A Fresh Look at Hallucinations and Parkinson’s

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by Dr. C |

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A loud crack. I turned and yelled at my grandson, “Keep the billiard balls on the table!” The noise was so loud that I was sure the ball had smashed into the Sheetrock wall. I’ve been known to bounce a ball off the table practicing a special billiard shot. But, the ball was still on the table. The noise was from a normal shot, with a touch of enthusiastic child’s play. Was this an auditory hallucination associated with Parkinson’s?

I have a tingling feeling on my feet that causes me to think an insect is there. I swat my foot and check. Nothing there. I double-check because I don’t like spiders. Is that a tactile hallucination due to Parkinson’s?

Shadows out of the corner of my eye appear as a moving object, but on closer exam, I discover nothing. Everyone does that. I’m not hallucinating, right?

Sensory hallucinations are known to be associated with Parkinson’s and can be early signs of psychosis. Investigations into prelevodopa administration suggest the link between Parkinson’s and hallucinations existed before levodopa side effects. Maybe this non-motor Parkinson’s symptom doesn’t develop instantly as psychosis, but gradually worsens in that direction. In the early stages of Parkinson’s, perhaps the hallucinations are very mild.

There is a difference between hallucinations, minor hallucinations, and pseudohallucinations. A hallucination involves perceiving a sensation that does not correlate with reality, yet believing that it does – such as the billiard ball incident. I believed the ball came off the table and hit the wall. I saw it in my mind. If I swat at a bug that isn’t there, that seems to fit the definition. The shadow experience (a common phenomenon) is more of a pseudohallucination because I really don’t think there is something in the shadows, but I am going to check just to be sure.

I get feelings of depression which have no contextual foundation. The feeling can appear quite real, and if not managed, can become real. If there is no context (nothing in my life to cause me to feel depressed), then the internal stimulus creating a feeling of depression is a hallucination of sorts. If I believe in the depressed feeling, then it’s a hallucination. If not, then it’s a pseudohallucination.

Integrating a hallucination into my worldview can happen if I don’t use the conductor. The conductor is a mental construct I use to observe cognitive processes and direct change. By using a strong conductor, I can strip away the illusion and see the depression input for what it truly is: faulty input. There are days when my conductor malfunctions. For a short period of time, I will do the “dance of darkness,” oblivious to the dangers that come with believing in hallucinations.

I had a “first meet” exam with a new neurologist since moving to a new area. I always dread the first meeting because of the atypical, mostly hidden, nature of my Parkinson’s disease. When asked if I hallucinate, I paused before answering. Exaggerated sensory input happens to me all the time. Now, I am training my conductor to evaluate before seeking context and reacting.

Because of the conductor, most of the exaggerated stimuli stay just that. Occasionally, some stimuli sneak through and get incorporated into the search for finding context to make sense of it all. I know about the signal distortion and its effect on how I direct my attention. It becomes a pseudohallucination, not a hallucination. It’s hard work to keep the conductor in place all the time, but it’s a great benefit when I can use it.

I told the doctor I don’t hallucinate, even though I experience exaggerated signal input several times a day. I probably should have said, “I have pseudohallucinations.” But that’s a longer discussion about how Parkinson’s and I live together.

It’s a discussion about how a well-trained conductor can change how we process adherent brain input. It’s about pausing for the conductor immediately following exaggerated signal input. I didn’t know that when I reacted automatically to my grandson’s enthusiastic billiard playing a few years earlier. I didn’t know my brain was lying to me. Most importantly, I didn’t know something could be done to strengthen the lie detector — the conductor.


Note: 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 another 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. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews, and are intended to spark discussion about issues pertaining to Parkinson’s disease.


Derek C. Marshall avatar

Derek C. Marshall

Hallucination...where does it begin and/or end? Train the conductor...but the existential question exists: How do we know that our perception of hallucination is not itself an hallucination? There are profound questions that have no answers in the common sense. From here we are dropped off into the realm of the mystics...another hallucination?

Dr. C avatar

Dr. C

Hi Derek ~ Answering this is like discovering one hand clapping.
Dr. C.

Judith G. avatar

Judith G.

I enjoy your pieces in this format. Dr. C. Thank you. A question - you state that hallucinations exist in Parkinsons Disease that is not treated with Levodopa or similar acting on the motor symptoms drugs.. Are you speaking about the pseudohallucinations you write about or the full blown frightening hallucinations that send one flying to the Emergency Room? If the mild sensory distortions are present before the motor drugs are introduced, will the drug amplify the existing problem? Has this been documented anywhere?. Over the past 2 years I have met 2 Parkinsons patients suffering from sporadic hallucinations who never had hallucinations before the drugs were introduced. Of course I know this is anecdotal so I would love to be put on to some good documentation on the sequential order of hallucinations and Parkinson's disease. Again thank you for an interesting column Dr. C.

Dr. C avatar

Dr. C

Hi Judith ~ You make a very good point in your comment. I don't think it's something that is highly reported in the research literature. I think it would rely upon detailed clinical observations. It's something that I hope will be done in the future. I will, however, keep an eye out for more information on this topic. It is worth exploring further.
Thanks for reading my column and checking in with BioNews. I appreciate your thoughtful comments and feedback. I include links to references in the columns -- so perhaps exploring the links will lead you to find some answers to your thoughtful questions.
Dr. C.


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