People with Parkinson’s disease can see people and things that sighted people cannot.
這在巴金森氏症（PD）的病程中，其實是一個相當常見且令人困擾的現象，醫學上稱為**「巴金森氏症精神病性障礙」（PDP）**。
對於患者來說，他們看到的影像通常非常真實、具體，並非隨意胡言亂語。這背後有著明確的神經學原因，而不是患者「瘋了」或「看到不乾淨的東西」。
1. 為什麼會看到「不存在的事物」？
主要原因有三個層面：
- 多巴胺失衡（藥物因素）： 巴金森氏症的藥物（如左旋多巴）是為了補充大腦的多巴胺以改善運動能力，但如果大腦某些負責視覺與情緒的區域多巴胺活性過高，就會產生幻覺。這是一種「顧了手腳，卻干擾了大腦視覺處理」的副作用。
- 視覺處理系統退化： PD 患者的大腦在處理視覺訊號時會出現「雜訊」。當光線昏暗或環境雜亂時，大腦會試圖「補完」這些模糊的訊號，結果誤把窗簾看成站著的人，或把地上的電線看成蛇。
- 睡眠障礙： 許多患者有 REM（快速動眼期）睡眠行為障礙，夢境與現實的界線變得模糊，導致醒來後幻覺持續存在。
2. 他們通常「看到」什麼？
巴金森氏症的幻覺通常具有以下特徵：
- 小動物或小孩： 經常看到貓、狗在腳邊跑過，或是家裡出現陌生的孩童。
- 人影或側影： 感覺眼角餘光有人影閃過（稱為「過路幻覺」），或者感覺背後有人（稱為「存在感幻覺」）。
- 複雜且彩色： 幻覺通常是非常生動的彩色影像，且患者一開始往往能意識到「這不是真的」，但隨著病程進展，辨識真假的能力可能會下降。
3. 身為照顧者，該如何應對？
當患者說出他看到「不存在的人」時，您的反應非常關鍵：
✅ 建議的做法：
- 保持冷靜與同理： 對患者來說，那種視覺體驗是真實的。可以說：「我沒有看到那個人，但他讓你感到害怕嗎？」
- 改善照明： 幻覺最常發生在黃昏或深夜。增加室內亮度、消除牆上的大片陰影，能大幅減少大腦誤判的機會。
- 轉移注意力： 輕輕觸碰患者，或引導他觀察房間的其他地方，有時能讓幻覺消失。
❌ 避免的做法：
- 不要爭辯： 嚴厲否定（「那是鬼扯，根本沒人！」）會讓患者感到受挫、孤立，甚至產生受害妄想。
- 不要隨之起舞： 也不要假裝你也看到了（「喔對，他在那裡，我跟他打招呼」），這會強化患者的幻覺，讓認知更混亂。
4. 醫療上的處置
如果幻覺已經影響到患者的情緒（恐懼、焦慮）或睡眠，建議與神經內科醫師討論：
- 調整藥物： 醫師可能會嘗試減量某些容易引起幻覺的藥物（如抗膽鹼藥物或多巴胺受體促效劑）。
- 特定的抗精神病藥物： 有些特定藥物（如 Clozapine 或 Quetiapine）可以在不惡化手抖情況下，有效控制幻覺。
我可以如何協助您？
了解這種現象後，家屬的心理壓力通常會減輕一些。目前長輩看到的內容是否讓他感到驚恐？或者您想知道如何與醫師溝通，在「控制手抖」與「減少幻覺」之間取得平衡？
This is actually a fairly common and distressing phenomenon in the course of Parkinson’s disease (PD), medically known as Parkinsonian Psychotic Disorder (PDP).
For patients, the images they see are usually very real and concrete, not random ramblings. There are clear neurological reasons behind this, rather than the patient being “crazy” or “seeing something supernatural.”
1. Why do patients see “non-existent things”?
There are three main reasons:
- Dopamine Imbalance (Drug Factors): Parkinson’s disease medications (such as levodopa) are designed to supplement dopamine in the brain to improve motor function. However, if dopamine activity is excessively high in certain areas of the brain responsible for vision and emotion, hallucinations can occur. This is a side effect of “treating the hands and feet but interfering with the brain’s visual processing.”
- Degeneration of the Visual Processing System: The brains of PD patients experience “noise” when processing visual signals. When the light is dim or the environment is cluttered, the brain tries to “fill in” these blurred signals, resulting in mistaking curtains for standing people or electrical wires for snakes.
- Sleep Disorders: Many patients have REM (Rapid Eye Movement) sleep behavior disorder, blurring the line between dreams and reality, leading to persistent hallucinations after waking.
2. What do they usually “see”?
Hallucinations in Parkinson’s disease typically have the following characteristics:
- Small Animals or Children: Frequently seeing cats or dogs running past their feet, or unfamiliar children appearing in the house.
- Shadows or Profiles: Feeling shadows flashing in the corner of their eye (called “passing shadow hallucinations”), or feeling someone behind them (called “presence hallucinations”).
- Complex and Colorful: Hallucinations are usually very vivid, colorful images, and patients are often initially aware that “this isn’t real,” but as the disease progresses, their ability to distinguish between reality and illusion may decline.
3. How should you, as a caregiver, respond?
Your reaction is crucial when a patient says they saw a “non-existent person”:
✅ Recommended actions:
- Remain calm and empathetic: For the patient, that visual experience is real. You can say, “I didn’t see that person, but did they frighten you?”
- Improve lighting: Hallucinations most often occur at dusk or late at night. Increasing the brightness of the room and eliminating large shadows on the walls can significantly reduce the chance of the brain misinterpreting the image.
- Distract them: Gently touching the patient or guiding them to look at other parts of the room can sometimes dispel hallucinations.
❌ Actions to avoid:
- Don’t argue: Harsh denial (“That’s nonsense, there’s no one there!”) can frustrate, isolate, and even lead to paranoia in the patient.
- Don’t dance along: Don’t pretend you saw it too (“Oh yes, he’s there, I’ll say hello to him”), as this will reinforce the patient’s hallucinations and further confuse their cognition.
4. Medical Management
If the hallucinations are affecting the patient’s mood (fear, anxiety) or sleep, it is recommended to discuss with a neurologist:
- Adjusting medication: The doctor may try reducing the dosage of certain medications that easily induce hallucinations (such as anticholinergics or dopamine receptor agonists).
- Specific antipsychotic medications: Some specific medications (such as Clozapine or Quetiapine) can effectively control hallucinations without worsening the tremors.
How can I help you?
Understanding this phenomenon usually reduces the psychological stress on family members. Is what the elderly person is currently seeing terrifying? Or would you like to know how to communicate with your doctor to strike a balance between “controlling tremors” and “reducing hallucinations”?
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