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Parkinson’s Disease Seeing Things

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Parkinson√Ęs Disease Psychosis: A Caregiver√Ęs Story

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Whether you’re a caregiver or a person living with Parkinson’s, getting help starts with having a conversation about hallucinations and delusions related to Parkinson’s. Although it can be difficult, talking to a Parkinsons specialistand each otherabout what you’re experiencing is an important first step.

What Is The Prognosis And Life Expectancy For Parkinson’s Disease

    The severity of Parkinson’s disease symptoms and signs vary greatly from person to person, and it is not possible to predict how quickly the disease will progress.

    • Parkinson’s disease itself is not a fatal disease, and the average life expectancy is similar to that of people without the disease.
    • Secondary complications, such as pneumonia, falling-related injuries, and choking can lead to death.
    • Many treatment options can reduce some of the symptoms and prolong the quality of life.

    Knowing The Risk Factors

    Family members and caregivers should be aware of risk factors, and like with other PD changes, report them to the doctor. Reversible causes like urinary tract infections, sleep disturbances and medication changes can be addressed, and for most the symptoms will abate. Even over-the-counter drugs and supplements can pose risks for people with PD.

    Medication adjustments of antiparkinsonian drugs present a delicate balance to control both motor issues and manage psychological symptoms.1,4 The medical team may swap specific drugs or modify dosages to find the best fit for each person. Older people and those with vision problems are also more likely to develop these kinds of psychoses.

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    Comparison Of Hallucinators And Non

    The patients with isolated minor hallucinations were compared with the patients with no hallucinations . The only significant difference was a higher CES-D score in the group with minor hallucinations . When the presence of depression was determined using the cut-off values of the CES-D, depression was more frequent in the patients with minor hallucinations than in the patients without any hallucinations , but this difference did not reach significance.

    The patients with formed visual hallucinations are compared with the non-hallucinators in Table 5. Patients with visual hallucinations differed in a number of respects: they were older, had a longer duration of disease, had a more severe motor state, had more depressive symptoms, and were more likely to have cognitive impairment, day-time somnolence and a history of ocular pathology. They were less likely to receive anticholinergics or selegiline and received a higher daily dose of levodopa, but the levodopa-equivalent dose did not differ significantly between the two groups. Visual hallucinations were recorded in 70% of the patients with dementia versus 10% of non-demented patients , and in 55% of the patients with severe cognitive disorders versus 8% of the patients with absent or moderate cognitive impairment .

    The patients with hallucinations of any type were compared with the patients with no hallucinations. The results were identical to those of the preceding analysis, except for the degrees of significance .

    What Are The Later Secondary Signs And Symptoms Of Parkinson’s Disease

    9 Early Parkinsons Disease Symptoms Besides Tremors ...

    While the main symptoms of Parkinson’s disease are movement-related, progressive loss of muscle control and continued damage to the brain can lead to secondary symptoms. These secondary symptoms vary in severity, and not everyone with Parkinson’s will experience all of them, and may include:

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    Examples Of Delusions In Pd

    • Jealousy
    • Belief: Your partner is being unfaithful.
    • Behavior: Paranoia, agitation, suspiciousness, aggression.
  • Persecutory
  • Belief: You are being attacked, harassed, cheated or conspired against.
  • Behavior: Paranoia, suspiciousness, agitation, aggression, defiance, social withdrawal.
  • Somatic
  • Belief: Your body functions in an abnormal manner. You develop an unusual obsession with your body or health.
  • Behavior: Anxiety, agitation, reports of abnormal or unusual symptoms, extreme concern regarding symptoms, frequent visits with the clinician.
  • Neurological And Ophthalmological Assessments

    All participants were examined by a neurologist specialized in movement disorders to establish the clinical diagnosis of PD in PD patients and to exclude the presence of a neurodegenerative disorder in controls. To evaluate cognitive function, The Montreal Cognitive Assessment and CLOX1 were used. Furthermore, the neurologist interviewed each participant for the presence of VH using standardized questions on minor hallucinations and complex visual hallucinations, within the last six months. Questions on minor hallucinations included questions on visual illusions , presence hallucinations and passage hallucinations . In addition, questions on complex visual hallucinations included questions on hallucinations of objects, animals or persons and on the retainment or loss of insight. Furthermore, participants were asked to categorize the frequency in which they experienced VH into daily, weekly, monthly or never. While questioning the participants, the neurologist was also informed by the patients medical files. Presence of VH was defined as minor or complex visual hallucinations, occurring monthly or more frequently, in the last six months before inclusion.

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    Vision Problems Are Common In Parkinsons

    Research has shown that visual symptoms are extraordinarily common in people living with Parkinsons. Visual symptoms may occur due to changes in the front of the eye due to dry eye, changes in the retina , or changes in how our eyes move together. At the same time, many other things can affect vision, including diseases such as age-related macular degeneration, glaucoma, and cataracts, which increase with age. Distinguishing between visual symptoms caused directly by Parkinsons versus one of these other conditions can be difficult.

    Visual symptoms related to Parkinsons can be specific: eyes can feel dry, gritty/sandy, and may burn or have redness. You may experience crusting on the lashes, lids that stick together in the morning, sensitivity to light, or dry eye. On the other hand, symptoms can be non- specific: you may notice your vision just isnt what it used to be, and you have difficulty seeing on a rainy night, in dim lighting, or while reading, etc.

    There Are Many Types Of Professionals Who Can Help

    What is Parkinson’s Disease?

    While there are no proven ways to prevent most ocular conditions from developing, routine visits with an eye care professional can lead to early recognition and treatment of eye issues before they harm your quality of life. Between you, your neurologist, and an ophthalmologist, most visual complaints can be handled. However, when symptoms remain unchanged and unexplained, consultation with a neuro-ophthalmologist is probably warranted.

    A neuro-ophthalmologist is either a neurologist or an ophthalmologist with fellowship training in neuro-ophthalmology. Neuro-ophthalmologists have a unique appreciation for the intersection of the eyes and the brain and perform comprehensive testing in the office to determine where a visual or eye movement problem could originate. Once the location of the disturbance is identified, diagnostic testing , treatments, and therapies can be customized depending on the individual and their concerns.

    While your eye care professional may not be aware of common ocular symptoms that people living with Parkinsons experience, explaining the kinds of situations and triggers that bring on eye symptoms is usually enough for your physician to know where to look during the examination . Keeping a journal or diary of symptoms can also be helpful for both you and your physician.

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    What Is Parkinson’s Disease

    Parkinson’s disease is the second most common neurodegenerative disorder and the most common movement disorder. Characteristics of Parkinsons disease are progressive loss of muscle control, which leads to trembling of the limbs and head while at rest, stiffness, slowness, and impaired balance. As symptoms worsen, it may become difficult to walk, talk, and complete simple tasks.

    The progression of Parkinson’s disease and the degree of impairment varies from person to person. Many people with Parkinson’s disease live long productive lives, whereas others become disabled much more quickly. Complications of Parkinsons such as falling-related injuries or pneumonia. However, studies of patent populations with and without Parkinsons Disease suggest the life expectancy for people with the disease is about the same as the general population.

    Most people who develop Parkinson’s disease are 60 years of age or older. Since overall life expectancy is rising, the number of individuals with Parkinson’s disease will increase in the future. Adult-onset Parkinson’s disease is most common, but early-onset Parkinson’s disease , and juvenile-onset Parkinson’s disease can occur.

      Phenomenology Of The Hallucinations

      Minor hallucinations/illusions

      We grouped together in this category three types of phenomena. The most frequent type was presence hallucinations . The patient had the vivid sensation of the presence of somebody either somewhere in the room or, less often, behind him or her. In all cases, the presence was that of a person, and in one case it was also occasionally the presence of an animal . In seven cases, the presence was that of a relative . In all the other cases the presence was unidentified. The presence hallucinations were commonly as vivid as a hallucinated scene and were described as a `perception’. For instance, one patient said: `the image is behind me’, a second said: `I see someone arriving I turn back but nobody is there’, a third said: `I take a look I don’t see anything, but it is engraved in my mind’, and another said: `I have the impression that my mother is always there, that she is about to come into sight’. The passage hallucinations consisted of brief visions of a person or an animal passing sideways. If an animal was seen, the species was almost invariably specified , and in two instances it was a dog previously owned by the patient. Illusions occurred in nine patients . In five cases the illusion consisted of the transformation of an object into an animal .

      Case 1 .
      Case 2 .

      Formed visual hallucinations

      Case 3

      Auditory hallucinations

      Case 4

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      Medications To Help Treat Parkinsons Disease Psychosis

      Your doctor might consider prescribing an antipsychotic drug if reducing your PD medication doesnt help manage this side effect.

      Antipsychotic drugs should be used with extreme caution in people with PD. They may cause serious side effects and can even make hallucinations and delusions worse.

      Common antipsychotic drugs like olanzapine might improve hallucinations, but they often result in worsening PD motor symptoms.

      Clozapine and quetiapine are two other antipsychotic drugs that doctors often prescribe at low doses to treat PD psychosis. However, there are concerns about their safety and effectiveness.

      In 2016, the approved the first medication specifically for use in PD psychosis: pimavanserin .

      In clinical studies , pimavanserin was shown to decrease the frequency and severity of hallucinations and delusions without worsening the primary motor symptoms of PD.

      The medication shouldnt be used in people with dementia-related psychosis due to an increased risk of death.

      Psychosis symptoms caused by delirium may improve once the underlying condition is treated.

      There are several reasons someone with PD might experience delusions or hallucinations.

      What Is A Hallucination

      Understanding the Psychological Symptoms of Parkinson

      A hallucination is a perception of something that does not actually exist. This may be visualised, heard, felt, smelled or tasted. Hallucinations are sometimes confused with illusions, which are distortions of a reality rather than something that is purely imagined – as with hallucinations.

      Visual hallucinations: In Parkinson’s, hallucinations are most commonly visual and may be in black and white, in colour, still or moving. Often the images involve small animals and children. They may disappear quickly or may last for some time.

      Auditory hallucinations: auditory hallucinations are less common. These generally involve hearing voices or other familiar sounds. Auditory hallucinations can also be part of a depressive symptomatology.

      Tactile hallucinations: hallucinations may be tactile, that is, you may feel a sensation, like something touching you.

      Smell and taste hallucinations: less commonly you may feel that you can taste something you havent eaten, or you may smell something that is not present, such as food cooking or smoke.

      Usually hallucinations are not threatening or distressing. If you hallucinate you may be unaware that your perceptions are not real, and sometimes imagined images or sensations can be comforting. But hallucinations can also be distressing and you may feel threatened or frightened and may need reassurance and comfort from those around you.

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      Hallucinations And Delusions In Parkinsons Disease

      It might be surprising to learn that 20 to 30 percent of people with Parkinsons disease will experience visual hallucinations. While typically not a symptom of PD itself, they can develop as a result to a change in PD medication or as a symptom of an unrelated infection or illness. It is important to know the signs of hallucinations and how to manage them.

      Hallucinations and other more severe perceptual changes can be distressing to family often more so than to the person experiencing them. For the well-being of people with PD and caregivers, it is important to identify hallucinations as early as possible and take steps to reduce them.

      The following article is based on the latest research and a Parkinsons Foundation Expert Briefings about hallucinations and delusions in Parkinsons hosted by Christopher G. Goetz, MD, Professor of Neurological Sciences, Professor of Pharmacology at Rush University Medical Center, a Parkinsons Foundation Center of Excellence.

      Predictive Factors And Pathophysiology

      Minor hallucinations/illusions

      Patients with isolated minor hallucinations/illusions differed from patients without hallucinations only by the presence of more depressive symptoms on the CES-D rating scale, suggesting that depressive symptoms are a facilitating factor. Indeed, depression may sometimes trigger or aggravate hallucinations associated with deafness or ocular pathology . However, when we analysed depression according to CES-D cut-off scores, the difference between the Parkinson’s disease patients with minor hallucinations/illusions and those with no hallucinations was not significant. Interestingly, hallucinations involving the deceased spouse have been reported in up to half of widowed persons, with a higher frequency in the elderly . In the present study, the `presence’ was that of a deceased relative in only three cases bereavement cannot therefore explain the bulk of the cases.

      Dopaminergic agents and other treatments

      In the present study, non-hallucinators were more likely to be on anticholinergics or selegiline than patients with hallucinations. A similar paradoxical, negative association between anticholinergics and hallucinations was found by Sanchez-Ramos and colleagues . This reflects the recommendation whereby the use of these drugs in patients with cognitive impairment is avoided because of the well-known risk of cognitive worsening and/or hallucinations in this population.

      Cognitive impairment

      Sleepwake disturbances

      Motor status

      Depression

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      What Are The Causes

      Parkinsons, a neurodegenerative disorder of the brain, affects the cells that produce chemicals in the brain that control movement and balance. PD medications boost dopamine levels to ease motor symptoms.3

      However, too much dopamine can cause hallucinations and delusions. Other characteristics of disease progression such as cognition and visual-perceptual changes can also bring on these psychological changes.3

      Hallucinations According To The Duration Of The Disease

      Managing hidden Parkinson’s symptoms

      We found that the prevalence of hallucinations of all types and of visual hallucinations in the 3 months preceding inclusion in the study increased with the duration of the disease. Moreover, the duration of Parkinson’s disease was an independent predictor of visual hallucinations in the multivariate analysis. Other studies gave conflicting results on the relationship between hallucinations and disease duration. In a retrospective study of 100 patients, logistic regression analysis also showed an association between `psychosis’ and an increased duration of the disease . An association between the duration of the disease and the occurrence of hallucinations was also found by some investigators but not by others .

      Table 1

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      Hallucinations And Rem Sleep Disorders In Parkinson’s Disease

      At timestamp 1:58 in this recording of Thrive: HAPS 2020 Caregiver Conference, you will find a one hour talk by neurologist Joohi Jimenez-Shahed, MD. In it she delves into what REM sleep behavior disorder is and is not, and the distinctions between hallucinations, delusions, and delirium. Managment options for RBD and hallucinations are included.

      How Is Psychosis Managed

      The urgency of treatment will depend on the type and characteristics of psychosis. Sometimes, when the hallucinations are mild and benign, and insight is retained, it is best that the Parkinson regimen be kept as is. However, when a patient is experiencing more threatening paranoid delusions, then more aggressive treatment is warranted .

      The management of psychosis includes:

    • Ruling out the possible reversible causes
    • Simplifying the Parkinsons disease medication regimen
    • Adding a new or second generation antipsychotic
    • If psychosis occurs in a Parkinsons disease patient with cognitive impairment or dementia, a cholinesterase inhibitor may be considered
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      Who Is At Risk For Psychosis

      Theres no predicting with certainty which patients with Parkinsons disease will go on to develop symptoms like hallucinations or delusions. A number of risk factors both internal and external- are associated with the condition.Some of these risk factors include: age, duration and severity of Parkinsons disease and the taking of dopamine therapy.3-6

      I Had A Hallucination: What Next

      Hallucinations/Delusions

      Research has shown that for many people with PD who have them, hallucinations begin after a change in medication, more specifically, an increase in levodopa . Additional factors make a person more likely to experience hallucinations when medications are changed, such as other cognitive problems or memory issues, depression and sleep problems. Dementia|A term used to describe a group of brain disorders that cause a broad complex of symptoms such as disorientation, confusion, memory loss, impaired judgment and alterations in mood and personality.] also increases the risk of hallucinations and delusions when PD medications are changed. Dementia means cognitive changes whether in memory, judgment or attention that interfere with daily life.

      One thing that does not affect the risk of hallucinations is your regular dose of levodopa. Rather, studies show that it is a change in dose an increase in a dose that has been stable that sets off hallucinations.

      Tip: Experiencing a hallucination does not mean you are going crazy. Many people recognize that their hallucinations are not real. Do not react to these visions or sounds or engage them dismiss them. Bring up the topic with your doctor immediately.

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