Dear Laird: My husband has Lewy Body dementia and accuses me of infidelity. It’s not true, but I am unable to convince him otherwise. Is there anything I can do?

Hallucinations can occur as a symptom of dementia, and are particularly common in Lewy Body dementia and in the middle to late stages of Alzheimer’s disease. Initially, this can be perplexing for both the individual experiencing it and their caregivers.

It helps to understand how your loved one is feeling. They may feel threatened and vulnerable, perceiving nonexistent dangers like a tiger in the backyard or a burglar with a weapon. Driven by their fears, they might accuse you of abandonment or unfaithfulness. 

Time-shifting is another manifestation of their altered reality. I remember waking up in the morning and finding my dementia-affected wife all dressed and ready for an appointment that wasn’t scheduled until 3 p.m. 

These new behaviors signal the disease’s progression, which can be distressing. Instead of getting frustrated or upset—which can make things worse for your loved one—comfort them by affirming their feelings and addressing their fears. For example, if they imagine a threatening figure in the backyard, check and then reassure them that the person has left and that you are keeping watch. Telling them they are imagining things only denies their reality and may intensify their fear. It’s better to enter their world than try to bring them into yours.

A friend of mine once shared how his wife repeatedly saw a black dog running through their living room. Instead of dismissing her, he engaged with her in conversation and learned she had a black dog as a child, who was very special to her. After warmly reminiscing one evening, she stopped seeing the black dog.

Navigating the world of hallucinations with your loved one involves more than just managing symptoms—it’s about connecting with their experiences and providing comfort. Remember, stepping into their world and validating their perceptions can be therapeutic for both of you.