Hallucinations and delusions are two symptoms of Parkinson’s psychosis. Parkinson’s disease is a degenerative condition affecting the central nervous system (brain and spinal cord). Parkinson’s disease psychosis is one of the nonmotor symptoms of the condition. Motor symptoms include tremors, muscle stiffness, slowed movements, and loss of balance.
Hallucinations and delusions are fairly common among people with Parkinson’s — between 20 percent and 40 percent of individuals with Parkinson’s disease report experiencing them. However, they can sometimes be challenging to identify for those experiencing them and for caregivers and loved ones. Understanding how hallucinations and delusions manifest and when they are more likely to occur can help people with Parkinson’s disease and their loved ones better recognize them.
Hallucinations occur when a person sees, hears, feels, smells, or tastes something that isn’t actually there. Hallucinations happen when a person is awake — they are not dreams. People may be aware that they are experiencing a hallucination while it’s happening or realize it shortly after. This is called “retaining insight.” Losing insight — failing to realize something is a hallucination — can cause agitation and can also lead to falls or other accidents. “I acted out on many of my hallucinations,” one MyParkinsonsTeam member wrote. “One time I fell forwards, flat on my face, in an intersection!”
The Parkinson’s Foundation describes delusions as “illogical, irrational” and “persistent thoughts not based in reality.” Delusions are less common than hallucinations — about 1 in 10 people with Parkinson’s disease experience delusions. Delusions can be particularly challenging for family members and caregivers because a person with Parkinson’s may falsely believe someone is harming them. Delusions can also lead to unsafe behavior. A woman on MyParkinsonsTeam who cares for her mother wrote, “I have to take things away because she plays with things that can be dangerous. She tries putting things in outlets that don't belong.”
The precise reasons for Parkinson’s psychosis are not fully understood. Parkinson's psychosis may be a symptom of advanced Parkinson’s disease or a side effect of long-term use of dopamine treatments (called dopaminergic drugs). The likelihood of experiencing hallucinations and delusions increases the longer a person lives with Parkinson’s.
If hallucinations are experienced during the early stages of Parkinson’s, they could be a sign of dementia with Lewy bodies (DLB). DLB is a movement disorder that shares features of Parkinson’s. Differentiating between the two conditions can be challenging because of their many similarities.
Both Parkinson’s disease and DLB can lead to dementia. However Parkinson’s disease dementia typically begins at least one year after movement problems develop, whereas dementia in DLB coincides closely with movement symptoms.
Hallucinations are not limited to visions. People with Parkinson’s can hear something that isn’t there and even smell or taste something that isn’t there. Hallucinations can be categorized by the senses involved.
Visual hallucinations are common in Parkinson’s psychosis. People can have visions in black and white or in color that last a few seconds or much longer. Visual hallucinations often involve animals or people, such as a child or deceased family member. People often experience hallucinations in their peripheral vision and in low-visibility situations or dark lighting.
Members of MyParkinsonsTeam share examples of their visual hallucinations:
Auditory hallucinations occur when a person hears a sound that isn’t actually there. They happen less frequently than visual hallucinations. People often report hearing indistinct sounds, like music playing in another room.
MyParkinsonsTeam members share examples of auditory hallucinations:
People with Parkinson’s disease can also experience olfactory (smell), tactile (feel), and gustatory (taste) hallucinations. These types of hallucinations are less common than visual and auditory hallucinations.
Smelling cigarette smoke is an olfactory hallucination several members of MyParkinsonsTeam describe:
People with Parkinson’s delusions frequently believe they are being mistreated. As a result, people experience paranoia, mistrust, anger, and anxiety. Jealousy delusions — usually a belief that a spouse is being unfaithful — are very common. Persecutory delusions — the false belief that someone is cheating or conspiring against you — are also common. Persecutory delusions are often directed at someone the person with Parkinson’s interacts with regularly, like a spouse, family member, or caregiver.
Caregivers on MyParkinsonsTeam share their experiences with jealousy and persecutory delusions:
Some delusions are more general confusions of reality. As one caregiver described, “He mixes reality and old memories and TV programs and fantasy to create a different kind of reality.” Another caregiver shared, “He is POSITIVE we are not where we are, that he has two cats, etc.”
A person experiencing delusions may be anxious, fearful, or very agitated. Caregivers explain how delusions impact their loved ones’ behavior:
Understanding the risk factors for hallucinations and delusions can help you recognize symptoms of Parkinson’s psychosis. The following factors may increase the likelihood of experiencing hallucinations and delusions:
“We have noticed that when my father had delusions, it's been when his general health is not good, or when he has been in the hospital for PD-related issues,” a MyParkinsonsTeam member commented.
Questionnaires used in a clinical setting can help assess the risk of developing hallucinations or delusions, or establish that they are occuring. These include:
Individuals with Parkinson’s or their caregivers can speak with a neurologist to understand if any of these tools would be helpful in their particular situation.
Addressing Parkinson’s psychosis may involve changes to medications. A neurologist or psychiatrist may recommend discontinuing certain medications or adding in an antipsychotic medication. Often, a doctor will recommend discontinuing anticholinergics — medications frequently used to treat tremors or dystonia. Always consult your doctor before making any changes to your medication routine.
A neurologist will also look at factors other than medication which may contribute to hallucinations or delusions.
Learn more about managing psychosis in How to Manage Hallucinations and Delusions.
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