Management of Visual Hallucinations in Parkinson's Disease

Initial Assessment and Non-pharmacological Management

Visual hallucinations occur in up to 80% of patients with Parkinson's disease and form one of the core diagnostic criteria for Dementia with Lewy Bodies (DLB) 1
Rule out other causes of hallucinations, such as Charles Bonnet Syndrome (CBS), which is characterized by visual hallucinations with preserved insight, no other neurological explanation, and some degree of vision loss 2, 3
Patient and caregiver education about the nature of hallucinations can reduce anxiety and fear, and simple coping strategies like eye movements, changing lighting, or distraction techniques can be effective 2, 3

Rivastigmine has demonstrated efficacy in treating visual hallucinations in DLB trials, and the BEHAVE-AD scale has been used to evaluate the benefit of rivastigmine in visual hallucinations, demonstrating sensitivity to treatment effects 1, 4
The University of Miami Parkinson's disease Hallucinations Questionnaire captures both severity and frequency of visual hallucinations, and the North-East Visual Hallucination Interview (NEVHI) specifically assesses visual hallucinations and correlates well with the MDS-UPDRS hallucination item 4, 6

Regular monitoring using appropriate scales, such as the Neuropsychiatric Inventory (NPI), can assess hallucinations, and the University of Miami Parkinson's disease Hallucinations Questionnaire and the North-East Visual Hallucination Interview (NEVHI) can specifically assess visual hallucinations 1, 4, 5, 6
Increasing levodopa may help motor symptoms but can worsen psychotic symptoms, according to the Translational Neurodegeneration journal 4