If you are caring for someone with dementia, you may have experienced something deeply confusing and painful.
Your loved one insists, with total certainty, that someone stole from them.
They remember children being in the house overnight.
They are convinced a neighbor is watching or trying to harm them.
They can describe these events in vivid detail.
Yet they cannot remember what you said five minutes ago.
They do not recall that you just visited.
They forget conversations, meals, or plans that actually happened.
This often leaves caregivers feeling confused, frustrated, and asking a painful question:
How can someone with dementia remember something that is not true so clearly, while forgetting real events so completely?
The answer lies in how different memory systems in the brain are affected by dementia. Once you understand this shift, many confusing behaviors start to make more sense, and your responses as a caregiver can become calmer, more effective, and less emotionally draining.
In this post, you will learn:
- The two main memory systems involved in dementia
- Why emotional memories last longer than factual memories
- What delusions really are and why they feel so real
- Why logic and correction usually fail
- What actually helps when your loved one is distressed by a delusion
The Two Memory Systems Affected by Dementia
One of the most important things to understand about dementia is that not all memory is impacted the same way.
The brain relies on multiple memory systems, and dementia affects some of them much earlier and more severely than others. This uneven impact is a big reason caregiving can feel so confusing at times.
Factual Memory: Remembering What Actually Happened
Factual memory is responsible for storing reality-based information such as:
- What happened earlier today
- Who visited
- Where objects were placed
- What was eaten for meals
- Conversations and recent events
This type of memory depends heavily on two areas of the brain:
- The hippocampus
- The prefrontal cortex
In Alzheimer’s disease and many other dementias, the hippocampus is often one of the earliest and most affected structures. Over time, this leads to increasing difficulty forming and retrieving new memories, which helps explain why recent details fade first as part of the brain changes in Alzheimer’s disease.
When these areas struggle:
- Recent memories become fragile or disappear
- Time sequences become confusing
- Logical reasoning breaks down
- The ability to recognize inconsistencies is reduced
This is why your loved one may genuinely not remember something that just happened, even if it felt important or emotionally significant to you. It is not a lack of effort or caring. It is a change in how the brain is working.
Emotional Memory: Remembering How Something Feels
Emotional memory is a different system entirely.
It involves parts of the brain responsible for emotion, threat detection, and internal meaning-making. This system stores:
- Fear and anxiety
- Safety and danger signals
- Emotional meaning
- Old habits and emotional patterns
- Comfort, suspicion, and threat perception
Unlike factual memory systems, emotional memory often remains active much longer in the dementia process. This means feelings can stay strong even when facts disappear.
The brain may no longer remember what actually happened, but it still remembers how something felt. This is one of the most important shifts for caregivers to understand.
Why Delusions Feel So Real to Someone With Dementia
A delusion is a fixed belief that a person holds despite clear evidence that it is not true.
These beliefs are a common symptom in dementia, often showing up as suspicions or fears that someone is stealing from them, watching them, or trying to cause harm.
Delusions are not casual thoughts. They feel absolutely real to the person experiencing them.
This happens because when factual memory fails, the brain does not simply leave a blank space. Instead, it tries to make sense of confusion using emotional memory.
From the brain’s perspective, it is trying to protect the person.
If something feels unfamiliar, missing, or unsafe, the emotional memory system scans for explanations that match that feeling. Fear-based explanations often emerge because fear activates the brain’s alarm centers.
To the person with dementia, the emotional truth matters far more than factual accuracy.
Delusions Are Not Intentional or Manipulative
Caregivers often worry that their loved one is:
- Making things up
- Lying
- Being dramatic
- Trying to control the situation
This is not what is happening.
In dementia, delusions are symptoms of brain changes, not personality choices or intentional behavior.
They are not a choice.
They are not something the person can simply stop believing.
If you have been trying to explain, correct, or prove the truth, that makes sense. That is how healthy brains solve problems. But dementia changes the rules of how information is processed.
This shift alone can change how heavy these moments feel for caregivers.
Delusions vs. Confabulation: What’s the Difference?
Sometimes caregivers hear stories that are clearly untrue but do not seem emotionally charged or repetitive. This is often confabulation.
Confabulation occurs when the brain fills in missing information casually, such as:
- Saying someone visited when they did not
- Recalling eating a meal that never happened
- Sharing details that change each time they are told
Confabulation is usually:
- Inconsistent
- Not emotionally intense
- Not fixed on one belief
Delusions, on the other hand, are:
- Strongly held
- Emotionally charged
- Repeated frequently
- Resistant to reassurance or proof
Understanding this difference helps caregivers know when emotional support is essential versus when gentle redirection may be enough.
Why Logic and Proof Usually Make Delusions Worse
Many caregivers instinctively try to fix delusions by explaining the truth.
They show proof.
They reason.
They correct.
They reassure with facts.
Unfortunately, dementia damages the very brain systems needed to evaluate that information.
When you argue with a delusion, the person may experience:
- Increased fear
- Heightened agitation
- A sense of being dismissed or misunderstood
This is why most dementia care guidance emphasizes responding to hallucinations and delusions with reassurance rather than argument.
From the person’s perspective, you are contradicting something that feels emotionally undeniable.
Why Emotion Outlasts Facts in Dementia
Emotion is remembered more strongly than neutral information in all human brains, not just those affected by dementia.
In dementia:
- Factual memories fade quickly
- Emotional impressions linger
- Fear-based memories can become especially strong
This helps explain why your loved one may forget your visit but vividly remember the fear of believing someone was in their room.
What This Means for You as a Caregiver
Understanding the brain changes behind delusions does not make them disappear. But it does change how you respond.
Respond to the Emotion, Not the Story
The most effective responses focus on how the person feels, not on whether the belief is true.
Instead of:
- “That didn’t happen.”
- “You’re wrong.”
- “No one stole anything.”
Try:
- “That sounds really scary.”
- “I’m here with you.”
- “You’re safe right now.”
- “I can see this is upsetting.”
When the emotional need is met, distress often decreases even if the belief remains.
Avoid Arguing or Correcting
Correction often escalates fear rather than resolving it.
You do not need to agree with the delusion, but you also do not need to challenge it directly. Neutral, supportive language helps preserve emotional safety.
Look for Patterns and Triggers
Delusions often worsen under certain conditions, such as:
- Late afternoon or evening
- Poor sleep
- Hunger or dehydration
- Medication changes
- Overstimulation
- Certain television programs
- Low lighting or shadows
If symptoms seem worse later in the day, this may be part of late-day confusion and agitation, sometimes called sundowning.
Paying attention to patterns allows you to modify the environment and reduce triggers over time.
Frequently Asked Questions
Can someone with dementia stop believing a delusion?
In most cases, no. Delusions are driven by brain changes, not reasoning. The goal is not to eliminate the belief but to reduce distress.
Should I tell a doctor about delusions?
Yes. Delusions can be influenced by medical factors such as infections, medication side effects, sleep disruption, or sensory changes.
Do delusions mean dementia is getting worse?
Not necessarily. Delusions can fluctuate and may increase during times of stress or illness.
Is medication always needed for delusions?
Medication is not always the first or best solution. Environmental changes, reassurance, and emotional support often play a critical role.
A Supportive Final Thought
When someone with dementia remembers a delusion more clearly than reality, it is not because they are choosing fantasy over truth. It is because their brain has shifted from factual memory to emotional memory.
Once you understand this shift, your caregiving responses can change in ways that protect both your loved one’s sense of safety and your own emotional well-being.
You are not failing because logic does not work.
You are adapting to how the dementia brain now functions.
If you want guidance on responding calmly to delusions, understanding triggers, and building confidence in these moments, the Care Collective offers structured support, education, and real-world strategies for caregivers navigating exactly these challenges. You can learn more here.
You do not have to figure this out alone.
Sources & References
→ National Institute on Aging: What happens to the brain in Alzheimer’s disease
→ Alzheimer’s Association: Suspicion and delusions
→ National Institute on Aging: Coping with hallucinations, delusions, and paranoia
→ National Institute on Aging: Coping with agitation, aggression, and sundowning
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