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Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
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J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 24 October 2021

Hallucinations and Delusions

Hallucinations and Delusions

(p.111) 10 Hallucinations and Delusions
Dementia with Lewy Body and Parkinson's Disease Patients

J. Eric Ahlskog

Oxford University Press

Defining terms is an appropriate introduction to this chapter. Hallucinations imply seeing things that are not truly present, or hearing illusory voices or music. In DLB and PDD, hallucinations are nearly always visual and manifest as seeing nonexistent people or objects, such as strangers in the house or yard. The affected individual may realize that he or she is experiencing a hallucination, but some people may not recognize that these are not real. In other disorders auditory hallucinations may be present, such as hearing voices. However, such auditory hallucinations are rare in Lewy disorders. Delusions are defined as false, often irrational beliefs. Frequently, these will have a theme, such as the conviction that someone is spying, or paranoia about friends or neighbors. A common theme is spousal infidelity, sometimes nonsensical, such as an older adult’s accusations of their mate starting an extramarital affair after 50 years of marriage. Capgras syndrome is an uncommon but striking example of delusional thinking in which the spouse or other immediate family member is accused of being an impostor. Hallucinations or delusions may occur in Parkinson’s disease in the absence of frank dementia. However, dementia is the usual setting for these problems. Hallucinations are much more common than delusions. Sometimes they are very limited, perhaps only present at night. Hallucinations are a contraindication to driving a motor vehicle, for obvious reasons. The fundamental cause of hallucinations and delusions in DLB and PDD is the Lewy neurodegenerative process. The precise region of the brain that is responsible is not known, however. These often occur in the absence of any external provocative factors. However, medications are notorious for inciting such problems in susceptible people. Chapter 7 focused on simplifying medications especially for this reason. Drugs for parkinsonism are well-known culprits, in particular two classes: (1) the dopamine agonists: pramipexole (Mirapex), ropinirole (Requip) and rotigotine (Neupro patch); and (2) anticholinergic drugs: trihexyphenidyl (Artane) and benztropine (Cogentin). Carbidopa/levodopa by itself may provoke hallucinations, but that is not very common unless combined with other drugs for parkinsonism.

Keywords:   Exelon patch (rivastigmine), Neupro patch (rotigotine), Prozac class of medications (SSRIs), clozapine (Clozaril), donepezil (Aricept), hydrocodone, narcotic pain medications, oxycodone, pain medications, narcotic and nonnarcotic, urinary tract infections (UTIs)

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