Parkinson’s disease (PD) does not only affect the patient. Family, loved ones and caregivers are greatly affected as well. In the mid to late stages, hallucinations, or delusions can occur, often referred to as "psychosis" by healthcare professionals. Testing must be done to determine the probable cause and a treatment plan for this difficult condition. Most of the time, it is a side effect of medications or dopaminergic therapy; it can also be caused by dementia or delirium. This is usually attributed to the fact that so many of the medications for PD relieve motor symptoms by increasing dopamine in the brain.
Treatment can be challenging for the physician as he or she determines what is causing the psychotic episodes and adjusts medications accordingly. Increasing certain medications to help with PD symptoms can bring on the malady, and reducing medications to alleviate the hallucinations or delusions can cause the PD symptoms to worsen and become more bothersome. It is a delicate balancing act and a complicated process that often involves a 3-step approach including assessment and planning, adjusting or reducing any medications, and initiating antipsychotic therapy.
Approximately half of people with PD will experience an episode of Parkinson's disease psychosis, yet few know about the toll it can take on people with the disease and their caregivers.
To raise awareness and provide insight into the realities of managing these psychotic episodes, a spousal caregiver from Albuquerque, New Mexico, shares her story below of caring for a husband with this diagnosis as it progressed into a psychotic state and finally required his placement in a professional care facility:
A common question asked is how soon after diagnosis are symptoms of this condition experienced, and what are the beginning signs. My husband had always been an exceptionally calm and affectionate person, a tower of strength for friends and family. He enjoyed good health despite his advancing years. He died of Parkinson's at age 91 with full-blown PD psychosis.
He began having breathing difficulties at night and started using a breathing aid, but he couldn't tolerate it. When the tremors started, he was diagnosed with Parkinsonism. About four years later, PD was confirmed. With medications and exercise, we were able to live a normal life.
The first undeniable signs of psychosis appeared after his 90th birthday when he started hearing music. For him, it was the same songs repeating over and over again. His doctors tried a number of medications without success. He tolerated this bothersome affliction with good humor, even cracking jokes about it. A few months later, the hallucinations started. At first they were benign, but they became increasingly scarier. However, he was still in touch with reality. His memory was good—sometimes better than mine—and he was very faithful to his exercise regime.
A few months later, he became weaker and needed a wheelchair; the hallucinations overpowered him. Even then, his stature as a responsible husband was evident. Though he had previously made all the necessary provisions for after his death, he became worried and started trying again, even though he could barely read and certainly could not write. On his 91st birthday, he was no longer with us mentally. Two weeks later, his behavior became so violent that I was advised to place him in a nursing home with a dementia unit. He died there, two weeks later.
Managing the episodes was challenging throughout. In the beginning, the goal was to keep him safe. I had chairs placed around the house so that, when he got on his feet during a psychotic episode, he could be easily lead to a chair to sit down. This also helped with his mobility.
Listening was important. I let him give me the details of whatever frightened him, then I comforted, reassured him, and even prayed with him. As his condition worsened, I hired competent and loving caregivers. When swallowing became a problem, his diet changed to foods that he could handle and liked.
Emotionally coping with his condition posed yet another set of challenges.
He was a wonderful man who had earned my unconditional love during the decades of our marriage, so it took no effort on my part emotionally to give him all the support he needed.
In addition, I read as much information as possible about the disease from books and the internet, keeping abreast of new information as it became available. I shall always be grateful to the Veterans Administration's Geriatric Clinic, and especially to an outstanding social worker who was the backbone of my own support, including the most critical days toward the end. The VA was a beneficial resource and provided my husband with a cane, walker, hospital bed, and wheelchairs as needed.
As his disease progressed and family rallied to our sides, I discovered that it was best for me to live in the moment. "Don't think about the past or the future," I would say to myself.
Perhaps the most challenging aspect of caring for my husband with this disease was my own physical limitations. I had a total knee replacement operation shortly before his psychosis worsened, so I was in pain and physically handicapped when the situation got especially tough.
Toward the end, it was very difficult to admit that the caregivers and I were no longer able to tend to his daily needs and that the time had arrived for placement in a dementia unit of a nursing home.
Over the years, he saw many specialists, including neurologists and psychiatrists. I learned that, despite their efforts to juggle his medications and to try others, there was no medication available at the time that would completely alleviate his symptoms. It is difficult to accept and I am not sure anyone knows how to live with a disease that has no cure. We must simply do the best we can each day and continue to move forward.
Through this personal experience, my advice would be to become informed about the disease and seek out resources that are freely available. Put forth your best effort and accept your limitations humbly. Do not wait until you are overwhelmed before hiring caregivers to help and, even though it may be extremely painful, be ready to make the decision of placing you loved one in the hands of specialized care.
With continued support and research, I remain hopeful this disease will see a cure.