Hallucinations In Parkinsons Disease Patients
Hallucinations are sensory experiences that do not exist nor relate to reality, and they include the five senses, sight, touch, hearing, smell, and taste. These delusions occur due to changes in the brain. People with dementia, delirium, Parkinsons, and other aging-associated diseases may suffer from these delusions and hallucinations.
Parkinsons Disease is a neurodegenerative disorder. Most people think that it is a mobility disorder related to shaking, rigidity, and slow movements. However, it can also impact the mood and the ability to think clearly.Coping with the movement-related symptoms may be hard, but the behavioral changes can be more devastating since they affect their lives completely.
In this article, we will tackle the definition and how to deal with hallucinations in Parkinsons disease patients.
How To Talk To Someone With Hallucinations Or Delusions
- It is usually not helpful to argue with someone who is experiencing a hallucination or delusion. Avoid trying to reason. Keep calm and be reassuring.
- You can say you do not see what your loved one is seeing, but some people find it more calming to acknowledge what the person is seeing to reduce stress. For example, if the person sees a cat in the room, it may be best to say, “I will take the cat out” rather than argue that there is no cat.
Page reviewed by Dr. Chauncey Spears, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.
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.
How Hallucinations May Affect You
Hallucinations can be mild or they can be quite frightening, especially when you dont realise that the things you see or hear arent real. Some people will be aware that they are hallucinating, and some wont be. Some people might prefer to tolerate a relatively harmless hallucination, rather than reduce their medication and possibly have an increase in their physical symptoms.
What Is The Treatment For Parkinsons Disease
There is currently no treatment to cure Parkinsons disease. Several therapies are available to delay the onset of motor symptoms and to ameliorate motor symptoms. All of these therapies are designed to increase the amount of dopamine in the brain either by replacing dopamine, mimicking dopamine, or prolonging the effect of dopamine by inhibiting its breakdown. Studies have shown that early therapy in the non-motor stage can delay the onset of motor symptoms, thereby extending quality of life.
The most effective therapy for Parkinsons disease is levodopa , which is converted to dopamine in the brain. However, because long-term treatment with levodopa can lead to unpleasant side effects , its use is often delayed until motor impairment is more severe. Levodopa is frequently prescribed together with , which prevents levodopa from being broken down before it reaches the brain. Co-treatment with carbidopa allows for a lower levodopa dose, thereby reducing side effects.
In earlier stages of Parkinsons disease, substances that mimic the action of dopamine , and substances that reduce the breakdown of dopamine inhibitors) can be very efficacious in relieving motor symptoms. Unpleasant side effects of these preparations are quite common, including swelling caused by fluid accumulation in body tissues, drowsiness, , , hallucinations, and .
What To Do About Parkinsons Hallucinations
Hallucinations or other signs of Parkinsons psychosis should be discussed with a doctor. Depending on the cause and severity of hallucinations, the person may or may not need treatment. If an infection is the cause, it should be treated accordingly. A doctor may want to change or reduce the dosage of any medications that could cause hallucinations to stop Parkinsons psychosis.
In mild cases of hallucinations, the person may be aware that the images are not real. In these cases, if the hallucinations are not causing any distress, pharmaceutical treatment may not be necessary. Sometimes improved lighting in darkened or shadowy areas may help reduce occurrences.
Sometimes the person may not realize he or she is hallucinating. In these cases, especially if the hallucinations are severe and disturbing, a doctor may recommend adjustments to the persons current Parkinsons medications. However, this could potentially worsen movement-related Parkinsons symptoms. If these symptoms affect the persons quality of life, a doctor may instead recommend antipsychotic drugs, particularly clozapine or quetiapine, which typically help reduce hallucinations without affecting other Parkinsons symptoms.
What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinsons. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal; and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
What Is And Isnt Parkinsons Disease
I am often asked if Parkinsons Disease is a form of Alzheimers. is not Alzheimers, or a brain tumor, and the prognosis for Parkinsons, though not a perfect scenario, leaves room to live a productive life.
PD is a progressive and chronic neurological disease that often begins with mild symptoms that advance gradually over time. Symptoms can be so subtle in the early stages that they go unnoticed, leaving the disease undiagnosed for years. For patients with Parkinsons, there is a reduction in the body chemical , which controls movement and mood so simple activities like walking, talking and writing can be impacted.
Due to the complexity of PD, diagnosis is based on a variety of factors. The best diagnosis is made by an expert doing a careful history and exam followed by tracking responses to therapy. There is no blood or laboratory test to diagnose Parkinsons disease.
While Parkinsons reaches all demographics, the majority of people with PD are age 60 or older. Men and people with a family history of the disease have an increased risk.
What Are The Causes Of Parkinsons Disease
The cause of Parkinsons is unknown but researchers say that these following factors can cause this disease.
- Gene mutations
- Low levels of norepinephrine
- Presence of Lewy bodies
Researchers believe that the Lewy bodies present in the brain cells can hold an important clue to find out the cause of Parkinsons.
How Commonly Do Parkinsons Disease Patients Develop Psychosis
Psychosis in Parkinsons disease generally comes in two forms: hallucinations or delusions . When hallucinations occur, they are mostly visual . Sometimes, they can be threatening, but this is less common. Auditory hallucinations are rare in Parkinsons disease and if they do occur, they are usually accompanied by visual hallucinations.
Delusions are usually of a common theme, typically of spousal infidelity. Other themes are often paranoid in nature Because they are paranoid in nature, they can be more threatening and more immediate action is often necessary, compared to visual hallucinations . It is not uncommon that patients actually call 9-1-1 or the police to report a burglary or a plot to hurt them.
Unfortunately, psychosis occurs in up to 40% of Parkinsons disease patients . In the early stage of Parkinsons disease psychosis, the patient often still has a clear understanding and retains their insight, but this tends to worsen over time and insight may eventually be lost. At later stages, patients may be confused and have impaired reality testing; that is, they are unable to distinguish personal, subjective experiences from the reality of the external world. Psychosis in Parkinsons disease patients frequently occurs initially in the evening, then later on spills into the rest of the day.
Can Parkinsons Cause Sudden Death
Those managing patients with Parkinsons disease should be aware that one in six patients with PD dies suddenly. Sudden unexplained death in PD is also referred to as sudden and unexpected death in PD. Dehydration may contribute to the pathogenesis of sudden and unexpected death in PD and thus mortality in PD.
Naturalremedy For Parkinsons #7 Omega
Animal based omega-3 fatty acids are a powerful weapon inthe fight against Parkinsons disease. One of the main fatty acids, DHA, is oneof the essential building blocks for the human brain. Half of your brain andeyes are made up of fat and a large proportion of this is DHA fat.
Omega-3 fatty acids have the unique ability to cross theblood-brain barrier, something most conventional drugs cannot do. They helpincrease dopamine levels and reduce neuroinflammation in the brain, while atthe same time, stimulating neuron growth. So basically, EPA and DHA help preventbrain cell damage and keep the nervous system in tip top working order!
Best sources of animal based omega-3s are either fishoil, cod liver oil or krill oil. High strength krill oil is the preferred option as thiscontains a substance called Astaxanthin. Astaxanthin is a potent brain food nutrientthat has been shown to prevent neurodegeneration and inflammation of the brain.For dosages, take AT LEAST the highest recommended amount listed on the bottle the same goes with fish oil or cod liver oil. You cant overdose on thesesupplements so theres nothing to be concerned about. In fact, the more omega-3syou can get into you the better the results!
In addition to this, try and eat some cold water fattyfish such as salmon, tuna, mackerel, sardines or herring 3-4 times a week foran extra supply of DHA and EPA.
Network Changes And Thalamic Drivers
Visual hallucinations have fascinated neurologists and neuroscientists for many years, with their tantalisingly rich and often narrative detail. Due to their transient nature, they have been challenging to investigate, with no clear mechanism found, but many theories have been proposed. Previous models for visual hallucinations considered them as cortical release phenomena, where spontaneous activity occurs in the absence of visual stimuli. Alternative models suggested that hallucinations arise due to incorrect binding of objects into visual scenes.
Advances in computational modelling and network neuroscience have opened up approaches to understanding the brain in new ways. Recent models suggest that Parkinsons hallucinations could arise due to a shift in dominance of difference networks. Specifically, there is thought to be a breakdown in those networks directed to attention and perception, and overactivity of the default mode network ,, a large-scale network that becomes activated during rest, and in day dreaming and mind-wandering. Indeed abnormal levels of default mode network activation are seen in patients with Parkinsons hallucinations.
Adapted from Zarkali A, Adams RA, Psarras S, Leyland LA, Rees G, Weil RS. Increased weighting on prior knowledge in Lewy body-associated visual hallucinations. Brain Commun. 2019;1:fcz007. doi:10.1093/braincomms/fcz007
Who Is At Risk For Psychosis
Theres no predicting with certainty which patients with Parkinsons disease will go on to develop symptoms like hallucinations or delusions. A number of risk factors both internal and external- are associated with the condition.Some of these risk factors include: age, duration and severity of Parkinsons disease; and the taking of dopamine therapy.3-6
Parkinson’s Disease Psychosis: The What When Why And How
Psychosis is a psychiatric term used in neurology to refer to a spectrum of abnormalities. Parkinsons disease psychosis is where people experience hallucinations or delusions. Hallucinations is seeing, hearing, or smelling things that dont exist. With tactile hallucinations, one can feel a presence that isnt there. Delusions are believing something that is not true, like that a spouse is being unfaithful or caregivers are stealing. In this one-hour talk, movement disorder specialist Christopher Goetz, MD, focuses on hallucinations and spends a little time on delusions.
Tip 2: Whatand Howyou Eat Can Make A Difference
Theres no specific Parkinsons disease diet, but by adjusting your eating habits, you can help protect your brain. Diets that are good for your heart tend to also be good for brain health. Eating habits such as those promoted in the Mediterranean diet can help reduce inflammation, protect neurons, and promote better communication between brain cells.
Primarily, its important to eat plenty of fruit and vegetables, cut down on sugary foods and refined carbs, reduce fried and processed foods, and boost your intake of healthy fats and home-cooked meals. High protein meals may also help to benefit your brain chemistry.
Other Reasons For Cognitive Symptoms
Besides PD, there are other important causes of cognitive dysfunction to keep in mind. Medical illnesses such as thyroid disease or vitamin B12 deficiency can cause cognitive symptoms. Urinary tract infections or pneumonia can acutely cause confusion or hallucinations. In these settings, the cognitive symptoms are generally reversible after the infection or medical condition is treated. One should be aware that some medications for pain or bladder problems may cause sedation/sleepiness or confusion, and, thereby, impair cognitive function.
Bringing Light To Darker Side Of Parkinsons
Often the hardest part of Parkinsons disease psychosis is the fear of the unknown. As a person with Parkinsons, you may worry about having hallucinations and/or delusions and not being able to do anything about it. As a care partner, you may worry that you wont be able to help your person with Parkinsons feel safe if something does happen.
The good news is you now have information on what Parkinsons disease psychosis is; the risk factors to look out for; biological and environmental triggers that can bring them on; and how to manage them if they show up.
But what about the emotional toll these types of symptoms can place on you over the long-term as the person with Parkinsons or as a care partner?
The diagnosis of a chronic illness in and of itself requires a lot of adjustments. When you add something like Parkinsons disease psychosis into the mix, its important that you also add another level of self-care to your everyday life.
Phenomenology Of The Hallucinations
Minor hallucinations/illusions
We grouped together in this category three types of phenomena. The most frequent type was presence hallucinations . The patient had the vivid sensation of the presence of somebody either somewhere in the room or, less often, behind him or her. In all cases, the presence was that of a person, and in one case it was also occasionally the presence of an animal . In seven cases, the presence was that of a relative . In all the other cases the presence was unidentified. The presence hallucinations were commonly as vivid as a hallucinated scene and were described as a `perception’. For instance, one patient said: `the image is behind me’, a second said: `I see someone arriving; I turn back but nobody is there’, a third said: `I take a look; I don’t see anything, but it is engraved in my mind’, and another said: `I have the impression that my mother is always there, that she is about to come into sight’. The passage hallucinations consisted of brief visions of a person or an animal passing sideways. If an animal was seen, the species was almost invariably specified , and in two instances it was a dog previously owned by the patient. Illusions occurred in nine patients . In five cases the illusion consisted of the transformation of an object into an animal .
Case 1 .
Case 2 .
Formed visual hallucinations
Case 3
Auditory hallucinations
Case 4
Simple Tips To Sleep Better
Medications can manage your hallucinations so you can sleep better — and vice versa. But donât forget that sleep hygiene matters, too. These simple tips should help anyone with sleep problems:
- Sleep only as much as you need to feel refreshed.
- Wake up at the same time every day.
- Exercise daily — but not close to bedtime.
- Keep your bedroom cool.
- Limit fluid and avoid caffeine in the evening.
- If youâre hungry before bed, have a light snack.
- Get out of bed if you feel angry or frustrated.
Â
Types Of Hallucinations In People With Parkinsons Disease
Hallucinations involve the five senses: sight, smell, touch, hearing, and taste.
People with hallucinations have sensory experiences that feel real to them, but are not actually happening and are not apparent to anyone else.
Types of hallucinations include:
- Auditory: Hearing things
- Gustatory: Tasting things
For people who experience Parkinsons-related hallucinations, the hallucinations are usually visual. They are typically non-threatening, but less commonly they can be of a threatening nature.
Often people with Parkinsons disease psychosis see small people or animals, or loved ones who have already died. They are not interacting with them, just being observed.
Auditory hallucinations are more common in people with schizophrenia, but can happen with Parkinsons disease. With Parkinsons disease, auditory hallucinations are usually accompanied by visual hallucinations.
More specific types of hallucinations experienced by people with Parkinsons disease include:
Comparison Of Hallucinators And Non
The patients with isolated minor hallucinations were compared with the patients with no hallucinations . The only significant difference was a higher CES-D score in the group with minor hallucinations . When the presence of depression was determined using the cut-off values of the CES-D, depression was more frequent in the patients with minor hallucinations than in the patients without any hallucinations , but this difference did not reach significance.
The patients with formed visual hallucinations are compared with the non-hallucinators in Table 5. Patients with visual hallucinations differed in a number of respects: they were older, had a longer duration of disease, had a more severe motor state, had more depressive symptoms, and were more likely to have cognitive impairment, day-time somnolence and a history of ocular pathology. They were less likely to receive anticholinergics or selegiline and received a higher daily dose of levodopa, but the levodopa-equivalent dose did not differ significantly between the two groups. Visual hallucinations were recorded in 70% of the patients with dementia versus 10% of non-demented patients , and in 55% of the patients with severe cognitive disorders versus 8% of the patients with absent or moderate cognitive impairment .
The patients with hallucinations of any type were compared with the patients with no hallucinations. The results were identical to those of the preceding analysis, except for the degrees of significance .
Coping With A Parkinsons Diagnosis
A diagnosis of Parkinsons can be a frightening experience for both you and your loved ones. While there is currently no cure, there are treatments available for Parkinsons symptoms and lifestyle changes you can make to slow the progression of the disease and delay the onset of more debilitating symptoms, including Parkinsons disease dementia. Early diagnosis can prolong independence and help you to live life fully for much longer.
If youve been diagnosed with Parkinsons you may feel anger, deep sadness, or fear about what the future will bring. These feelings are all normal. Its also normal to grieve as you deal with this enormous adjustment.
Give yourself some time to adjust. As with any major change in life, dont expect that you will smoothly snap into this new transition. You may feel alright for a while, and then suddenly feel stressed and overwhelmed again. Take time to adjust to this new transition.
Learn all you can about Parkinsons disease and Parkinsons disease dementia. Educating yourself and making important decisions early can help you feel more in control during this difficult time.
Reach out for support. Living with Parkinsons presents many challenges, but there is help available for this journey. The more you reach out to others and get support, the more youll be able to cope with symptoms while continuing to enrich and find meaning in your life.
Practical Tips For Caregivers Of People With Parkinson’s Psychosis
This 2-page tip sheet has bullet point suggestions for what to do if the person you care for experiences hallucination, delusions or confusion, or becomes agitated or aggressive. In addition, there are tips for how to best be prepared for a doctors appointment when you bring this behavior to the attention of your medical team.
A Caregivers Guide To Parkinsons Disease Psychosis
While more than 50% of those taking carbidopa-levodopa may experience psychosis , medication management of these symptoms is a balancing act. First, families must bring psychotic behavior to the attention of your medical team. Medical causes of the behavior, like infection must be ruled out, followed by a review of medications and possible medication adjustments before a lifestyle changes and possible medications for treatment are added.
Can Hallucinations Be Treated
The treatment for hallucinations consists primarily of removing any existing medical cause, especially reducing or stopping any triggering pharmacological cause for example by reducing a dose or discontinuing treatment with a certain drug. If the increase in motor symptoms then becomes troublesome, a return to the earlier anti-Parkinsons drug may be considered, but with the addition of an atypical neuroleptic drug.
Most neuroleptics can worsen Parkinsons and are forbidden when treating people with the condition. Medications for dementia can also reduce the incidence of illusions and hallucinations when there is underlying cognitive impairment. Parkinsons treatments are developing fast and it is likely that we will see even more effective ways of avoiding and treating hallucinations in the coming years.
The most important thing is to report hallucinations to your doctor or nurse, and to discuss if they should be treated in some way.
Risk Factors For Parkinsons Hallucinations
Not much is known about what causes hallucinations with Parkinsons disease. Because people living with Parkinsons disease also are at risk of vision impairment, these problems may contribute to the occurrence of hallucinations. Older people and those with advanced stages of Parkinsons also tend to have a higher risk of hallucinations.
Hallucinations can be a side effect of a medication or caused by an infection. In these cases, the hallucinations are related to Parkinsons but not caused by the disease itself.
Treating Psychosis That Can Accompany Parkinson’s Disease
Although treatment options are limited, physicians must learn to recognize and effectively treat Parkinson’s psychosis.
A new medication may soon be available to treat the hallucinations and delusions that often accompany Parkinson’s disease. “It shows promise in improving the hallucinations without worsening the motor functions,” says Jennifer G. Goldman, MD, an associate professor of neurology at Rush University Medical Center in Chicago.
She explained that, to date, good medications for treating Parkinson’s psychosis have been unavailable. “It would be very exciting to have another agent available to use,” she says.
Parkinson’s Psychosis People who have Parkinson’s disease may develop psychosis, possibly as a result of the medications used to treat the movement disorders but also possibly related to the disease itself. These misperceptions can range from illusions, such as a chair looking like a dog, to false beliefs, perhaps of an unfaithful spouse or an imaginary person living in the house, Goldman explains.
The hallucinations are primarily visualone of the many differences between psychosis symptoms in Parkinson’s and those in schizophrenia. With schizophrenia, people might have delusions of grandeur, believing they have unreal abilities, or they might hear voice commands. With Parkinson’s psychosis, Goldman explains, auditory hallucinations are infrequent and if they arise, generally are confined to background noise, such as children or music playing.