Sees things that aren't there or experiences paranoia
Hallucinations and paranoia
Hallucinations are a side effect in about 30 percent of people taking Parkinson's drugs -- particularly dopamine agonists -- and they usually occur only after many years. The problem is more likely to arise in patients with dementia. A symptom of psychosis, the hallucinations are often benign at first, involving visions of children, strangers, or animals around the home. Usually, a Parkinson's patient realizes the episodes aren't real but may not tell anybody about them for fear that he's losing his mind.
Parkinson's drugs may also trigger serious psychosis, in which people can't tell what's real and what's not. About 5 to 10 percent of people with Parkinson's disease get caught up in delusions (false or illogical beliefs) and paranoia -- such as becoming convinced that others are spying on them. The most common delusion, says Friedman, is that the patient's spouse is having an extramarital affair. Such distressing psychotic symptoms can make the patient extremely difficult to care for, and they're a major factor leading to placements in nursing homes.
To treat hallucinations and delusions, doctors switch or try to reduce the Parkinson's medicine -- but the catch-22 is that the pills are crucial for controlling the patient's motor problems. Physicians may prescribe atypical antipsychotic drugs such as Seroquel (quetiapine) or Clozaril (clozapine).
It's common for people with Parkinson's disease to complain of excessive drowsiness during the day. Several factors are to blame. One is that, for various reasons, most Parkinson's patients don't get enough sleep at night. When levodopa or dopamine agonists wear off in the nighttime, symptoms of stiffness, tremor, and slowness of movement resurface, says Kelly Lyons, a research associate professor of neurology at the University of Kansas Medical Center in Kansas City. A severe tremor might wake the person, as might stiffness as he tries turning over in bed. Or discomfort may keep him from falling asleep to begin with.
Another complication is that Parkinson's patients tend to suffer from sleep disorders, including:
* Sleep apnea -- interrupted breathing episodes during slumber
* Periodic limb movements -- repeated jerking motions of the legs while asleep
* Restless leg syndrome -- uncomfortable tingling or crawling sensations in the legs, causing an irresistible urge to move them during sleep
* REM sleep behavior disorder -- "acting out" of vivid dreams, sometimes leading to punching or kicking of bed partners
What's more, studies show that Parkinson's drugs have sedative effects, says Lyons. The challenge is to try adjusting the medication dose or scheduling, or switching to another drug, while still keeping motor symptoms well controlled. Other medicines prescribed for anxiety, depression, and psychosis can also cause daytime sleepiness. Altogether, Lyons says, "the whole sleep cycle is just really messed up" for the Parkinson's patient.