It is important that you talk to your doctor so that hallucinations and delusions can be treated appropriately. In mild cases no specific action may be required and simple reassurance that the images, sensations or sounds are harmless may be all that is needed.
Underlying illness
Any underlying illness, such as a chest or bladder infection, should be treated first as this may resolve hallucinations or delusions.
Medication
If hallucinations or delusions are not causing distress your doctor may decide just to monitor the situation rather than treat immediately as adjusting or introducing medications can interfere with other Parkinson’s symptoms.
If however they are distressing it is likely that your doctor will alter your Parkinson’s medications. Usually amantadine and anticholinergics are stopped first, followed by dopamine agonists as necessary. If the tendency to hallucinate is pronounced, it might be appropriate to treat with levodopa on its own. Your doctor will always try to balance the lowest possible dose with an acceptable affect on motor symptoms.
For some people such adjustments may not stop hallucinations or delusions, or may mean that other Parkinson’s symptoms are not adequately controlled and so quality of life is compromised. Finding the right balance between good symptom control and hallucinations can be tricky and if this balance is not found then special drugs, known as neuroleptic or antipsychotic drugs, may be prescribed to control the hallucinations. The older, conventional neuroleptics generally worsen Parkinson’s symptoms and are therefore not used to treat people with the disease.
Clozapine is an atypical neuroleptic drug which has proved to be useful in treating hallucinations or delusions in Parkinson’s without worsening other symptoms. It is normally given in doses of between six to 50 mg per day, and the dose must be slowly increased because of the tiredness that may appear as a side effect in some people. Clozapine has a certain risk for agranulocytosis, a side effect on white blood cells, and therefore blood tests must be performed regularly during treatment with this drug.
Quetiapine is another atypical neuroleptic that has been suggested for treating hallucinations or delusions in Parkinson’s but clinical studies on its effectiveness have been questionable and it remains unclear whether this drug is appropriate. Neuroleptics other than clozapine and quetiapine should not be used in Parkinson’s because of the risks of worsening other symptoms. In particular, antipsychotic medication can lead to bradykinesia.
As always, you must consult with your doctor regarding medications. Any potential risks should discussed and weighed up against the distress and adverse effects non-treatment may cause.
Memory problems
For those who show signs of memory problems certain drugs used to treat dementia may help with hallucinations or delusions as well as improving memory. Your doctor will be able to advise which medications may be suitable, again weighing up any potential worsening of other symptoms.
Sleep disturbance
If hallucinations or delusions occur as a result of sleep disturbance, such as sleeping a lot during the day, it is important to try to re-establish a more ‘normal’ sleep pattern. There are many reasons for sleep patterns being disturbed and once these are treated, hallucinations or delusions may well stop or subside considerably. For further information on this see sleep.
