Editor’s Note: The following column was originally published on Feb. 25, 2022.

Thanks to breakthroughs in medicine and nutrition in recent years, we are living longer than ever before. But this increase in life expectancy also brings an increase in the number of diseases, injuries and impairments that affect older adults. With this in mind, we at the local Visiting Angels office in Salem have created this series of articles to keep our older population and their families informed and to offer some practical advice for meeting the challenges faced by seniors and those who care for them.

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While Parkinson’s disease is most commonly known for the stiffness, shaking and difficulty with balance and walking that it causes, 40 percent of those with the disease are also affected by hallucinations and delusions. These symptoms are known as Parkinson’s disease-associated psychosis, and although they can be the result of the changes to the brain caused by the disease, other factors can contribute to their onset.

Hallucinations occur when the person is awake, and they can affect any of the five senses. The person may see or hear things that aren’t there, or they could experience phantom smells, unusual tastes or feel things touching their skin. However, hallucinations involving smell, taste and feel are less common than visual or auditory experiences.

Delusions occur less frequently, affecting only about 8 percent of people with Parkinson’s disease, but they are found more often in people with advanced stages of the disease. Delusions include thoughts, feelings or fears which have no physical basis and that are not a normal part of that individual’s personality. 

The most common delusions for people with Parkinson’s are unfounded jealousy, feelings of persecution, health concerns and paranoia. These delusions can lead to agitation and aggression in Parkinson’s patients and may lead them to act out physically or refuse needed medication that they erroneously believe to be poisoned.

Medication is one of the three main factors that can lead to the onset of psychosis in people with Parkinson’s disease. Many of the medications prescribed to treat motor function impairment can also lead to temporary changes in mood and behavior, because of their effect on the balance of dopamine in the brain.

Parkinson’s dementia is another factor that can contribute to psychosis in people with the disease. Dementia can be diagnosed in people who have lived with Parkinson’s for a year and whose reasoning skills have declined. As Parkinson’s disease progresses, the changes in the brain that first affect muscle control and coordination later extend to the parts if the brain that control cognitive functions, which can lead to hallucinations.

The third major contributor to hallucinations and delusions in Parkinson’s patients is delirium, which may lead to sudden-but-passing behavioral changes. It may not take long for delirium to set in, but it can typically be corrected by treating the causes that led to the condition in the first place. These can include fevers, infections, trauma, strokes, heart or liver disease, and medications, to name a few. Delirium in people with Parkinson’s disease can also be induced by changes in environment, such as a hospital stay.

Other contributors to Parkinson’s disease-associated psychosis include problems with sleep, vision impairment, age, and alcohol use. It is estimated that half the people living with Parkinson’s disease experience depression, which can also increase the risk for psychosis.

It is important that Parkinson’s psychosis be reported immediately to the persons’ doctor or medical provider to keep the situation from getting worse. Medication changes can be made to lessen those symptoms of psychosis brought on by medicines used to treat Parkinson’s disease, and in other cases, antipsychotics can be prescribed to adjust the brain chemistry leading to hallucinations. However, in some cases antipsychotics may cause an increase in hallucinations, so they must be used with care.

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Information provided by Visiting Angels, America’s choice in homecare. Visiting Angels’ non-medical homecare services allow people to continue enjoying the independence of their daily routines and familiar surroundings. To set up an appointment for a no-obligation in-home consultation, call 330-332-1203.