Tremors and rigid muscles are the Parkinson’s disease (PD) symptoms people are most familiar with. But the disease can also cause other mental and physical issues. Among the non-motor symptoms of Parkinson’s disease, hallucinations and delusions can be the most alarming.
“People who experience these worry that they’re a sign of declining mental health,” says Yikun Wang, D.O., a neurologist at Henry Ford Health. “Hallucinations and delusions can be frightening, but it’s important to recognize when they’re happening and learn how to handle them.”
How Common Are Delusions in People With Parkinson’s?
As with any disease, the symptoms of Parkinson’s are wide-ranging and diverse. The physical, mental and emotional effects of the disease impact everyone differently. And while hallucinations and delusions may not be the symptoms that first come to mind, they are relatively common in people with Parkinson’s.
“It doesn’t happen to everyone, but it is very common,” says Dr. Wang. “Up to 60% of people with Parkinson’s will experience some type of hallucinations or delusions over the course of the disease.” She notes that the risk of these symptoms can increase as the disease progresses.
What Causes Delusions in Parkinson’s?
Whether a patient with Parkinson's disease develops hallucinations depends on the interaction of disease-related neurodegeneration, medication and individual risk factors,“ says Dr. Wang. “Depending on those factors, some people are more likely to hallucinate than others.”
Triggers for hallucinations and delusions can include:
- Dopamine agonist medications (especially when starting a new drug or changing the dosage)
- Infection (such as a urinary tract infection, cold or pneumonia)
- Poor sleep
- Stress
- Unfamiliar environment (such as during a hospital stay)
Types of Delusions and Hallucinations
People with Parkinson’s can have different types of delusions and hallucinations. Collectively, these symptoms are referred to as Parkinson’s psychosis. But hallucinations and delusions each have unique characteristics.
A delusion typically involves fixating on a false belief. In people with Parkinson’s, delusions can be persecutory (thinking people are out to get you) or paranoid (such as being convinced a partner is cheating on you).
Hallucinations are when you see, feel or hear something that isn’t really there. You might think someone is in the room with you, mistake a pile of clothes for a cat, hear music playing or feel like bugs are crawling on your skin.
How to Handle Parkinson’s Hallucinations and Delusions
Parkinson's Disease Treatment At Henry Ford
“Early on in the disease, hallucinations tend to be mild, and patients know they’re not real,” explains Dr. Wang. While these can be disconcerting, they aren’t generally dangerous.
“It’s different when patients start to lose insight, believe the hallucinations are real and react to them,” she says. People can become physically aggressive, especially if they think someone is breaking into their house or attacking them in their bed.
“Caregivers shouldn’t try to argue with someone who’s experiencing hallucinations or try to convince them the hallucination is not real,” says Dr. Wang. “It’s better to gently redirect their attention instead of trying to correct their misperception.”
Talking to Your Doctor About Parkinson’s Psychosis
If you or a loved one with Parkinson’s starts experiencing hallucinations or delusions, it’s important to talk to your doctor. They can assess your medications to see if that might be contributing to the psychosis. You may be able to change medications or adjust dosages to relieve symptoms.
For hallucinations and delusions that are getting more severe, your doctor may consider prescribing antipsychotic medication. Nuplazid is an FDA-approved medication specifically to treat psychosis in Parkinson’s.
“Don’t try to hide these symptoms if you start experiencing them,” urges Dr. Wang. “It’s important to recognize what’s happening and discuss it with your doctor."
Reviewed by Yikun Wang, D.O., a neurologist who sees patients at Henry Ford Hospital and Henry Ford Medical Center-Royal Oak.
