Delusions are specific and fixed beliefs that are very real and true to the person experiencing them. They can contradict all semblance of reality and rational thought, but no amount of convincing could change what the person believes is true. Additionally, if you try to convince someone experiencing a delusion that it's not true, they can become suspicious and doubt you, making an already difficult situation even worse.
Delusions happen much less frequently than hallucinations. Only about 10% of people with Parkinson's experience them, but because they're often ongoing, involuntary, and feel very real to the person, they can be much more difficult to manage and treat.
The most common delusions people with Parkinson's experience are:
The belief that their spouse is being unfaithful
The belief that their care partner is poisoning them with their medications
The belief that people are stealing their stuff, or they're going to steal it
The single most important thing to do if your loved one with Parkinson’s is experiencing delusions is to tell their physician right away. The earlier they know what's going on, the sooner they can begin interventions to help them feel better. Once you share your concerns, your physician will typically do a clinical evaluation, review medications and dosage, assess their lifestyle, and determine the severity of their symptoms. Depending on what they find, they may refer the Parkinson’s patient to counseling or therapy, adjust their medication, change their medication, eliminate a particular medication, or do all the above. If none of those strategies work, they may try antipsychotic drug therapy to see if they can adjust chemical levels in the brain. This can bring an entirely different set of problems with it, so it's important to be invested every step along the way and be sure you're well-informed before you move in that direction.
You might hear some people refer to delusions as Capgras Syndrome. Capgras syndrome, or delusion doubles, is delusional misidentification syndrome. It is a syndrome characterized by a false belief of identical doubles of someone significant to the patient. To better understand Capgras Syndrome and learn tips for helping to manage symptoms of Capgras, watch this video: https://www.youtube.com/watch?v=eBaL36d_iLk
If the person you're caring for experiences confusion or delusions, here's what you can do in the moment.
Stay as calm and patient as you can and remember that this belief has nothing to do with you and only with what is going on in their mind.
Remove any objects in the room that could pose a danger to them or anyone else.
Clear space so there are no tripping hazards and so it's easy for the person to move around.
Do not try to reason with the person or convince them why their belief is false.
Reassure them that everything is going to be okay.
If the person becomes aggressive, minimize your movements, and remain calm.
Ask the person to talk to you about what they are feeling and really listen to them, so they don't feel threatened
If you feel like you or they are in danger, call 911.
Here are a few actions you can take once the delusion has passed:
Inform your person's physician immediately.
Educate others who may care for your person on how to handle the situation if it happens when they're around.
If your person is open to it, discuss the episode with them and ask them to explain what the experience is like for them and if there's anything different you could do next time.
Seek expert advice if you feel like you need support in managing these episodes.
If the person you are caring for experiences delusions or confusion:
Tell their doctor
Stay calm and patient
Keep dangerous objects in secure locations
Arrange furniture in a way that someone who is confused will not trip/fall
Do not argue or challenge the person
Educate others who frequently spend time with your loved one and allow them to help
Sources: The Davis Phinney Foundation. Page 92. In the past year, my person with Parkinson's has begun experiencing delusions and frequently accuses me of having an affair. No amount of denial can convince them otherwise. What can I do? Every Victory Counts for Care Partners. "Manual." Sixth Edition, 2021.