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She hears bells ringing and thinks I have set alarms, thinks I have put stickers on plug sockets and is sure someone is coming into her flat when she goes out. This is very distressing for her. Her health otherwise is so good and no sign of memory problems. She is very sharp and knows what is going on apart from these episodes.

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This is a problem if something new. You need her checked for a UTI. While at the doctors, get her a good checkup. Labs included. There may be something physical causing this. Could she be overdosing on her meds?
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Something pretty serious appears to be going on. Agree to check on a UTI. The elderly do not present as younger people do - they act crazy instead, sometimes.
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Get medical advice a.s.a.p.

Make sure you take a list of any medications she is currently taking, including over-the-counter as well as prescribed ones.

Big hugs to you both.
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Call the Doc.
1st suspect as others already said is UTI.
Or other infections, low sodium, kidney function, stroke - many things the Doctor will want to rule out.

Is there a regular time of day this happens? End of day fatigue?

Sundowning, or sundown syndrome, is a neurological phenomenon associated with increased confusion. Faded light, low light, and increased shadows may contribute to confusion and fear. Or upset in their circadian rhythms.

Don't jump to sundowners conclusion, but discuss with the Doc too.
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