“Treating hallucinations” in PD (review article)

The most recent issue of “Expert Review of Neurotherapeutics” includes a review article on the treatment of hallucinations in Parkinson’s disease.  Of course this applies to Lewy body dementia as well.

While the full article is behind a pay-wall, the article’s highlights are viewable:

Article highlights

* Hallucinations, especially visual hallucinations, are common in Parkinson’s disease and impact upon quality of life for patients and carers.

* The development of visual hallucinations signals advancing disease and is often accompanied by cognitive impairment.

* When hallucinations develop acutely, triggers such as infections, dehydration and the effects of new medication should be systematically investigated and treated.

* Optimisation of vision and hearing impairment and education and support including the provision of respite care, are effective strategies for all patients.

* The efficacy of psychological therapies for these symptoms is under-researched.

* Rivastigmine has good evidence for reducing visual hallucinations and improving cognition and is available in capsule and transdermal patch forms.

* In more severe cases, an atypical antipsychotic may be required. Pimavanserin is the only FDA-approved drug for this indication but access is limited. Clozapine also has good evidence though is associated with rare but often predictable serious adverse effects. Quetiapine has a better safety profile but has less evidence for efficacy. All antipsychotics are associated with increased morbidity and mortality in PD which must be balanced with the quality of life implications of untreated psychosis for individual patients.

* Cholinesterase inhibitors and antipsychotics should be withdrawn slowly to reduce the risk of rebound symptoms and a withdrawal syndrome.

* Electroconvulsive therapy may be helpful in complex cases where other treatments have failed.

You can find these highlights (and purchase the full article) on this webpage.

Treating hallucinations in Parkinson’s disease
Alice Powell, Elie Matar & Simon J.G. Lewis
Expert Review of Neurotherapeutics
Volume 22, 2022 – Issue 6, Pages 455-468
Published online: 14 Dec 2020

Maybe we can obtain the full article and dig further.  I’m particularly interested in what the article has to say about education, support, and respite care.  And I’m curious to know what it says about the use of cholinesterase inhibitors as a treatment for hallucinations.