Esther Heerema, MSW

Hallucinations in Lewy Body Dementia: Should You Use the Therapeutic Lie?

By October 13, 2013

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Hallucinations can occur at times in Alzheimer's disease, but they are extremely prevalent in Lewy body dementia, with about 80% of people with LBD experiencing them.

Hallucinations can be distressing for the person with LBD to experience, and they also may be difficult for caregivers to know how to handle. So, what's an effective way to respond to these hallucinations?

While there's no one-size-fits-all response, one approach you may want to avoid using (or at least use with caution) for someone with Lewy body dementia is the therapeutic lie. The therapeutic lie, where the caregiver may bend the truth with good intentions, has been recommended by some people in an attempt to reassure someone with Alzheimer's disease.

However, people with Lewy body dementia who hallucinate are often functioning at a higher cognitive level since hallucinations tend to develop early in LBD than in Alzheimer's. Some caregivers have shared that their attempts to untruthfully reassure someone have backfired because the person with LBD could detect the untruth and then became even more upset.  In other situations, however, caregivers have had success in "going along with" the hallucination, and expressed that they felt this was the only way they could help their loved one at that time. (Of interest, the Lewy Body Dementia Association has a forum where caregivers share some concerns and ideas.)

My Two Cents

When working with someone who has dementia (regardless of its type), I would advocate for first trying validation therapy, distraction through meaningful activities or other kinds of reassurances. To me, these other approaches- when possible (and I realize there may be times where they're not possible or effective)- make sense, both because they are often helpful, as well as due to my own preferences for how I would want to be treated.

For more ideas on how to respond, here's an article I recently wrote on this topic:  Responding to Hallucinations in Lewy Body Dementia

More About Lewy Body Dementia

How Is Lewy Body Dementia Different from Alzheimer's Disease?

Does Lewy Body Dementia Have Stages? How Does It Progress

A Surprising Early Sign of Lewy Body Dementia

Capgras Syndrome in Lewy Body Dementia: What Is It and How Should You Respond?

October 15, 2013 at 12:21 am
(1) Peggy Watson says:

Agreed that validation and redirection work wonderfully well to diffuse a potentially explosive situation. Example: “I agree with you, I wouldn’t like that either – lets go get some ice cream!” or “You are so right about that, I feel the same way, lets go for our walk”. Have you ever won an argument with your loved one with dementia? Validation is an evidence based intervention developed by Naomi Feil. Thanks for sharing Validation for those who may not have tried it yet.

February 28, 2014 at 2:17 pm
(2) Deborah Kallam says:

My mom had Alzheimer’s. She passed away in Jan 2012. Her roommate at the nursing Home has Lewy Dementia and does experience halusenations at times. She knows something is going on and feels that she is crazy. I am researching this form of dementia for answers for the both of us. Alzheimers has been in my family for years as my Grandmothers on both side had it and also 4 of my mothers sisters, but the Lewy Dementia is new to me. Thank you for any advice to help her with this desease and myself. Deborah

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