Parkinson’s disease (PD) is associated with behavioral changes such as irritability and anger. These behavioral changes may coincide with cognitive decline and forms of psychosis, including delusions, hallucinations, or paranoia. Behavioral and mood changes in people with Parkinson’s can be especially difficult for family members and caregivers, as MyParkinsonsTeam members often express.
“Are outbursts of verbal anger and a hateful tone part of PD? Hubby is getting more difficult,” wrote one member. Another member shared, “Today is OK, but a couple days ago my husband with Parkinson’s had an angry outburst at a friend’s house. It was quite embarrassing — and it was over nothing. My friend and her husband were both shocked and afraid.”
“My mom is more confused and very irritable as well. She says things that she would never have said before,” a member said.
PD is a progressive neurological disorder that affects the nervous system. Common symptoms include balance problems, slow movement, muscle stiffness, rigid facial expressions, and tremors. Cognitive, mental, and behavioral changes can also occur. There is currently no cure for Parkinson’s, but medication and physical therapy can help people manage their symptoms. In rare cases, brain surgery such as deep brain stimulation can also be an option.
The emotional toll of a Parkinson’s diagnosis and the limitations caused by the condition can lead to feelings of frustration, shame, or fear — resulting in mood changes like anger and irritability.
However, Parkinson’s is also considered a neuropsychiatric condition because the disease itself can cause mood disorders. Parkinson’s causes a decrease in dopamine, a neurotransmitter that affects both movement and mood. Low dopamine neuron levels are associated with an increase in depression and anxiety among people with Parkinson’s. The disease also causes abnormalities with a protein in the brain called alpha-synuclein. This protein is associated with behavioral disturbances and cognitive impairment in people with Parkinson’s.
Dementia and psychoses are also caused by changes in brain chemistry due to Parkison’s. These conditions can lead to delusions, hallucinations, paranoia, passage (the sense that someone is walking by when no one is there), and agitated behavior. Some Parkinson’s medications used to treat depleted dopamine may cause psychosis-like behavior as a side effect.
Behavioral and mood disorders may be treated with antidepressants, selective serotonin reuptake inhibitors, or antipsychotic medications like clozapine, along with mental health counseling.
Informal caregivers — particularly family members — often play a significant role in helping and caring for loved ones with Parkinson’s. Research has shown that caregivers are especially affected by caring for someone dealing with cognitive and mental dysfunctions from Parkinson’s. These caregivers report higher caregiver burden and lower overall well-being and quality of life than caregivers of people with PD without significant cognitive impairment. Many caretakers of people with Parkinson’s experience anxiety and depression.
The stress of caregiving is a common topic of conversation on MyParkinsonsTeam. One member wrote, “My wife has Parkinson’s. It is hard to deal with all her ups and downs. We are both exhausted.”
Another member wrote about her husband with Parkinson’s: “His dementia is hard. He is emotional at times, angry at times, and is not aware where he is at times.” One member said, “My husband has Parkinson’s, dementia, diabetes, and a bad heart. It is getting more and more difficult to give him his medications, as he gets very angry and does not take them.”
It’s important to remember that anger and irritability in people with Parkinson’s is often a part of the disease. It is not your fault.
Delusions, in particular, can be difficult to manage. A delusion is when someone has a strong, irrational belief about something that isn’t true. Hallucinations, on the other hand, are when someone perceives something that isn’t there. Hallucinations can involve sight, sound, smells, or other sensations. It’s essential for caregivers to plan ahead for disease progression — including behavioral changes.
“My husband has PD dementia. He suffers from delusions and some paranoia. The past week or so has been difficult. He believes the delusion so strongly that it keeps him stressed. At times he won’t eat, and he is having trouble sleeping,” wrote a member.
“I am a caregiver for my husband,” another member said. “His physical symptoms are getting worse, but the mental issues are by far the hardest to deal with. His paranoia, delusions, and hallucinations have gotten so bad that I am exhausted just trying to reassure him. I can’t remember the last time I have gotten a good night’s sleep. My husband naps all day long, then is up most of the night. I try to nap when he does, but it’s just not restful sleep.”
Here are some tips for caregivers on how to manage psychotic symptoms when caring for someone with Parkinson’s:
It’s essential for caregivers of people with Parkinson’s to find ways to manage stress, particularly when dealing with anger, agitation, or any psychotic symptoms. Here are some things you can do to help manage the challenges of caregiving:
If you’re feeling overwhelmed, talk to your health care providers. They can make a referral for psychotherapy or counseling to help you cope with stress as a caregiver.
MyParkinsonsTeam is the social network for people with Parkinson’s disease and their loved ones. More than 85,000 members come together to ask questions, give advice, and share their stories with others who understand life with Parkinson’s.
Are you caring for someone with Parkinson’s and dealing with anger and irritability? Do you have tips or questions about mood changes and Parkinson’s? Comment below, or start a conversation on MyParkinsonsTeam.