More Than Motor: A Look at the Mental Side of Parkinson’s Disease
I always felt a strong connection to the patients with Parkinson’s in my care while a student nurse. I always felt as though, to a degree, I could commiserate with them better than my other patients. Although I do deal with a tremor and walking issues from my chronic illness it is the mental and cognitive issues that truly connect me to the individuals with Parkinson’s disease that were in my care.
Many individuals do not discuss the mental side of Parkinson’s. You may be aware of symptoms associated with Parkinson’s disease, like resting tremors and loss of balance. But more than half of people living with Parkinson’s over the course of their disease will experience a lesser-known aspect of the disease—hallucinations, and delusions.
This is something that I have dealt with as a result of my bipolar disorder. Much like individuals with Parkinson’s disease, it is something that is not often talked about. Many of the delusions and illusions of Bipolar Disorder and Parkinson’s disease are quite similar.
A few great examples of this are small animals in the peripheral vision or hearing music that is not there. I can’t tell you how many times I have been in tears after thinking a small cat or rabbit had run into my car from my peripheral vision while driving. Nor would I like to admit how many times I’ve told my children to turn down a song or tv show that wasn’t even on.
Related: Understanding Mental Illness: Living with Bipolar Disorder
Causes of Psychosis in Parkinson’s Disease
Psychosis – a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality. This can range from severe confusion (disordered thinking) to seeing things that aren’t there (hallucinations) or believing things that aren’t real (delusions).
There are three main causes of hallucinations and delusions in Parkinson’s disease. Each can occur separately or in combination with one another. The effects can occur over only a short period of time, or be long-lasting.
Many of the medications used in individuals with Parkinson’s Disorder can cause a rise in dopamine and decline in acetylcholine that lead to severe emotional and behavioral changes.
Dopamine (along with serotonin and norepinephrine) is one of the chemicals known as neurotransmitters that tell the neurons in our brain which emotion we should be feeling. Any rise or fall in these chemicals can lead to severe side effects such as anxiety, sadness, or even delirium.
Although dementia is more commonly thought to be a symptom for individuals with Alzheimer’s disease it can also be present in individuals with Parkinson’s disease.
In dementia, chemical changes in the brain lead to a change in the individual’s memory, thinking, motor skills, and mood.
In some individuals, a form of dementia known as dementia with Lewy bodies is present. In this form of dementia abnormal deposits (called Lewy bodies) of a protein known as an alpha-synuclein form on the brain.
Delirium is an often reversible form of psychosis that is brought on by changes in environment or certain medical conditions such as infections, electrolyte imbalances, or liver disease. Delirium can also be caused by medications such as SSRI’s, opioid pain medications, and others.
Although short-lived in many cases delirium presents as an altered level of consciousness, disorganized thinking, or hallucinations.
Types of Psychosis in Parkinson’s Disease
There are many different ways that mental and emotional changes can present in individuals with Parkinson’s Disorder. Some are more severe than others. However, each can drastically change the quality of life for an individual with Parkinson’s disorder.
There are many types of hallucinations that an individual can experience whether part of Parkinson’s disease or any other disorder. Each of these hallucinations comes with an alteration of one or many of the senses.
It is estimated that 20-30% of individuals with Parkinson’s disease suffer from at least one type of hallucination. The risk of experiencing hallucinations rises the longer an individual is living with a Parkinson’s disease diagnosis.
Visual Hallucinations: The belief that one is seeing something that is not actually present. These hallucinations can take many forms from the benign to downright frightening.
Auditory Hallucinations: The belief that one is hearing something that is not actually there. Often one believes that they hear music or someone calling their name.
Olfactory Hallucinations: The belief that one is smelling something that is not actually there. This could be the smell of a familiar perfume, cigar smoke, or other common smell from the individual’s past.
Tactile Hallucinations: The belief that one is feeling a sensation of something that is not real. This is often seen as a feeling that one has insects crawling on them.
Gustatory Hallucinations: The belief that there is a bitter or abnormal taste in the mouth that is not actually present.
In some instances, the individual is able to “retain insight” and are aware that they are experiencing a hallucination. In others, they are unaware that what they are experiencing is not reality.
An illusion is the misinterpretation of things in the individual’s environment. Illusions are similar to hallucinations because they present the individual with a reality that is not true. however, they are often based on an improper interpretation of things that the individual is seeing, hearing, or otherwise experiencing.
An example of this would be an individual interpreting a pile of clothing on a chair as another person. Another one that I witnessed commonly was sensing the nasal cannula (an oxygen delivery tube) as spiders or other insects on the face rather than mere plastic.
Delusions are less common than visual hallucinations or illusions. Rather than causing the individual to experience sensory experiences differently, delusions can cause illogical, irrational, or dysfunctional views.
These views are not based on any reality but are very real to the person experiencing them. They can cause the individual to feel unsafe in their environment and can lead to arguing and aggression.
Often, delusions can begin as merely generalized confusion but progress to beliefs that others are plotting against them or out to hurt them.
Common Delusions in Parkinson’s Disorder:
Percusatory: The belief by an individual that they are being attacked, harassed, or conspired against.
Jealousy: The belief by an individual that they are being cheated in life or in love.
Somatic: The belief by an individual that their body is not working as it should be.
Supporting Your Loved One with Parkinson’s Disease
Although there is currently no cure, there are many ways that you can help to support your loved one who is experiencing delusions and hallucinations as a part of their Parkinson’s disease diagnosis.
- Quality of Lighting: Many hallucinations occur in an environment in which an individual is placed in a low light or poor quality light setting. By improving the quality of light for an individual it can be easier to avoid or deal with hallucinations.
- Visibility: As with poor lighting, poor visibility can be a contributing factor to delusions and visual hallucinations.
- Support: Provide an ear, shoulder, and other support for an individual with Parkinson’s disease while they are having a hallucination or trying to process what they believe they have seen or experienced.
- Validation: Even though you are not able to see or hear what the individual with Parkinson’s disease may be experiencing it is important to validate their experience.
In my experiences in working with individuals with Parkinson’s disease, I spent many hours within the delusions of one individual or another. It could be exhausting to keep up with who they believed they were from one day to another, what time period they were in at any particular interaction, and even who they believed I was. However, I would not change the experiences I had with these individuals for anything.
I have held “babies” until they fell asleep for them, walked in circles looking for long lost loved ones, and even pet invisible dogs. I can honestly say that these interactions taught me so much about the importance of stepping outside of ourselves and realizing the importance of others, even if only for the moment. It is so important to be a part of their world because for many it is difficult if not impossible for them to return to ours.
People often don’t tell their Parkinson’s specialist about their symptoms, which can make them a challenge to diagnose. Possibly, people with Parkinson’s or their care partners are embarrassed by reporting hallucinations or delusions or do not realize they are part of the disease. It is important to understand and report even early signs of delusions or hallucinations as early as possible for the best outcomes.
If you or someone you care for is experiencing these symptoms, you are not alone, and you may be able to get help. Talk to a Parkinson’s specialist to learn more about available treatment options, such as an FDA-approved medication indicated for the treatment of hallucinations and delusions associated with Parkinson’s disease.
Learn more about hallucinations and delusions associated with Parkinson’s at MoretoParkinsons.com.