Will stopping the meds stop his delusions?

A fellow caregiver asked...

Will reducing or discontinuing Sinemet reduce my father's paranoia and delusions? My 86-year-old father suffers from Parkinson's, Lewy Body dementia, congestive heart failure and kidney problems. He is now living with us and on Hospice, primarily for the CHF. He has exhibited hallucinations, extreme paranoia and aggressive behavior at times. He imagines that he has been tied up and beaten, that we are trying to kill him when we place the oxygen canula on him, etc. He thinks the food we serve him is poisoned and insists that I taste it first in front of him. I have heard this sort of thing can be caused by the years of use of Parkinson's meds. At this point, would it be worth risking an increase in motor problems (as he is not very ambulatory anymore)to try to reduce the paranois and behavior issues?

Expert Answer

Graham A. Glass, MD, is the co-founder of PEAK Neurology and Sleep Medicine, LLC with multiple locations across Alaska. Previously, he was deputy director of the San Francisco Parkinson's Disease Research, Education, and Clinical Care Center PADRECC and assistant clinical professor of neurology at the University of California, San Francisco (UCSF). Glass received his medical degree from the University of Texas Health Sciences Center at the San Antonio School of Medicine and completed his neurology residency at Tufts-New England Medical Center. He subsequently completed a fellowship in movement disorders at the Mayo Clinic.

Patients with Lewy Body dementia or Parkinson's disease with dementia can have hallucinations regardless of the medications that they take, but sinemet can make the hallucinations more common and worse. That being said, the other Parkinson's medications are often more likely to cause hallucinations than sinemet. Typically, we try to use the "lowest, most effective dose" of sinemet to keep patients comfortable in terms of rididity, stiffness and other motor symptoms with the sinemet but know that sometimes this can result in hallucinations and confusion and we have to choose what to do. Sometimes, medications such as donepazil, galantamine, or rivastigmine can help with these hallucinations and sometimes other medications such as quetiapine may be used by some doctors. Typically, we try very hard to look over all of the patients' medications and make sure to remove ones (even if not for Parkinson's) that may worsen hallucinations and confusion, as this is often overlooked.