Parkinson’s Hallucinations & Delusions: What Caregivers Should Do

Parkinson’s Hallucinations & Delusions: What Caregivers Should Do
Watching someone you love experience hallucinations or delusions can be frightening and confusing. But these symptoms can occur in Parkinson’s disease and do not mean your loved one is “going crazy.” Hallucinations, delusions, and other changes in perception can have several causes, including Parkinson’s itself, medications, infections, or other medical problems. 

The most important thing you can do is not argue with what your loved one is experiencing—and not ignore it, either. Knowing how to respond can reduce fear, prevent conflict, and help the medical team find the right treatment.

What Should I Do If My Loved One With Parkinson’s Has Hallucinations or Delusions?
If someone with Parkinson’s experiences hallucinations or delusions, stay calm, provide reassurance, avoid arguing about what they see or believe, and report the symptoms to their healthcare provider. The doctor may review medications, look for infections or other medical problems, assess cognition, and determine whether treatment is needed. Sudden hallucinations or delusions developing over hours or days require prompt medical evaluation because they can be caused by delirium, infection, medication changes, or another acute medical problem. 

What Are Hallucinations and Delusions in Parkinson’s?
A hallucination occurs when someone sees, hears, feels, smells, or otherwise senses something that isn't actually present. Visual hallucinations are particularly common in Parkinson’s and may involve seeing people, animals, shadows, or objects.

A delusion is a persistent false belief that feels completely real to the person experiencing it. Someone may believe a spouse is being unfaithful, that someone is stealing from them, or that another person is trying to harm or poison them.

Together, these symptoms may be described by doctors as Parkinson’s disease psychosis. Parkinson’s Foundation estimates that hallucinations or delusions affect roughly 20–40% of people with Parkinson’s, although prevalence varies depending on how symptoms are defined and the stage of disease. 

Why Does Parkinson’s Cause Hallucinations or Delusions?
There isn't always one simple explanation.
Possible contributors include:

• Parkinson’s-related changes in the brain
• Parkinson’s medications
• Dementia or cognitive changes
• Sleep disorders
• Vision problems
• Infections or other illnesses
• Delirium
• Medication changes or interactions

Some medications used for Parkinson’s can contribute to hallucinations or psychosis. Other medications, including certain anticholinergic drugs and some over-the-counter medications, may also play a role. Never stop or reduce Parkinson’s medication without medical guidance. 

What Should I Say During a Hallucination?
One of the most important things for caregivers to remember is: don't argue.
If your loved one sees a person or animal that isn't there, telling them repeatedly, “There's nobody there!” may increase their fear or frustration.
Instead:

• Remain calm.
• Speak slowly and reassuringly.
• Acknowledge that the experience is real to them.
• Help them feel safe.
• Redirect their attention when appropriate.
• Turn on additional lights if the environment is dark.
• Reduce clutter and confusing shadows.

For example, rather than insisting that there is no animal in the room, you might say, “I understand that you see a cat. You're safe, and I'm right here with you.”
The goal isn't necessarily to convince them that the hallucination isn't real. The goal is to reduce fear and maintain safety. 

What If My Loved One Is Having a Delusion?
Delusions can be particularly difficult for families because the person may strongly believe something that isn't true.
For example, someone might believe that their spouse is having an affair or that a caregiver is stealing from them.
Trying to prove the belief is wrong can sometimes escalate the situation.
Instead, focus on the emotion behind the belief.
If your loved one is frightened, reassure them. If they're angry, give them space. If they're becoming increasingly agitated, prioritize safety rather than winning an argument.
Caregivers should also tell the healthcare team what is happening—even if their loved one doesn't recognize or acknowledge the symptoms. Caregivers may notice changes that the person with Parkinson’s does not.

When Should You Call the Doctor?
Any new hallucination or delusion should be discussed with the medical team, even if it seems minor.
Call promptly if symptoms are becoming more frequent, frightening, disruptive, or difficult to manage.
Sudden changes are especially important. Hallucinations or delusions that appear rapidly over hours or days can signal delirium, an infection such as a urinary tract infection or pneumonia, dehydration, a medication problem, or another medical condition. 
Seek urgent medical help if your loved one becomes a danger to themselves or someone else, becomes severely confused, extremely agitated, or cannot be safely cared for at home.

How Are Parkinson’s Hallucinations and Delusions Treated?
Treatment depends on the underlying cause.
A healthcare provider may:

1. Look for an infection or other medical problem.
2. Review all medications.
3. Adjust Parkinson’s medications when appropriate.
4. Evaluate cognition and other symptoms.
5. Recommend behavioral and environmental strategies.
6. Consider medication specifically for Parkinson’s disease psychosis when necessary.

Certain antipsychotic medications can worsen Parkinson’s motor symptoms, so medication choices should be made by a healthcare professional familiar with Parkinson’s. Pimavanserin is FDA-approved specifically for Parkinson’s disease psychosis; other medications may also be considered depending on the individual.

How Can Caregivers Make the Home Safer?
Simple environmental changes may help.
Keep rooms well lit, particularly hallways and bedrooms. Reduce shadows and clutter. Maintain a predictable routine and encourage good sleep habits.
If hallucinations are worse in the evening, additional lighting and stimulating, meaningful activities may help. Familiar environments may also be easier to manage than unfamiliar surroundings. 
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And remember: caregiver support matters, too. Hallucinations and delusions can be exhausting for families. Asking for help, taking breaks, and using support groups can make caregiving more sustainable.

Questions People Ask About Parkinson’s Hallucinations and Delusions
1. Are hallucinations a normal part of Parkinson’s?
They can occur in Parkinson’s, particularly as the disease progresses, but they should always be reported to the healthcare team.
2. Does having hallucinations mean my loved one has dementia?
No. Hallucinations can have multiple causes, including medication effects, vision problems, infections, delirium, and Parkinson’s-related changes. Hallucinations alone do not automatically mean dementia. 
3. Should I tell my loved one that the hallucination isn't real?
You don't necessarily need to argue or repeatedly correct them. Staying calm, acknowledging their experience, and providing reassurance is often more helpful. 
4. Can Parkinson’s medications cause hallucinations?
Yes. Some Parkinson’s medications can contribute to hallucinations or delusions, which is why medication review is an important part of treatment. 
5. Can hallucinations and delusions be treated?
Yes. Treatment may involve identifying an underlying medical problem, adjusting medications, environmental strategies, counseling, and—in appropriate cases—medication specifically for Parkinson’s disease psychosis.

Conclusion
Hallucinations and delusions can be among the most challenging non-movement symptoms of Parkinson’s—for both the person experiencing them and the people who love them.
The most important steps are to stay calm, avoid arguing, protect safety, document what you're seeing, and communicate with the healthcare team.
Most importantly, remember that these symptoms are medical issues—not something your loved one is doing intentionally. With the right evaluation, treatment, and support, hallucinations and delusions can often be managed more effectively.

Why Support Matters
A diagnosis of any form of Parkinson’s can feel overwhelming. But with the right support and resources, individuals can maintain independence, quality of life, and emotional well-being.
For resources, referrals, and support in navigating Parkinson’s and related conditions, contact the Parkinson’s Association of Southwest Florida at www.paswfl.org or call 239-417-3465.
For over 25 years, PASWFL has provided free, high-quality services and programs to individuals and families touched by Parkinson’s disease in Southwest Florida. Their goal is simple: help people live well with PD, regardless of where they are in their journey.
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Each week, PASWFL offers more than 25 free programs and support groups, including:

• Wellness and fitness classes
• Speech Exercise classes
• Educational seminars
• Support for care partners
• Support groups

There are no fees to become a member, and PASWFL welcomes anyone touched by PD.

Take the First Step Toward Living Well
If you suspect early Parkinson’s or have been recently diagnosed, you don’t have to face it alone.
👉 Click here to sign up for the PASWFL newsletter
👉 Click here to become a member—it’s free and confidential
To learn more, visit www.paswfl.org and discover the power of support, education, and community.