Hallucinations in Parkinson’s

Author is Dr. Mick Reedy, Movement Disorders Specialist
with Inova Parkinson’s and Movement Disorders Center.

What are Hallucinations?

Hallucinations are when you see, hear, smell, feel, or sense things that are not really there. Many people with Parkinson’s experience them, though usually much later in the disease. Risks for developing hallucinations include older age, poor sleep, vision problems, memory problems, and infections. Certain Parkinson’s medications may worsen hallucinations.

Hallucinations vs. Illusions

Illusions are when your brain gets confused about something real. For example, you might think a coat rack is a person, that the sound of leaves rustling is someone talking, or that a puddle of water looks like a face. Everyone can experience illusions, but they happen more often in people with Parkinson’s. They are not harmful but should be mentioned to your neurologist.

Hallucinations are things your mind makes up that are not real. There are a few types of hallucinations:

1. Presence hallucinations: Feeling like someone is nearby when there is not. This can be scary and make you paranoid.
2. Passage hallucinations: Seeing something out of the corner of your eye that disappears when you look. These might be shadows, shapes, animals, or people. Seeing shadows is common for everyone.
3. Gustatory hallucinations: Tasting things that are not there. These are rare in Parkinson’s Disease.
4. Olfactory hallucinations: Smelling things that are not there.
5. Tactile hallucinations: Feeling things on your skin that are not there. This can be very uncomfortable and scary but is also rare.
6. Auditory hallucinations: Hearing sounds or voices that are not there. People usually hear hearing muffled sounds but may sometimes hear music or people talking. This ranges from pleasant to disturbing but is also rare in Parkinson’s Disease.
7. Visual hallucinations: Seeing people, animals, or objects that are not there. These can start simple, like seeing flowers or animals, and can become more complex and harder to recognize as not real. Some people see small children, friends, loved ones, or total strangers. They might even interact with you and can become scary over time.

What causes hallucinations?

While Parkinson’s itself can cause hallucinations, there are other reasons you might have them. Once other causes are ruled out, your doctor will check your medications.

Even Parkinson’s medications can sometimes make hallucinations worse. Your neurologist will review your medicines to ensure they are safe.

Treatment

If needed, your doctor might prescribe medication to help with hallucinations. These can include:
• Memory-boosting medications
• Antipsychotics

Behavioral strategies to manage hallucinations include:
• Staying busy with activities you enjoy.
• Exercising and taking regular walks.
• Trying musical therapy or listening to music you enjoy.
• Keeping a regular schedule: Go to bed and wake up at the same time every day.
• Letting sunlight into your rooms and keeping the lights on during the day.
• Keeping your bedroom dark and quiet at night.

Your neurologist will discuss these options if they are necessary. There is no one-size-fits-all treatment, so your doctor will find what works best for you. If hallucinations are very distressing or cause delusional thinking, a regular or as-needed antipsychotic might be necessary. Since some medications can take 1 to 2 months to work, it important to start them early if needed.

Key Takeaways:

• Not everyone realizes they are hallucinating, especially over time.
• Hallucinations can start small and even be amusing but often become more troubling and complex.
• Tell your neurologist if you have illusions or hallucinations.

For more information

This recording and slide deck from our Care Partner Tips and Tricks series may be helpful too:
Dealing with Behaviors Brought on by Hallucinations and Delusions