The line between dream and delusion in dementia, especially in conditions like Lewy Body Dementia (LBD), is often very thin and blurred. People living with dementia may experience vivid hallucinations or false beliefs that feel as real to them as dreams do when we sleep. These experiences are not just imagination; they stem from changes in the brain caused by the disease.
In LBD, abnormal protein deposits disrupt brain areas responsible for perception and cognition. This can lead to complex visual hallucinations—seeing people, animals, or scenes that aren’t there—and delusions such as believing a loved one has been replaced by an imposter. These symptoms arise because the brain’s systems for forming beliefs and evaluating reality become impaired. The person might assign too much importance to irrelevant stimuli or misinterpret what they see around them.
Unlike ordinary dreams that occur during sleep and fade upon waking, these hallucinations and delusions happen while awake but can feel dreamlike because of their vividness and emotional impact. They can be confusing both for the person experiencing them and their caregivers since it’s hard to distinguish what is real from what is not.
This fine line creates challenges in care: treating these symptoms requires understanding that they are part of the illness—not simply “making things up.” Medications used must be chosen carefully because some drugs effective for other dementias may worsen symptoms in LBD.
Ultimately, recognizing this delicate balance between dream-like visions and fixed false beliefs helps provide compassionate support tailored to each individual’s experience rather than dismissing their reality outright. It reminds us how dementia alters perception deeply—turning waking moments into a landscape where dreams mingle with delusions without clear boundaries.
