Hallucinations and Delusions in PD

Hallucinations and delusions are collectively referred to as psychosis.

Visual hallucinations are the most common type of hallucination.  In a visual hallucination, someone sees things that are not actually there.  There can also be auditory and olfactory hallucinations.  Often hallucinations are not alarming to the person experiencing them.

Delusions are when there is an alternative view of reality: an entire irrational story is created.  Paranoia is a common type of delusion.  Capgras delusions are a specific type of delusion where the person believes that a spouse, adult child, or other family member has been replaced by an imposter.


Caregivers Coping with Hallucinations and Delusions | Downloadable Documents | Online Articles | Podcasts & Webinars | Expert-level Resources


Special Section: Caregivers Coping with Hallucinations and Delusions

A Caregiver’s Guide to Parkinson’s Disease Psychosis 

By Andrew J. Ridder, MD.  Published by Michigan Health, Brain Health Blog, February 16, 2017

While more than 50% of those taking carbidopa-levodopa may experience psychosis (a break with reality), medication management of these symptoms is a balancing act.  First, families must bring psychotic behavior (primarily hallucinations, delusions and illusions) to the attention of your medical team.  Medical causes of the behavior, like infection must be ruled out, followed by a review of medications and possible medication adjustments before a lifestyle changes and possible medications for treatment are added.


Hallucinations

Published by the Alzheimer’s Association

This web page has two sections; one on understanding hallucinations and the other on coping strategies.  Links within the text take you to pages which explain brain function and changes, non-drug approaches to behavior management and medications for behavioral symptoms.


Hallucinations and Delusions in Parkinson’s Disease

Published by the Parkinson’s Foundation, Parkinson’s Today Blog, March 23, 2018

This blog post is based on the latest research and a Parkinson’s Foundation Expert Briefing about hallucinations and delusions in Parkinson’s.  After an explanation of what hallucinations and delusions are, there are tips for what to do, how to minimize these behaviors through lifestyle changes, and medication treatment options.


Parkinson’s Disease Psychosis: A Little-Known Symptom of PD

By Anne-Marie Botek.  Published by Aging Care

One of the lesser-known symptoms of Parkinson’s Disease is Parkinson’s psychosis.  This webpage explains the prevalence, causes and symptoms, treatment options of PD psychosis.  More useful to caregivers are sections on potential triggers of psychotic episodes and what caregivers can do about PD psychosis.


Practical Tips for Caregivers of People with Parkinson's Psychosis

Published by the Parkinson’s Foundation

This 2-page tip sheet (PDF) has bullet point suggestions for what to do if the person you care for experiences hallucination, delusions or confusion, or becomes agitated or aggressive.  In addition, there are tips for how to best be prepared for a doctor’s appointment when you bring this behavior to the attention of your medical team.


Downloadable Documents (PDF)

Hallucinations and Delusions in Parkinson's

By David Burn and Marjan Jarhanshahi.  Published by Parkinson’s UK, May 2013

This 5-page information sheet (PDF) has a good general description of common hallucinations and delusions experienced by those impacted by Parkinson’s as well as possible causes, treatment options and caretiver tips.


Psychosis: A Mind Guide to Parkinson’s

By Linda Minton, Kate Perepezko, and Gregory Pontone, MD.  Published by National Parkinson Foundation (Now the Parkinson's Foundation)

Can be downloaded as a PDF or ordered the Parkinson's Foundation online store.  This 40-page booklet is a thorough guide to all aspects of Parkinson’s psychosis, including symptoms, causes, treatment options, coping strategies for both the family and person experiencing the psychosis, and a chapter on tips for caregivers.


Online Articles

Hallucinations/Delusions

Published by the National Parkinson Foundation (Now the Parkinson's Foundation)

This webpage provides information on the differences between hallucinations, delusions, delirium, dementia; risk factors, causes and treatment options for each as well as some coping strategies for family members and care partners when dealing with one or more disorder.

The bottom of this webpage features a 4-minute video. It is a first hand account by a caregiver about her husband's developement of hallucinations and how the two of them manage day-to-day.


Psychosis in Parkinson’s

By Mosaic Science.  Published by the Caregiver Space, March 17, 2017

This blog post shares the experience at least half of people diagnosed with Parkinson’s - developing Parkinson’s disease psychosis (PDP).  It further shares the impact on those treated by the newly approved, Nuplazid, the first drug to specifically treat delusions and hallucinations associated with PDP.


Psychosis in PD (PDP)

By Maria De León, MD.  By defeatparkinsons.com, February 7, 2017

Psychosis causes high levels of caregiver burden and stress.  It leads to significant disability and poor quality of life.  The risk of developing psychosis increases with disease duration.  Dr. De León lists many causes of underlying neuropsychiatric disturbances possible in PD, and causes of psychosis common to the elderly.


Podcasts & Webinars

Cognition and Psychosis

By PMD Alliance, June 17, 2020

In this 48-minute webinar, geriatric psychiatrist Daniel Weintraub, MD, provides an overview of the neuropsychiatric and cognitive symptoms that can occur in PD, as well as how those symptoms can be managed.  
Webinar notes on the Stanford PD Community Blog


Demystifying Hallucinations, Night Terrors and Dementia in Parkinson’s

By Benevilla and the Parkinson’s Disease Foundation, May 21, 2013

This two-hour webinar includes extensive discussion about hallucinations, delusions, illusions and other examples of Parkinson’s psychosis (as well as  discussions about PD Dementia and sleep disorders) in Parkinson's. Presenters: Rohit Dhall, MD, MSPH (he was at the Muhammed Ali Parkinson's Center in 2013, currently Director of Neurodegenerative Disorders, University of Arkansas for Medical Sciences) and Vergilio Gerald H. Evidente, Director, Movement Disorders Center of Arizona in Scottsdale. Pay particular attention to Dr. Rohit Dhall’s description of the causes of PD psychosis (and the difference with other psychoses) as well as treatment options and what to discuss with your movement disorder specialist. Dr. Evidente gives a clear description on differences in PD dementia, Alzheimer's and other dementias. [Requires registration, but is free.]


Hallucinations and Parkinson’s with Dr. Friedman

By the Parkinson’s Disease Foundation (Now the Parkinson’s Foundation), December 13, 2017

This 16-minute video is a series of interviews with Parkinson’s patients who experience hallucinations interspersed with comments by Dr. Friedman about the causes of hallucinations in Parkinson’s disease, communicating with your neurologist and medication adjustments to diminish hallucinations.


Parkinson’s Disease Psychosis: Hallucinations Delusions and Paranoia

By the Parkinson’s Foundation, February 27, 2018

As part of Parkinson’s Disease and its treatment, hallucinations, illusions, delusions, suspiciousness and paranoid behaviors occur in over 50% of patients.  In this 1-hour webinar Dr. Christopher Goetz suggests lifestyle changes, medication adjustments and a recently FDA approved drug to specifically treat psychosis in Parkinson’s Disease.


Treating Parkinson’s Hallucinations and Delusions

By the Michael J. Fox Foundation, May 19, 2016

This 1-hour webinar is a discussion of Parkinson’s psychosis; prevalence within the Parkinson’s community (more than half of those with PD may experience one of the major symptoms); how it develops; and how it can be treated without impacting motor symptoms. The focus is on a new treatment option and family dynamics while dealing with Parkinson’s psychosis.  [Registration is required, but is free.]


Expert-Level Resources

A Review of the Pathophysiology and Treatment of Psychosis in Parkinson’s Disease

By Laura B. Zahodne and Hubert H. Fernandez.  Drugs Aging, 2008, vol. 25, no. 8, pages 665-682

A thorough description of the underlying causes of psychosis in Parkinson’s with links to many other studies focusing on particular presentations of disorders or treatment options for these disorders.



Last updated August 2020 by Stanford Parkinson's Community Outreach.