Visual Hallucinations In Parkinsons Disease: Towards Better Understanding And Treatments
Parkinsons disease is a common neurodegenerative disease, affecting more than 2% of people over 75, with estimated 7 to 10 million affected people worldwide. Although traditionally Parkinsons disease is thought of as a disorder of movement, with tremor and slowing of movement being the cardinal features, it can cause a wide range of other non-motor symptoms and frequently leads to dementia. These non-motor symptoms, are common, can occur even before motor symptoms become evident and are often the most troubling for patients.
Visual hallucinations, the sensation of seeing objects that are not really there, are a common non-motor symptoms in PD, affecting up to 70% of individuals over the course of the disease. As well as causing distress, visual hallucinations have a significant impact on the quality of life of patients and their families: hallucinations often herald the cognitive decline and are a strong predictor for nursing home placement.
The wide variety of visual hallucinations
The experience of visual hallucinations vary from person to person and can change across the course of the disease. Commonly, people with Parkinsons disease experience one or more of the following hallucinations:
Figure 1. Giuseppe Archimboldo, Portrait with Vegetables . A famous example of pareidolia. The same painting is seen as a collection of vegetables or a face .
Visual hallucinations are challenging to treat
A better understanding of hallucinations is needed
What Treatments Are Available For Parkinsons Psychosis
Your doctor may first reduce or change the PD medication youre taking to see whether that reduces psychosis symptoms. This is about finding a balance.
People with PD may need higher doses of dopamine medication to help manage motor symptoms. But dopamine activity shouldnt be increased so much that it results in hallucinations and delusions. Your doctor will work with you to find that balance.
First Drug Approved For This Indication
WASHINGTON The FDA has approved pimavanserin for the treatment of hallucinations and delusions associated with psychosis experienced by some people with Parkinsons disease, the agency announced Friday.
Hallucinations or delusions can occur in as many as 50% of patients with Parkinsons disease at some time during the course of their illness, the FDA said in a press release.
Hallucinations and delusions can be profoundly disturbing and disabling,Mitchell Mathis, MD, director of the Division of Psychiatry Products in the FDAs Center for Drug Evaluation and Research, said in the release. Nuplazid represents an important treatment for people with Parkinsons disease who experience these symptoms. It is the first drug approved for this indication, the FDA noted.
In a 6-week clinical trial of 199 participants, Nuplazid was found to be superior to placebo in decreasing the frequency and/or severity of hallucinations and delusions without worsening Parkinsons diseases primary motor symptoms.
The drug has a Boxed Warning advising of an increased mortality risk associated with the use of these drugs to treat older people with dementia-related psychosis, which would be an off-label use.
In clinical trials, the most common side effects reported by participants taking Nuplazid were swelling usually of the ankles, legs, and feet due to peripheral edema nausea and confused state.
Also Check: Does Sam Waterston Have Parkinson
Read Also: Parkinson’s Caused By Herbicide
Changes In Nerve Network Of Brain May Cause Presence Hallucinations
My first experience with hallucinations was terrifying not for me at first, but for my husband, who watched it happen.
We were on a cruise, and my anti-nausea medications interacted with my Parkinsons medications, resulting in two episodes. The first occurred in the middle of the ship around tons of people. I was sitting in the theater waiting for a show to start when my husband walked up and asked me to scoot over a seat. I told him that my mom was sitting there and had just walked over to the bar to get a drink. He was very confused because my mom was not with us on the trip.
Later that night, I had another episode. While my husband was sleeping, I tore apart our room, thinking I was packing. He woke up and asked, What are you doing? I told him that we had to go pick up our dog from doggy day care. After a few moments of total confusion, he reminded me that it was the middle of the night and we were in the middle of the ocean. He also told me that our dog was safe at my parents house and not at day care.
To learn more about Parkinsons hallucinations, I spoke with Andrea Frost, whose brother has the disease. She shared the following story with me:
I also talked with Alan Tobey, a 77-year-old living with Parkinsons, who said:
What Makes Some People With Parkinsons More Susceptible To Parkinsons Disease Psychosis
Not everyone living with Parkinsons will experience hallucinations and/or delusions, but there are several things that can increase your risk. Here are a few to look out for. Be sure to speak to your doctors and care partners if you notice any changes.
- Increased sleep disturbances such as REM Sleep Behavior Disorder, sleep apnea, vivid dreaming and sleep interruptions
- Vision problems such as blurry or double vision
- Hearing problems
Don’t Miss: Is Tinnitus A Symptom Of Parkinson’s Disease
Memory Problems And Dementia
Research shows that hallucinations and delusions often happen when someone with Parkinsons also has problems with memory, thinking problems or dementia.
If you experience hallucinations at an early stage of Parkinsons, it could be a sign of another medical condition, such as dementia with Lewy bodies.
Recruitment And Administration Of Questionnaire
patientslikeme® is an online patient network where members share personal health data to track their disease progression, communicate with other patients, and contribute to research studies. Members of the community are regularly invited to participate in optional questionnaire-based research studies . Although patients with any illness are able to sign up to the website, patientslikeme® has a large online community of individuals with PD at the time of this study, there were 6841 such members.
All members of the patientslikeme® community who had previously self-identified as having PD were invited to participate in the study via email . The link provided in the email enabled potential participants to access the study information and indicate whether or not they wished to participate. Submission of the completed questionnaire was interpreted as provision of consent for study enrollment in line with ethical guidelines from The University of Sussex on the acquisition of anonymous questionnaire-based data from patient groups . The online survey remained open for 1 week and to verify the testretest reliability of the EH questionnaire and, in line with routine practice in questionnaire-based surveys hosted on the patientslikeme® platform, all participants were invited by email to complete a retest phase 2 weeks later in which an identical questionnaire was administered.
Figure 1. Flowchart illustrating the recruitment and progression of participants through the study.
I Had A Hallucination: What Next
Research has shown that for many people with PD who have them, hallucinations begin after a change in medication, more specifically, an increase in levodopa . Additional factors make a person more likely to experience hallucinations when medications are changed, such as other cognitive problems or memory issues, depression and sleep problems. Dementia|A term used to describe a group of brain disorders that cause a broad complex of symptoms such as disorientation, confusion, memory loss, impaired judgment and alterations in mood and personality.] also increases the risk of hallucinations and delusions when PD medications are changed. Dementia means cognitive changes whether in memory, judgment or attention that interfere with daily life.
One thing that does not affect the risk of hallucinations is your regular dose of levodopa. Rather, studies show that it is a change in dose an increase in a dose that has been stable that sets off hallucinations.
Tip: Experiencing a hallucination does not mean you are going crazy. Many people recognize that their hallucinations are not real. Do not react to these visions or sounds or engage them dismiss them. Bring up the topic with your doctor immediately.
How Can I Get Help
First and most importantly, if you find yourself experiencing symptoms such as hallucinations or delusions, speak out. It is essential to talk about your full range of Parkinsons disease symptoms with your treatment team. A dialogue among patients, care partners, and physicians is a critical component of the effective management of your condition.
References: 1. Forsaa EB, Larsen JP, Wentzel-Larsen T, et al. A 12-year population-based study of psychosis in Parkinsons disease. Arch Neurol. 2010 67:996-1001. 2. Ravina B, Marder I Neural Neursurg Psychiatry. 2011 70:734-738. 4. Fenelon G, Mahieux F, Huon M, Ziegler M. Hallucinations in Parkinsons disease: prevalence, phenomenology and risk factors. Brain. 2000 123:733-745. 5. Wolters ECh. PD- related psychosis: pathophysiology with therapeutical strategies. J Neural Transm. 2006 71:31-37. 6. Goldman JG, Holden S. Treatment of psychosis and dementia in Parkinsons disease. Curr Treat Options Neurol. 2014 16: 281. 7. Goldman JG, Vaughan C, Goetz CG. An update expert opinion on management and researcl, strategies in Parkinsons disease psychosis. Expert Opin Pharmacother. 2011 12:2009-2024. 8. Data on file, ACADIA Pharmaceuticals Inc. 9. Fenelon G, Alves G. Epidemiology of psychosis in Parkinsons disease. } Neurol Sci. 2010 289:12-17.
You May Like: How Do You Die From Parkinson’s
Examples Of Delusions In Pd
- Belief: Your partner is being unfaithful.
- Behavior: Paranoia, agitation, suspiciousness, aggression.
Recommended Reading: Parkinsons Multiple System Atrophy
Delusions From Parkinsons Disease
Delusions affect only about 8 percent of people living with PD. Delusions can be more complex than hallucinations. They may be more difficult to treat.
Delusions often start as confusion that develops into clear ideas that arent based on reality. Examples of the types of delusions people with PD experience include:
- Jealousy or possessiveness. The person believes someone in their life is being unfaithful or disloyal.
- Persecutory. They believe that someone is out to get them or harm them in some way.
- Somatic. They believe they have an injury or other medical problem.
- Guilt. The person with PD has feelings of guilt not based in real behaviors or actions.
- Mixed delusions. They experience multiple types of delusions.
Paranoia, jealousy, and persecution are the most commonly reported delusions. They can pose a safety risk to caregivers and to the person with PD themselves.
PD isnt fatal, though complications from the disease can contribute to a shorter expected life span.
Dementia and other psychosis symptoms like hallucinations and delusions do contribute to increased hospitalizations and increased rates of death .
One study from 2010 found that people with PD who experienced delusions, hallucinations, or other psychosis symptoms were about 50 percent more likely to die early than those without these symptoms.
But early prevention of the development of psychosis symptoms may help increase life expectancy in people with PD.
Don’t Miss: Does Parkinson’s Disease Cause Memory Loss
Get The Every Victory Counts Manual For Care Partners
Do you have the Every Victory Counts Manual for Care Partners! Released in 2021, this resource is available at no cost in print and digital versions. To learn more and request your copy, .
This content was supported in part by Acadia Pharmaceuticals. To learn more about Parkinsons disease psychosis, visit moretoparkinsons.com
What Should I Do When My Loved One Is Experiencing A Hallucination
Most importantly, dont try to convince your loved one that what theyre experiencing isnt real. Theyll feel like youre putting down an experience that seems authentic to them.
Once a person has lost insight, itll be very difficult to convince them that what theyre experiencing isnt happening. Trying to argue with them may agitate and even enrage the person. Making them anxious could cause their hallucinations to get worse.
Instead, talk to the person gently and reassuringly. You might say something like, I understand that you see a dog in the corner of the room. Everything is going to be OK. Youre safe. You might even say that the dog must have left already.
Remember that the person cant control what theyre experiencing. Try to be as sympathetic as you can when you talk to them.
One approach that can help is to turn on all the lights in the room. Hallucinations are more likely to happen in dimly lit areas, and this can be caused by disease-related changes that affect the eyes.
Then, have the person really focus on what theyre seeing. That may reset their brain and help them see whats actually in front of them.
If the person doesnt have insight, try a distraction. Move them to a different room. Turn on the TV or play a game they like.
Try to keep your loved one as calm as possible. If they become very agitated or violent, call their doctor or 911.
Don’t Miss: Does David Brooks Have Parkinson’s
How Hallucinations Affect People Living With Parkinsons
Around 50% of people with Parkinsons disease will experience hallucinations. But what are they and what causes them? Professor Per Odin a neurologist and head of the Neurology Department at Lund University, Sweden shares what you need to know about the symptom.
What are hallucinations?
Hallucinations are sensory experiences that appear real but are created by our brains. They can affect all five of our senses.
You might hear voices that no one else hears or see things that no one else sees. They are normally separate from illusions, which are distorted or misinterpreted real perceptions for example, you could see a person where there is actually a tree.
What causes hallucinations in people living with Parkinsons disease?
Hallucinations are very common in Parkinsons disease. More than half of patients experience them at some stage.
They are normally thought to be an effect both of the condition itself and of Parkinsons medication. The risk of hallucinations increases with cognitive impairment, longer disease duration, age, and other diseases.
Visual and auditory hallucinations may occur as a side effect of drugs which are used to treat Parkinsons. They are often dose-dependent and in principle reversible.
What types of hallucinations can people living with Parkinsons experience?
Visual hallucinations are the most common in Parkinsons disease. Auditory hallucinations occur mainly in depression. Tactile or olfactory sensations are unusual.
The Cause Of Parkinsons Delusions And Hallucinations
Some risk factors associated with the development of psychosis in Parkinsons disease include:
- Age: Parkinsons disease usually occurs in people over age 60.
- Duration and severity of Parkinsons disease: Psychosis is more common in advanced or late-stage Parkinsons disease.
- Later onset: Occurring later in life
- Hyposmia: A decreased sense of smell
- Cognitive impairment: Problems with thinking, including trouble remembering, difficulty learning new things, difficulty concentrating, problems making decisions that affect everyday life
- Depression: People who have both depression and Parkinsons disease are at a greater risk of developing psychosis.
- Diurnal somnolence: Daytime sleepiness
- REM sleep behavior disorder: A sleep disorder in which you physically act out dreams involves making vocal sounds and sudden, often extreme, arm and leg movements during REM sleep
- Visual disorders: Impaired vision
- Severe axial impairment: Speech, swallowing, balance, freezing of gait
- Autonomic dysfunction: Impairment of the autonomic nervous system , which controls involuntary or unconscious actions such as heart rate, breathing, body temperature, blood pressure, digestion, and sexual function
- High medical comorbidity: The existence of more than one condition or illness in the same person at the same time with Parkinsons disease, may include conditions such as dementia, depression, and sleep disorders
Read Also: Why Do People Get Parkinson’s
What Are Parkinsons Disease
Delusions are false beliefs that are not based on reality. These beliefs are fixed. People experiencing them are unlikely to change or abandon these beliefs, even when presented with evidence that they are false.
Delusions experienced by people with Parkinsons disease are usually of a common theme. These may include:
- Spousal infidelity
- Thinking that people are stealing their belongings
- Thinking people are trying to harm them
- Thinking people may put poison in their food
- Thinking people are switching out or substituting their medications
- Other beliefs based on paranoia
What Are Parkinsons Hallucinations
Symptoms of psychosis occur in up to 50% of people with Parkinsons disease.
Parkinsons disease psychosis is considered a neuropsychiatric condition. This means it involves neurology and psychiatry . While the psychosis involves mental health symptoms, they are caused by Parkinsons disease, which is a disease of the nervous system.
Psychosis in Parkinsons disease comes in two forms:
- Hallucinations: Sensory experiences that are not really happening
- Delusions: False beliefs not based on reality
These symptoms can be debilitating and scary for the people experiencing them. They can interfere with a persons ability to care for themselves and to relate to other people.
Psychotic symptoms in Parkinsons disease are associated with increased caregiver distress, risk of hospitalization and nursing home placement, and healthcare costs.
A study suggests the presence of hallucinations and delusions in people with Parkinsons disease is a predictor of mortality .
Recommended Reading: Music Therapy For Parkinson’s Disease
Whats The Treatment For Parkinsons Disease Psychosis
The single most important thing to do when it comes to Parkinsons disease psychosis is to tell your care providers and partners the minute you notice changes in your vision, hearing, thinking and behavior. The earlier they know whats going on, the sooner they can begin interventions to help you feel better.
Once you bring your concerns up to your doctor, they will typically do a clinical evaluation, review your medications and dosage, assess your lifestyle and determine the severity of your symptoms. Depending upon what they find, they may refer you to counseling or therapy, adjust your medication, change your medication, eliminate medication or do all of the above. If none of those strategies work, they may try antipsychotic drug therapy to see if they can adjust chemical levels in the brain. This can bring with it an entirely different set of problems so its important to be invested every step along the way and be sure youre well-informed before you move in that direction.
Dont Miss: Judy Woodruff Parkinsons