Hallucinations can be described as sensory perceptions that happen while awake that are mistakenly thought to be real. In Parkinson’s it is often described as “seeing things that aren’t there.”
In Parkinson’s, hallucinations are most commonly visual and described as objects, people or animals. For many, they are benign visions that the individual experiencing them knows are not real. In more severe cases, a person may not know the visions are not real or may be distressed by and try to interact with them. Illusions can also occur in which a real object is perceived but misinterpreted—for example, trees are mistaken for people.
Not all people with Parkinson’s experience hallucinations.
The risk of hallucinations is greater in older people, those with cognitive problems, and those taking higher doses of Parkinson’s medicines, narcotics, sleep medicines and sedatives.
It is important to inform your doctor about even the mildest hallucinations because they may alter how you “see” and interact with your environment. An example is the person who trips or falls while trying to step over a dog that is not really there. Another good reason to tell your doctor is that treatment is available. Hallucinations can start as benign, non-troubling and even pleasant sights, but they can change overtime to become more distressing
In some cases, hallucinations may be a sign of another medical problem or condition that requires treatment such as an infection, dehydration or a side effect of a new medication. This is especially true if confusion, or hallucination come on abruptly or worsen suddenly.
How are hallucinations treated?
Although all Parkinson’s medications can cause hallucinations, some are more likely than others to do so. Your clinician can work with you to review your medicines and make changes to treat the hallucinations while still optimizing physical and mental function.
Finally, cognition and memory enhancing medications such as rivastigmine (Exelon) or antipsychotic medicines such as quetiapine (Seroquel) or Clozaril may help curb hallucinations.
Among specialists who can help with the management of hallucinations is the occupational therapist. Kay Ballen, OTR/L, an occupational therapist at the Booth Gardner Parkinson’s Care Center, has clear advice for patients and their families.
“Improving household lighting, using night lights and addressing vision problems like cataracts can be helpful,” Ballen said. Occupational therapists can also work with families to identify and reduce potential safety hazards, she said.
How should you talk to a loved one who is having hallucinations? The first step is to stay calm and don’t rush to argue with your loved one and isist they are real. If the person has retained some insight, you can gently remind them that they are not real. It is helpful to calmly redirect the person to something calming, move to another room or surrounding. Be sure to discuss this problem with your healthcare provider for further treatment.
Neuropsychologists, counselors, occupational therapists are specialists that can all help caregivers by offering strategies for redirecting behavior and alleviating distress.
Author: Monique Giroux, MD