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Parkinson’s and Hallucinations

Hallucinations are the perception of objects or sounds that do not exist. These perceptions are rare and can occur in the later stages of Parkinson’s disease. They do not mean that you have dementia and they can be treated.

Nearly 1/3 of people with Parkinson’s disease experience hallucinations

Hallucinations can take different forms:

  • Visual: People, especially loved ones, or absent pets.
  • Auditory: Sounds, music or voices that others cannot hear.
  • Tactile: Feeling that something or someone is touching you or is near you when this is not the case.
  • Taste: Tasting food that has not been eaten.
  • Smell: An odour that others do not smell.

Visual hallucinations are the most common in people living with Parkinson’s disease. Auditory, taste, smell and touch hallucinations are quite rare.

Hallucinations are different from delusions, which are thoughts, beliefs or worries that have no basis in reality.

Hallucinations often occur in low light conditions or when the person is in an altered state of consciousness, such as when the person is just waking up.

Hallucinations can have several causes:

  • Adverse effects of some medications that enter the brain are the main cause of hallucinations. These include antiparkinsonian drugs, pain killers, muscle relaxants, and sedatives.
  • Neuron degeneration can spread to areas of the brain responsible for vision. The brain can then misinterpret the images transmitted to it or create perceptions without any external stimulus.
  • Other medical conditions related or unrelated to Parkinson’s disease. Infection, cognitive disorders, dementia, visual impairment can also cause hallucinations.

Most people living with Parkinson’s disease do not experience hallucinations. Some episodes are often associated with:

  • Dementia
  • Old age
  • Time since Parkinson’s disease diagnosis
  • Some antiparkinsonian medications
  • Anaesthesia
  • Major infections
  • Severe insomnia

Hallucinations are conscious processes that last a certain amount of time. You can talk about them with someone close to you when they occur.

To know if you are hallucinating, you need to be able to confront reality with your perception. You can do this verification yourself or with the help of someone close to you.

In any case, you have to be prepared to accept that your perception may have been tainted. Fortunately, these hallucinations are not related to Parkinson’s disease progressing into a form of dementia. They usually disappear when you change your medications.

Speak to your neurologist. They will be able to do tests to evaluate the causes of your hallucinations and possibly review your medication dosages.

Not all forms of hallucinations need to be treated. Occasional spots or insects in your visual field do not need treatment if they do not disrupt your daily life. However, talk to your neurologist to review your medication.

Inform your loved ones about your hallucination tendency and your most frequent hallucination patterns. Reassure them that these hallucinations are harmless, that you remain perfectly sane and that these episodes are not linked to an accelerated progression of Parkinson’s disease. Talk to them about how you feel during these episodes and what they can do to support you adequately.

The first step in the treatment of hallucinations is to gradually decrease your antiparkinsonian medication doses. Of these, dopaminergic agonists (pramipexole, ropinorole, rotigotine) are the drugs with the highest hallucinogenic profile.

The process of lowering the doses of these drugs, or even eliminating them altogether, must be controlled by your neurologist. Its duration will depend on the medication type and dose you are taking, as well as how long you have been taking it.

Your hallucinations may also be treated with antipsychotic drugs, such as quetiapine or clozapine.

Your loved one’s hallucination episodes are certainly disturbing, but they are usually harmless. Unlike hallucinations caused by other neurodegenerative diseases, hallucinations associated with Parkinson’s disease are most often benign.

Not all hallucinations need to be treated. If they do not disrupt your loved one’s daily life, there are ways to manage them well. It is still important to inform your neurologist for proper follow-up.

Talk to your loved one about their hallucinations. Together, determine what you can do when they are having a hallucination. This will help both of you be prepared and reassured when it happens.

If the hallucinations are severe, do not tell your loved one that the hallucinations are not real. This will only increase the disparity between reality and the hallucination. It may also create unnecessary conflict with your loved one who is convinced that they are hallucinating.

Hallucinations usually appear several years after the onset of Parkinson’s disease. They usually begin with minor visual images that are not frightening, such as a stain on the floor or a moving wall. The stain might look like an insect, for example. If the hallucinations progress, they may include children, animals or tiny people.

At first, most people realize that these hallucinations are not real. Later, the perception between reality and hallucinations may become blurred. Over time, hallucination episodes can potentially become more vivid and threatening.

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