Taylor Rush, PhD, is a clinical psychologist at the Cleveland Clinic’s Center for Neurological Restoration. She describes the various Parkinson’s psychosis symptoms that caregivers can watch out for in their loved ones.

It can be difficult at first sometimes for caregivers to recognize symptoms of psychosis in their loved ones because the person with Parkinson’s may not always realize that they’re experiencing psychosis. Some of the symptoms can be incredibly subtle at first.

And so there are different forms of psychosis, including hallucinations, which can be something that someone sees or something they hear. And delusions are more a change in how someone perceives reality in terms of their thoughts and what they think is going on around them.

So usually when I’m talking to caregivers, I may ask, “You know this person well, you’ve known them for years. And you know when you may start to see small shifts in their behavior. And you may see them be preoccupied, you may notice that they seem distracted, or they might be staring at nothing with some engagement.”

And they may ask some questions that seem a little odd, like, “Did you see that cat that just walked by?” Or, “Did you hear someone talking outside?” Or, “Weren’t you just in here?”

Or they may experience some odd thoughts that have some themes of confusion or suspicion. And it may be toward people that they have known and trusted for years. And that could look like, “I think my daughter is trying to steal my money.” “I think my family is plotting against me; they’re trying to get me into an assisted living facility” — even if there may have been no talk or concern about this leading up to this person’s comments.

And sometimes again, they can be more subtle, where someone may feel a sense of presence, like someone is there, but isn’t. Or they may think that they see something move out of the corner of their eye, but when they turn and actually look, there’s nothing there.

Sometimes you may notice that a loved one will wake up and they seem distressed because sometimes people can have more fleeting hallucinations upon waking. And so they may think that they saw someone in the bedroom or they heard a fire alarm go off. And so these can be things that can also indicate that perhaps some of how they’re perceiving things is changing a little bit.

Ultimately, I would say trust your gut. Remember that you know your loved one well, you know when something seems off, and it’s important to talk to them about it and also make sure that you then involve your neurologist.