Hallucinations & Delusions in Parkinson's

Hallucinations & Delusions in Parkinson’s

Among potential non motor symptoms of Parkinson’s disease, hallucinations and delusions can be, understandably, some of the most challenging.

The Michael J. Fox Foundation for Parkinson’s Research defines these as:

Hallucinations are seeing, feeling or hearing things that aren’t there.
Delusions lead a person to firmly believe in scenarios or situations that never happened or are not true.

Not everyone with Parkinson’s disease will experience hallucinations or delusions, which are collectively referred to as psychosis. Like all Parkinson’s symptoms, if, when and to what degree they occur varies from person to person. If they do develop, it’s usually after many years or decades of life with Parkinson’s.

Sometimes, but not always, hallucinations and delusions can happen as part of significant memory and thinking changes (dementia).

What Are Hallucinations?

The most common hallucinations are visual — seeing things or people that aren’t there. These may be mild and include pleasant images, like children playing in the backyard or a visit from a dear relative who has passed away. But hallucinations could instead be frightening, involving things like an intruder or unknown person in the home.

Sometimes a person realizes hallucinations are not real. Other times, they don’t. Hallucinations come and go — they can happen a few times a month or year or they could happen multiple times per day.

What Are Delusions?

While hallucinations involve hearing, seeing or sensing things that are not there — delusions affect how a person thinks about situations or scenarios. Common delusions include infidelity: a partner or spouse is being unfaithful or having an affair. Another common idea is that loved ones are stealing money from a person or their business. Delusions can, of course, feel hurtful to loved ones and be challenging to work through.

What Causes Hallucinations and Delusions?

There are many possible reasons for hallucinations and delusions. Sometimes, they are brought on temporarily – by a medication change or illness – and resolve once those are addressed. Parkinson’s disease itself can cause these symptoms, but other factors can bring them on or worsen them:

Certain Parkinson’s medications.

Other non-Parkinson’s or over-the-counter medications.

Unrelated conditions, like a urinary tract infection, cold, COVID or pneumonia.

Unfamiliar environments, like being in the hospital, and big changes in a day-to-day routine.

Surgery or other procedures.

Sleep disruptions, such as not sleeping well for a few nights in a row.

Stress, such as from losing a job to a loved one passing away.

Vision and hearing loss, as these can cause misinterpretation of normal images or sounds.

Hallucinations and delusions can happen together but having one doesn’t necessarily mean you’ll have the other. In some cases, a hallucination could bring on or worsen a delusion.

How Are Symptoms Treated?

The most important first step is talking with your loved ones and your care provider. These symptoms can be confusing, concerning or embarrassing so many people, understandably, don’t want to bring them up. But your doctor and family can’t help if they don’t know what’s going on. Remember: If these symptoms happen, they are part of Parkinson’s, not part of you.

If hallucinations and delusions happen, your doctor will review whether you’ve recently started or adjusted medications, if you might have a new illness or infection, and if there are any other changes to your personal or medical status.

Guidance for Care Partners

There are many tips and tricks care partners and family members can use in everyday routines to lessen the severity and frequency of these symptoms. These could include keeping a calm and safe-feeling environment at home and redirecting away from a hallucination or delusion instead of arguing about the truth. For more tips, see this blog from The Michael J. Fox Foundation for Parkinson’s Research.

Adjust Parkinson’s and Other Medications

Your doctor may lower or discontinue certain medications to limit these symptoms. When it comes to Parkinson’s medications, the challenge becomes finding the balance of enough medication to support movement but not increase hallucinations or delusions. When symptoms are significant, bothersome, or posing safety concerns for a person or their loved ones, doctors may prescribe medication to treat them.

As with all symptoms of Parkinson’s, they vary from person to person and change over time. While people are generally most familiar with the motor symptoms of Parkinson’s disease, hallucinations and delusions are some of a number of non-motor symptoms that can sometimes have a major impact on people. Find out more about the signs and symptoms of Parkinson’s disease.

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