Understanding hallucinations, delusions, and illusions

Last updated Feb. 24, 2025, by Agata Boxe
Fact-checked by Patrícia Silva, PhD

At some point, your loved one with Parkinson’s disease may experience hallucinations, delusions, or illusions. It can be challenging for your loved one and you, as a spouse and caregiver.

While Parkinson’s is generally known for causing symptoms such as tremors and rigidity, it can also trigger psychosis, which is a loss of contact with reality.

Parkinson’s psychosis may involve hallucinations, delusions, and illusions, and often arises as a side effect of Parkinson’s medication. Other potential causes include certain mental states of confusion, such as Parkinson’s dementia or delirium.

Having a deeper understanding of what it is like to experience false perceptions, beliefs, and distortions may help you feel better equipped to handle them as a caregiver for a spouse. It could also possibly soften their impact on your relationship and family life.

Parkinson’s hallucinations

Your spouse may, at some point, see a person or object that you don’t, because that individual or thing is not actually there.

Hallucinations are false perceptions of objects, people, sounds, and other phenomena that affect your senses, from vision to smell.

Some people with Parkinson’s and hallucinations may recognize that what they are perceiving is not real, while others do not. They may at first know they are hallucinating but, as the disease progresses, no longer recognize that their hallucinations are not real.

If your spouse has started experiencing hallucinations or having them more often, you should tell the doctor or share an update with the healthcare team.

Visual hallucinations

The most common type of hallucination that people with Parkinson’s experience is visual.

Your spouse may imagine seeing people, pets, objects, or other visual phenomena. It could be a deceased relative sitting on the sofa, a fluffy cat staring your loved one in the eye, or a flash of light flickering in the corner.

Visual hallucinations are more likely to appear when in low light or surroundings with poor visibility.

People with Parkinson’s who take certain Parkinson’s medications may become more susceptible to visual hallucinations the longer they are on the treatment, and the higher the dose they’re taking.

Auditory and other sensory hallucinations

People with Parkinson’s disease may also experience hallucinations that affect other senses — such as hearing, smell, and touch — although these are less common than visual ones.

Auditory hallucinations include hearing voices or sounds that are not real. In Parkinson’s, they are usually muffled and hard to understand as opposed to being actual words. 

Other types can affect the sense of smell, touch, and taste:

• Olfactory hallucination involves smelling a nonexistent odor.
• Tactile hallucination causes a sensation on the skin, like crawling bugs.
• Gustatory hallucination is when there is an unusual or bitter taste in the mouth, even when not eating anything.

Presence and passage hallucinations

Parkinson’s can also cause what’s known as presence hallucinations, which is when an individual senses that someone is in the room, or standing nearby, even though no one is there.

Or people may see a person, a pet, or a shadow briefly pass by in the periphery of their vision, which is called a passage hallucination.

Parkinson’s illusions

Illusions involve sensory misperceptions of reality, and are a bit different than hallucinations. Rather than seeing a person or object that is not there, your spouse may perceive something that exists as something or someone that it is not.

While illusions can affect different senses, people with Parkinson’s most commonly experience visual illusions, sometimes called minor hallucinations. An example would be your spouse thinking that a coat hanging in the closet is actually you.

Visual illusions typically last for just seconds and tend not to be upsetting.

Other types of visual illusions in Parkinson’s disease include:

• perceiving faces and the shapes of objects as distorted
• misidentifying the color of an object as different than it really is
• seeing one object as two or more
• perceiving something as bigger or smaller than it is
• seeing stationary objects in motion.

Parkinson’s delusions

Delusions are false, irrational, and illogical beliefs that are not based on reality. Unlike hallucinations and illusions, which are rooted in sensory perceptions or misperceptions, delusions are related to thought processes.

Persecutory delusions can cause your spouse to believe that someone — such as a friend, family member, or even you — is causing harm in some way or is planning to do so. For example, individuals with persecutory delusions may think that other people are conspiring against them or stealing from them. They may become suspicious and agitated around other people, including their own spouse, or withdraw from social interaction.

If your spouse accuses you of cheating, then it may be that your loved one is experiencing jealousy delusions. Your spouse may also become upset, paranoid, and aggressive. The most severe cases associated with Parkinson’s have been referred to by researchers as the Othello syndrome because of how greatly they can affect a relationship. Othello syndrome is named after the Shakespeare character Othello, whose unfounded jealousy of his wife led to tragic consequences.

Somatic delusions are when your spouse thinks that something is wrong physically — possibly with the body, or with health overall. In some cases, loved ones have complained that certain parts of their body are not functioning correctly or that they have parasites. They may become so anxious and concerned that they constantly want to go to the doctor.

Advice for caregiver spouse

Taking care of a spouse who is experiencing Parkinson’s psychosis symptoms can be extremely difficult. You may feel anxious, angry, or hurt, especially if your loved one is accusing you of harmful behavior or being dishonest.

If you can, try to create a safe, supportive environment for you and your partner by finding ways to deal with these challenges.

First, keep in mind that your loved one’s psychosis is not about you — even when it feels that way— and that you didn’t do anything to cause it. Knowing that it is likely being triggered by your spouse’s medication, the disease itself, or some other factor may help you maintain an emotional or mental boundary between yourself and the situation.

Other strategies may also help in managing your spouse’s Parkinson’s psychosis:

• Report psychosis symptoms to your spouse’s neurologist, who may, for instance, adjust your partner’s Parkinson’s medication.
• Write down your spouse’s psychotic symptoms and when they occur — such as the date, time of day, and how often — so you can share the information with your loved one’s doctor.
• Request a referral to a mental health specialist for Parkinson’s psychosis treatment if symptoms are ongoing.

You should also make sure all rooms are well lit to help prevent visual hallucinations.

Sleep problems are often linked to Parkinson’s hallucinations. If your spouse has sleep issues, you or your spouse should let the doctor know.

Good sleep hygiene can also be helpful in managing Parkinson’s psychosis. This may entail heading to bed and waking up at the same time every day, and avoiding screens before going to sleep.

When your spouse is having illusions or hallucinations, don’t try to explain why they are not real. Instead acknowledge what your loved one is saying while gently redirecting focus, perhaps by playing a favorite song or taking a walk together.

Always prioritize the safety of you and your spouse. If you are worried that your loved one’s behavior could become dangerous, call 911.

Parkinson’s caregivers of loved ones with psychosis are vulnerable to burnout. Nurture your resilience with self-care. Your well-being matters as much as your spouse’s.

If possible, take scheduled breaks from your caregiving responsibilities by asking friends or family to help. You might also consider professional respite care services.

Do carve out some regular time for soothing hobbies, such as reading, painting, or gardening. You can also try the Dutch art of niksen, or doing nothing, to let your mind wander and relax.

Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.