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.
What Causes Parkinsons Disease
The most prominent signs and symptoms of Parkinsons disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems associated with the disease. Scientists still do not know what causes the neurons to die.
People with Parkinsons disease also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinsons, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying position.
Many brain cells of people with Parkinsons disease contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic mutations that impact Parkinsons andLewy body dementia.
Treatment Of Neurobehavioral Features
Treatment of cognitive deficits associated with PD is as challenging as the treatment of Alzheimers disease and other dementias. While the general assumption has been that cognitive deficits are a feature of late-stage PD, clinically inapparent cognitive changes on neuropsychiatric testing may be found . With the introduction of cholinesterase inhibitors such as donepezil , rivastigmine , and galantamine and the NDMA antagonist memantine , it is possible that cognition, orientation and language function will improve, and that such improvement will lead to a meaningful improvement in function. Both donepezil and rivastigmine improve cognition to the same effect, but donepezil is better tolerated . The largest and best-designed study of rivastigmine in dementia associated with PD involved 541 patients enrolled in a 24-week randomized, multicenter, double-blind clinical trial . The patients had a relatively mild dementia , with onset of dementia about 2 years after onset of PD symptoms. The mean ADAS-cog score, the primary efficacy variable, improved by 2.1 points in the rivastigmine group, compared to 0.7 in the placebo group , and the MMSE improved by 0.8 in the rivastigmine group and worsened by 0.2 in the placebo group . At the end of the study, 55.5% were receiving 9 to 12 mg. The adverse effects that were significantly more frequent in the rivastigmine group were nausea, vomiting, dizziness, and tremor.
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Atypical Parkinsonism Or Parkinsons Plus Syndromes
Parkinsons Plus Syndromes are less common than Parkinsons disease.
Some atypical parkinsonism syndromes include:
Multiple system atrophy This is a category of several disorders in which one or more body systems deteriorate.
Your doctor may classify you as having MSA-P, in which parkinsonian symptoms are dominant or MSA-C, in which dysfunction of the cerebellum is dominant.
The names of some of these syndromes include olivopontocerebellar atrophy , Shy-Drager syndrome , and striatonigral degeneration .
Progressive supranuclear palsy Symptoms of this condition usually begin after age 50 and proceed more rapidly than Parkinsons disease.
In people with PSP, problems with eye movement can lead to blurry vision. Falls tend to occur early in the course of the disease, and dementia may occur later in the disease.
Corticobasal degeneration This condition may cause jerking and loss of control in a limb, often without weakness in that limb.
If you have this disorder, you may be given Botox to help your limb relax.
Lewy body dementia LBD is the second leading cause of dementia in the elderly, after Alzheimers disease.
In this condition, the same Lewy bodies occur in the brain as in Parkinsons disease, but in multiple areas of the brain.
If you have LBD, you may experience speech problems, hallucinations, and gradual cognitive decline.
Common Drugs For Parkinson’s Disease
Levodopa and carbidopa . Levodopa is the most commonly prescribed medicine for Parkinsonâs. Itâs also the best at controlling the symptoms of the condition, particularly slow movements and stiff, rigid body parts.
Levodopa works when your brain cells change it into dopamine. Thatâs a chemical the brain uses to send signals that help you move your body. People with Parkinsonâs donât have enough dopamine in their brains to control their movements.
Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better, so you can take less of it. That prevents many common side effects of levodopa, such as nausea, vomiting, and irregular heart rhythms.
Sinemet has the fewest short-term side effects, compared with other Parkinsonâs medications. But it does raise your odds for some long-term problems, such as involuntary movements. An inhalable powder form of levodopa and the tablet istradefylline have been approved for those experiencing OFF periods, OFF periods can happen when Parkinsonâs symptoms return during periods between scheduled doses of levodopa/carbidopa.
People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual movements within a few hours of taking the medicine. Changes in the amount or timing of your dose will usually prevent these side effects.
Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole , rotigotine , and ropinirole , .
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They Despise What They Do Not Know
Many patients complain of the disdainful reaction they encounter when they ask their doctors about adding mucuna to their treatment regimen.
As it is an unorthodox therapy, it is perfectly understandable that the physician does not want to prescribe mucuna: it is not part of the generally accepted body of treatments they are trained to manage..
When a doctor decides to incorporate mucuna, he faces new difficulties, particularly with patients treated with other drugs. This requires the additional effort of studying the situation and designing a strategy for each individual case.
On the other hand, we cannot allow patients to treat themselves in hiding. Therefore, it is desirable that as doctors, we have to educate ourselves about mucuna so that we can choose to use it or not in a particular type of patient.
One should never despise the unfamiliar. After studying the properties of mucuna and weighing its advantages and disadvantages, we should decide on a rational basis, whether it is beneficial, neutral, or inadvisable for a specific case.
If the patient perceives that we master the subject, he will entrusted his care to us, rather than attempting to treat himself. That way, he will cooperate if we ban the mucuna or recommend a gradual dosage pattern. We earn their trust when we have enough information and credibility.
Common Symptoms Of Drug
The motor features of PD are often very easy to see via a neurologic exam in a doctors office. Rest tremor for example, is seen in virtually no other illness and can therefore be very important in diagnosing PD. But there is one other common condition that induces the symptoms of PD, including a rest tremor, which must be considered every time PD is being considered as a diagnosis, and that is drug-induced parkinsonism.
Parkinsonism is not technically a diagnosis, but rather a set of symptoms including slowness, stiffness, rest tremor, and problems with walking and balance. This set of symptoms can be caused by PD, but also can occur as a side effect of certain prescription medications .
A number of medications can cause parkinsonism because they block the dopamine receptor and thereby mimic the symptoms of PD that are caused by loss of dopamine neurons in the brain. Reviewing a patients medications is therefore a critical step for a neurologist when seeing someone with parkinsonism. Anti-psychotics and anti-nausea treatments make up the bulk of the problematic medications, although there are other medications that can also cause parkinsonism. The primary treatment for this type of parkinsonism is weaning off of the offending medication, if possible.
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Names Of Parkinsons Drugs
Drugs for Parkinsons can be divided into three categories.
On our website, we have listed drugs in the following order to help you see each category clearly.
- The class or type of drug, for example levodopa.
- The generic name, such as co-beneldopa, which will include the active ingredients of the drug. For example, co-beneldopa is a combination of levodopa and benserazide.
- The brand name. For example, Madopar is the name that the pharmaceutical company, Roche, uses to sell co-beneldopa.
Your specialist will decide whether to prescribe you branded or generic versions of your medication. It usually depends on which area of the country you are in or what is most common to prescribe in that area. Once there are no longer any legal rights to the brand name any company can make generic versions of a drug.
The active ingredient of a generic drug is always the same as the branded version and lots of people wont have any problems using the generic medication.
In the UK, a generic or branded medicine needs a licence and there is a strict process for this. This means that the quality of a generic or branded version of the same medicine will be the same, and they will also act in the same way.
If you find that you respond a bit differently to generic medication, discuss this with your specialist or Parkinsons nurse.
The brand name will usually be the most visible name on your packet of medication. The generic name is usually written in small print.
New Medications For Off Time
A number of new medications approved recently are designed to reduce OFF time. These medications fall into two major categories:
- Medications that lengthen the effect of a carbidopa/levodopa dose
- Medications that are used as needed if medication effects wear off
Well give specific examples below. In general, new medications that extend the length of a carbidopa/levodopa dose are used if OFF time is somewhat predictable and occurs prior to next dose. New medications that are used as needed are most beneficial when OFF time is not predictable.
New medications that lengthen the effect of a dose of carbidopa/levodopa
- Istradefylline is an adenosine A2A receptor antagonist which was approved in the US in 2019 as an add-on therapy to levodopa for treatment of OFF time in PD. Unlike many of the other medications, it has a novel mechanism of action and is the first medication in its class to be approved for PD. It acts on the adenosine receptor, which modulates the dopaminergic system, but is not directly dopaminergic. The drug was developed in Japan and underwent clinical trials both in Japan and in the US.
- Opicapone is a catechol-O-methyltransferase inhibitor that is taken once a day. It was approved in the US in 2020 as an add-on therapy to levodopa for motor fluctuations.
New formulations of levodopa designed to be used as needed if medication effects wear off
Other medications used as needed if medication effects wear off
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Impulsive And Compulsive Behaviours
People who experience impulsive and compulsive behaviours cant resist the temptation to carry out an activity often one that gives immediate reward or pleasure.
Behaviours may involve gambling, becoming a shopaholic, binge eating or focusing on sexual feelings and thoughts. This can have a huge impact on peoples lives including family and friends.
Not everyone who takes Parkinsons medication will experience impulsive and compulsive behaviours, so these side effects should not put you off taking your medication to control your symptoms.
If you have a history of behaving impulsively you should mention this to your GP, specialist or Parkinsons nurse.
Asking your specialist to make changes to your medication regime or adjusting the doses that you take is the easiest way to control impulsive and compulsive behaviours. So, if you or the person you care for is experiencing this side effect, tell your healthcare professional as soon as possible before it creates large problems.
If you are not able to get through to your healthcare professional straight away, you can call our Parkinsons UK helpline on 0808 800 0303.
We have advice that can help you manage impulsive and compulsive behaviours as well as information on what behaviour to look out for.
If you’re under treatment for coronavirus, and are experiencing side effects with your Parkinson’s treatment, please report it on the government’s Yellow Card website.
Specific Warning About Mucuna
We assume that all contraindications, interactions, precautions and side effects that we know about synthetic levodopa should be considered when taking levodopa from mucuna.
Specific contraindications include thinning of the blood , and care should be taken with antiplatelet and anti-inflammatory drugs because mucuna increases clotting time.
Mucuna should not merge with anticoagulants or with antiplatelet drugs such as clopidogrel. Caution should be exercised and the additive effect should be taken into account if it is associated with acetylsalicylic and NSAIDs .
We should also be careful with antidiabetic medicines: mucuna lows glycemic index, and thus is to be considered a potential additive effect. Other interactions are possible, so always consult your regular doctor.
On the one hand, it can be argued that mucuna has been used for many centuries in India and has been available for several years online without a prescription, and yet serious problems have not been revealed. But that is just an observation.
Regarding Sinemet and Madopar, we have thousands of controlled studies, while publications on mucuna are still scarce. One must therefore use greater caution when choosing mucuna. While the future appears to be positive, we need the confirmation of more scientific studies.
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Side Effects Of Medication
All prescribed medication can have potential side effects, including those used to treat Parkinsons.
Many people find their Parkinsons medication works very well when they start taking it, but this may change over time and side effects can develop.
Some things you think are symptoms of Parkinsons may actually be side effects of medication.
Some peoples side effects will have a big impact on their lives and have to be kept under control along with the symptoms.
What To Expect From Your Doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Do you have symptoms all the time or do they come and go?
- Does anything seem to improve your symptoms?
- Does anything seem to make your symptoms worse?
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What Tests Will Be Done To Diagnose This Condition
When healthcare providers suspect Parkinsons disease or need to rule out other conditions, various imaging and diagnostic tests are possible. These include:
New lab tests are possible
Researchers have found possible ways to test for possible indicators or Parkinsons disease. Both of these new tests involve the alpha-synuclein protein but test for it in new, unusual ways. While these tests cant tell you what conditions you have because of misfolded alpha-synuclein proteins, that information can still help your provider make a diagnosis.
The two tests use the following methods.
- Spinal tap. One of these tests looks for misfolded alpha-synuclein proteins in cerebrospinal fluid, which is the fluid that surrounds your brain and spinal cord. This test involves a spinal tap , where a healthcare provider inserts a needle into your spinal canal to collect some cerebrospinal fluid for testing.
- Skin biopsy. Another possible test involves a biopsy of surface nerve tissue. A biopsy includes collecting a small sample of your skin, including the nerves in the skin. The samples come from a spot on your back and two spots on your leg. Analyzing the samples can help determine if your alpha-synuclein has a certain kind of malfunction that could increase the risk of developing Parkinsons disease.
What Are The Symptoms Of Parkinsons Disease
Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:
Other symptoms include:
- Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
- Handwriting changes: You handwriting may become smaller and more difficult to read.
- Depression and anxiety.
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What Are The Side Effects Of Parkinson’s Drugs
The most common reactions include nausea, vomiting, dizziness , sleepiness and visual hallucinations.
In the last few years, levodopa and dopamine agonists in particular have been associated with the emergence of behavioral changes such as impulse control disorders. These are characterized by failure to resist an impulse to perform certain actions.
Impulse control disorders include a range of behaviors such as compulsive gambling or shopping, hypersexuality, binge eating, addiction to the Internet or to other recreational activities. These activities are often pleasant in the moment, but over time may become harmful to you or to others. If you are experiencing these behaviours, tell your neurologist/doctor. Often the medication can be adjusted which can reduce or control the behaviour.
Care partners can play an important role in helping to identify when these behaviours occur. If you are a care partner, tell the person if you have noticed a change in his/her behaviour or personality and encourage him/him/her to speak with the doctor immediately so medication can be adjusted.