HALLUCINATIONS IN
PARKINSON’S DISEASE
Main
symptoms of Parkinson’s disease
Parkinson’s disease (PD) is a slowly
progressive degenerative disease of brain. The major symptoms are tremors
(shivering), slowness of movements, stiffness and postural imbalance. These symptoms lead to motor disability and
interfere with walking, as well as with other activities of daily living.
Memory
impairment in Parkinson’s disease
The mental functions are usually normal in
patients with PD, however, 10% of patients can develop dementia (memory
impairment along with other cognitive dysfunction), especially in later stages
of illness.
What
are hallucinations?
Other significant problem in people with PD
in later stages is hallucination. Hallucination is often visual. In this
condition, patient sees something, which is not there. For example, they may
see snakes or lizards in their room (which are not there), and get disturbed
with them. They may also see strangers in their house, which are supposedly
there to spy on them or harm them. These hallucinations are very upsetting for
the patient, making them anxious and depressed. Some patients also have sleep
disturbance due to hallucinations.
What
are the causes of hallucinations in patients with PD?
1.
Adverse effects of anti-parkinsonian
medicines.
2.
Infections such as urinary
tract infection or pneumonia,
3.
Side effects of other
medications such as pain killers and sleeping pills,
4.
Parkinson’s disease mimic such
as Diffuse Lewy body disease (DLBD). In DLBD, patients may have slowness and
rigidity (just like PD). However, they have prominent hallucinations and
dementia (unlike PD). Moreover, DLBD patients do not respond to levodopa
treatment.
Other
symptoms of psychosis in patients with PD
1.
Illusions,
2.
Delusions especially paranoid
3.
Confusion,
4.
Sleep disturbance
Delusion refers to a condition where a
patient believes in something, even when there is an evidence of the contrary.
How
common is psychosis in PD?
About one third of patients with PD suffer
from psychosis. So, it is quite common.
How
do we manage psychosis in patients with PD?
Management of psychosis can be done in a
stepwise fashion as outlined below:
1.
Underlying alternate causes
should be looked for and managed. This would include looking for infection and
offending drugs.
2.
Comorbid psychiatric
conditions, such as anxiety and depression, if present, should be treated.
3.
Minor symptoms such as vivid
dreams or minor hallucinations (which are non-disturbing in nature) do not
require any treatment.
4.
Anti-parkinsonian drugs should
be reduced or stopped. First to eliminate are trihexiphenydyl, amantadine and
selegeline/rasagiline. If psychotic symptoms persist, then, the next drugs to
be reduced are dopamine agonists (ropinirole and pramipexole), entacapone and
levodopa.
5.
In people with cognitive
impairment, cholinesterase inhibitors such as rivastigmine or donepezil can be
used.
6.
Anti-psychotic medication-
quetiapine is the most commonly used.
7.
The first and only FDA approved
drug for treating PD psychosis (hallucinations and delusions) is PIMAVANSERIN
(Nuplazid). The dose is 34 mg capsules once daily.
DR SUDHIR KUMAR MD DM
Consultant Neurologist
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
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