Parkinson’s Hallucinations and Delusions: Why They Happen and How to Cope
Parkinson's DiseaseManaging Parkinson’s Psychosis

Parkinson’s Hallucinations and Delusions: Why They Happen and How to Cope

Use these strategies to help manage visual and auditory hallucinations.
Parkinson’s Hallucinations and Delusions: Why They Happen and How to Cope
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Updated on October 25, 2024
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Most people don't associate Parkinson's disease with hallucinations. However, according to the Parkinson's Foundation, psychosis symptoms — including disordered thinking, delusions, and hallucinations — affect more than half of people with the disease.

These symptoms aren't always bothersome but can be distressing, says Mill Etienne, MD, associate professor of medicine and neurology at New York Medical College, a member of Touro University, in Valhalla, New York. "Some patients are aware that the hallucinations are not real, but some lack the insight. This can be difficult for the patient, and it also ultimately impacts cohabitants or caregivers. It is important to find out why the person is hallucinating and having delusions, as this will impact what treatment options are available," Dr. Etienne says. "Often the psychosis is temporary and related to either an infection or a medication side effect, while other times, it may be related to the development of dementia or the progression of the disease."

A combination of medical treatments and lifestyle adjustments can help alleviate psychosis symptoms, Etienne continues, so it's important to tell your doctor. In the meantime, here's more information on what Parkinson's related psychosis entails and possible ways to cope.

What Is Parkinson’s Related Psychosis?

Parkinson's related psychosis is a nonmotor symptom of Parkinson's disease that causes people to become very confused, perceive things that aren't there, or believe things that aren't true.

It's unclear what exactly causes Parkinson's disease with hallucinations or delusions, but experts believe that brain chemistry plays a role.

 Specifically, psychosis may be a side effect of medications used to treat Parkinson's. In particular, dopaminergic therapy, which increases dopamine levels in the brain, could cause psychosis as a side effect. Alternatively, psychosis may stem from neurological changes as the disease progresses. Delirium, which can result from an infection, stroke, heart disease, fever, certain medications, or another underlying medical condition, may also cause temporary psychosis.

"A provider who sees people with Parkinson's disease should inquire at each visit if the person hallucinates. Often patients do not report them and do not know their medications cause them," says Marie-Hélène Saint-Hilaire, MD, professor of neurology at Boston University Chobanian and Avedisian School of Medicine and neurologist and ambulatory director of the neurology clinic at Boston Medical Center. "It is important to identify and treat them because they increase the risk of hospitalization and visits to the emergency department."

Below, we take a closer look at how hallucinations, delusions, and other psychosis symptoms can affect people.

Hallucinations

"Hallucinations are basically something that you sense that is not actually there," says Meredith Bock, MD, chief medical officer at Remo Health and volunteer assistant clinical professor in geriatrics at the University of California in San Francisco.

These can affect any of the five senses, Dr. Bock says, but are usually visual. "Minor visual hallucinations are very common. That's usually a shadow in your peripheral vision, something that looks like an animal scurrying by, a person walking by," Bock says. "They're usually transient and often not too bothersome."

Hallucinations can also be more elaborate, Etienne says. "I once had a patient who frequently saw numerous dead relatives at the dinner table numerous nights per week," he says. "The patient did not mind this, but the spouse did as the spouse watched the patient engaging with people who were not there."

Additionally, Etienne continues, people may hear sounds (such as voices or music) or smell scents (usually foul) that aren't real. "Interestingly, studies have shown that patients with Parkinson's disease may lose some of their sense of smell years before the onset of Parkinson's disease," he says. Psychosis can also involve touch or taste, such as the sensation of bugs crawling on the skin or a bitter taste in the mouth, he adds.

Delusions

Delusions are false, illogical, irrational, and dysfunctional beliefs or persistent thoughts, according to the Parkinson's Foundation. They can be very distressing and may cause people to become aggressive, argumentative, agitated, or unsafe, per the organization.

"Delusions are a false, fixed belief that's maintained despite evidence to the contrary," Bock says.

 "Usually, they're kind of paranoid in nature." Some examples of this are: "My spouse is cheating on me." "People are stealing money from me." "There are intruders in the house." Roughly 8 percent of people with Parkinson's disease experience delusions, according to the Parkinson's Foundation.

Other Symptoms of Parkinson’s Related Psychosis

Many people with psychosis also experience illusions, Bock says. Unlike hallucinations, which aren't rooted in reality, illusions involve misinterpreting real sensory input.

 "A common one is seeing a face in a pattern, like in a wallpaper pattern or wood grain," Bock says.
At times, psychosis doesn't involve false beliefs but disordered thinking, Etienne says. "Sometimes psychosis could be a sense of confusion or disorientation," Etienne says. "We often see this when patients are admitted to the hospital."

Risk Factors for Parkinson’s Related Psychosis

Not everyone with Parkinson's disease develops psychosis, and there's no surefire way to predict who will.

 However, certain factors can increase a person's risk. According to the Parkinson's Foundation, these include the following:

  • Dementia or memory problems
  • Depression
  • Sleep disorders, including vivid dreaming, REM sleep disorder, and insomnia
  • Vision difficulties
  • Older age
  • Advanced or late-stage Parkinson's disease
  • Use of medications for Parkinson's disease, including dopaminergic medicines

How to Cope With Parkinson’s Related Psychosis

Coping with psychosis requires a holistic, multifaceted approach. Your healthcare team will work with you to determine the best course of action depending on your symptoms and needs, but the following are some frequently recommended tips.

1. Address Potential Underlying Causes

As mentioned, underlying medical conditions like an acute infection, nutrient deficiency, or electrolyte imbalance can contribute to delirium and psychosis.

 A healthcare provider may order tests to see if a health problem could be behind the symptoms, Dr. Saint-Hilaire says. "Sometimes the provider will do urine and blood tests to be sure that hallucinations are not caused by an underlying medical condition like an infection, especially if the onset is rapid," she says.

Additionally, Etienne says that it's important to address issues such as cataracts, diabetes, and hearing loss, as the loss of one or more of the five senses can increase your risk of psychosis.

"Appropriate use of hearing aids and having conditions like diabetes mellitus addressed can be helpful, as diabetes can impact sensory function," he says. "It is important to follow up with your doctor regularly and not automatically blame any new symptoms on Parkinson's disease. It is quite possible there is another condition occurring that is negatively impacting Parkinson's disease."

2. Talk to Your Doctor About Adjusting Your Medication

As mentioned, psychosis is a side effect of some medications used to treat Parkinson's disease.

 "People with Parkinson's disease have a problem with dopamine in the brain. The Parkinson's medications try to increase dopamine action in the brain," Etienne says. "That increase in dopamine activity in the brain is precisely one of the mechanisms that contribute to psychosis. This can make for a difficult balancing act." Medications with anticholinergic effects, including those that treat urinary symptoms of Parkinson's disease, can also cause psychosis symptoms, Saint-Hilaire says.

Etienne suggests talking to your doctor about changing your medication regimen to minimize side effects. That may entail decreasing your dose, discontinuing a particular drug, or increasing your dose of another Parkinson's medication, such as cholinesterase inhibitors, which may help alleviate psychosis symptoms.

If that doesn't work, Bock says that your doctor may advise trying an antipsychotic medication. "Those have more side effects, so you reserve them only for situations in which the hallucinations are truly bothersome and can't be addressed in other ways," she says.

3. Establish a Healthy Routine

"A structured daily routine provides a sense of stability and predictability, which can ease the anxiety or disorientation that may accompany psychosis," says Barbara Sparacino, MD, a physician at The Aging Parent Coach in Miami. "This is particularly important when establishing and maintaining a regular sleep schedule."

Inadequate sleep, she explains, can worsen psychosis, and sleep disorders are common in Parkinson's disease.

Exercising, eating nutritious meals, practicing good sleep hygiene, avoiding alcohol and nicotine, spending time in natural light, and engaging in relaxing activities may help you get better shut-eye.


4. Create a Calm, Well-Lit Environment

Sensory overload may be distressing for people with psychosis, so creating a calm, structured environment is recommended, Dr. Sparacino says. "Keep the lighting consistent, minimize loud or abrupt noise, and reduce clutter or visual distractions," she says. "These changes can help decrease the intensity of hallucinations and other symptoms."

Regarding lighting, Etienne advises keeping your home well lit, as hallucinations are more likely to occur in dark and shadowy areas.

 "Keeping the lights on until it is time for sleep can be helpful," he says.

5. Manage Stress

Bock says that stress — mental or physical — can trigger or intensify symptoms, so finding ways to manage it is crucial.

"Poor sleep, stress, illness, even a common cold or urinary tract infection — any kind of stress on the body or mind can increase your risk of psychosis," she says.

Other than addressing underlying health problems, Bock says that stress relief looks different for everyone and recommends choosing a method that works for you.

"For some people, exercise can be really stress reducing. I know that's certainly the case for me. Some people may prefer other strategies, like mindfulness or meditation. Others have individual counselors or therapists who can help them process what they're going through with a new diagnosis or changes in their new normal," she says. "Leaning on your family, friends, and social networks — we know that is stress reducing and cognitively beneficial. Many people also find a lot of respite and comfort in spiritual practice. It really just depends on the person."

The Takeaway

Parkinson’s with hallucinations and delusions can be challenging for patients, family members, and caregivers, but it is highly manageable. If you’re experiencing psychosis symptoms, talk to your doctor as soon as possible. They can check for underlying health issues and, potentially, adjust your medications. Above all, remember that you’re not alone. Psychosis is incredibly common, and your healthcare team, loved ones, and community are there to support you.

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Jason Paul Chua, MD, PhD

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Jason Chua, MD, PhD, is an assistant professor in the Department of Neurology and Division of Movement Disorders at Johns Hopkins School of Medicine. He received his training at the University of Michigan, where he obtained medical and graduate degrees, then completed a residency in neurology and a combined clinical/research fellowship in movement disorders and neurodegeneration.

Dr. Chua’s primary research interests are in neurodegenerative disease, with a special focus on the cellular housekeeping pathway of autophagy and its impact on disease development in diseases such as Parkinson disease. His work has been supported by multiple research training and career development grants from the National Institute of Neurological Disorders and Stroke and the American Academy of Neurology. He is the primary or coauthor of 14 peer-reviewed scientific publications and two peer-reviewed online learning modules from the American Academy of Neurology. He is also a contributing author to The Little Black Book of Neurology by Osama Zaldat, MD and Alan Lerner, MD, and has peer reviewed for the scientific journals Autophagy, eLife, and Neurobiology of Disease.

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