Parkinson's Disease Psychosis: What to Know | MyParkinsonsTeam

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Delusions vs. Hallucinations: 9 Differences To Recognize in Parkinson’s

Medically reviewed by Amit M. Shelat, D.O.
Written by Alison Channon
Updated on June 23, 2023

What is real, and how can you be sure? For someone living with Parkinson’s, it can be difficult to know at times. “In my peripheral vision, I see cats curled up and sleeping all around the house,” shared one member of MyParkinsonsTeam. Another member wrote, “My husband from time to time suffers the delusion that we’re living in a hotel, and he wants to go home. Nothing I say changes his mind.”

While Parkinson’s disease is well known for causing motor symptoms, between 20 percent and 40 percent of individuals with the condition report hallucinations (sensing something that isn’t there) and delusions (persistent, illogical thoughts not based in reality), two symptoms of Parkinson’s disease psychosis.

Identifying hallucinations and delusions can sometimes be challenging for those experiencing them — and for their caregivers and loved ones. Understanding how hallucinations and delusions manifest and how to tell them apart can help people with Parkinson’s disease and their loved ones better recognize them and talk to their doctors about ways they can be managed.

Keep reading for tips on how to identify hallucinations and delusions that may occur with Parkinson’s.

1. People May Realize Their Hallucinations Aren’t Real

Hallucinations occur when a person sees, hears, feels, smells, or tastes something that doesn’t exist. 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.

2. Delusions Involve False Beliefs Not Based in Reality

The Parkinson’s Foundation describes delusions as “illogical, irrational” and “persistent thoughts not based in reality.” Delusions are less common than hallucinations — about 8 percent of 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.

3. Seeing Things Is a Common Type of Hallucination

Visual hallucinations are the most common type of hallucination 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:

  • “I started having hallucinations a few nights ago. There was a cat crawling around the living room and climbing on furniture.”
  • “I see the random cat or rabbit pop out when walking through the house. I’ve momentarily thought there was someone in my yard.”
  • “When I’m sitting at my desk, I wear glasses and in my peripheral vision to the left side of my head I see people standing next to me as I am seated. It’s not the same person. It could be a teenage boy or an adult woman.”

4. A Person May Hallucinate Hearing Distant Sounds

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:

  • “My husband had an auditory hallucination last night for the first time. He got into his wheelchair and went looking for water that he ‘heard’ running.”
  • “I kept hearing a faint repetitive alarm in my head, just like my alarm. Checked the cell phone alarm to make sure I had turned it off.”
  • “Hearing a radio, TV, or something and absolutely KNOW there is nothing on? This is almost a constant thing for me. The upside for me is it’s music, although it’s hard to make out the tunes most of the time.”

5. Hallucinations May Involve Other Senses as Well

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:

  • “I have, over the past few months, been having the issue of smelling smoke occasionally when there is none. It’s subtle and will last for about an hour.”
  • “I can smell cigarette smoke; smelled it all day today and there is no one anywhere who smokes.”
  • “It’s nice to hear I’m not alone in this. It’s just my hubby and me and neither of us smoke, nor does anyone we know, unless my cat is secretly lighting one up without my knowledge. LOL!”

6. Early Hallucinations May Point to Lewy Body Dementia

If hallucinations occur during the early stages of Parkinson’s, they could be a sign of Lewy body dementia (LBD). LDB is a movement disorder that shares features of Parkinson’s. Differentiating between the two conditions can be challenging because of their many similarities.

Parkinson’s disease dementia typically begins at least one year after movement problems develop, whereas LDB coincides closely with movement symptoms.

7. Belief of Mistreatment Is a Common Delusion

Delusions often focus around a person’s belief they’re 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:

  • “Husband still thinks I’m slipping out at night, which I understand is the number one delusion for a spouse!”
  • “He is saying I am lying to him, and he is showing signs of being paranoid.”
  • “They provoke severe anxiety in my husband and sometimes he believes men are after him. He can become distrustful of me and his health care aide, whom he likes very much. These bad episodes can last one hour or six hours.”
  • “My mom tells me I don't feed her or I make her eat things that she doesn't like.”

8. Delusions May Confuse Reality With Memory or TV

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.”

9. Delusions May Lead to Anxiety or Agitated Behavior

A person experiencing delusions may be anxious, fearful, or very agitated. Caregivers explain how delusions impact their loved ones’ behavior:

  • “He believes the delusion so strongly that it keeps him stressed. At times he won’t eat, and he is having trouble sleeping.”
  • “She gets agitated, asks where she is, and sometimes has intense moments of confusion and fear.”
  • “My man friend, age 92, gets feisty and argumentative. It is extremely hard for me to keep a civil tongue. He's angry even when you accept his version of reality.”

Hallucinations and Delusions May Both Pose Dangers

Keep in mind that both hallucinations and delusions can be dangerous if you or your loved one acts on them. “I acted out on many of my hallucinations,” one MyParkinsonsTeam member wrote. “One time I fell forwards, flat on my face, in an intersection!”

Delusions can also lead to unsafe behavior. A MyParkinsonsTeam member who cares for a parent 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.”

Managing Hallucinations and Delusions

Managing hallucinations and delusions may involve making changes to Parkinson’s medications, addressing underlying health conditions, and making household changes to keep your loved one safe. A neurologist or psychiatrist may recommend discontinuing or updating the dosage of some medications, or adding in a new medication to treat Parkinson’s psychosis. Talking openly with your loved one’s health care provider about these symptoms is the first step in finding effective treatment options.

Learn more about ways to manage hallucinations and delusions.

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By joining MyParkinsonsTeam, members gain a community of more than 98,000 people who understand the challenges of living with Parkinson’s disease, including hallucinations and delusions.

Do you have any tips for recognizing hallucinations or delusions? Share your experiences in the comments below or start a conversation in your Activities.​

    Updated on June 23, 2023
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    Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Alison Channon has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

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