The Surprising Link Between Parkinson’s,Dementia,adn Psychedelics: Understanding Visual Hallucinations
Visual hallucinations can be deeply unsettling,but their origins aren’t always what they seem. Recent research published in Schizophrenia Bulletin reveals a fascinating connection between the visual disturbances experienced in Lewy body diseases (like parkinson’s Disease, Parkinson’s Disease Dementia, and Dementia with Lewy Bodies) and those induced by serotonergic psychedelics. This isn’t to suggest a casual link, but rather a shared neurological basis that could revolutionize how we approach treatment.
Decoding the Brain’s Visual Landscape
The International consortium on Hallucinations Research delved into neuroimaging and pharmacological data, comparing brain activity in both conditions. While the cause of hallucinations differs – temporary psychedelic effects versus chronic disease progression – the brain patterns are strikingly similar. Both scenarios heavily involve serotonin receptor activity,notably within the visual and associative cortices.
Specifically, the 5-HT2A and 5-HT1A receptors emerge as key players. Psychedelics trigger hallucinations through activation of these receptors. Interestingly, in Lewy body diseases, an increase in 5-HT2A receptors correlates with the severity of visual hallucinations.
A Cortical Imbalance: Why Things Appear Distorted
A common thread across both conditions is a cortical imbalance. This means reduced activity in the primary visual areas (were initial sensory input is processed) coupled with heightened activity in the associative cortices (responsible for interpreting and making sense of what we see). This mismatch can lead to distorted perceptions, especially in individuals with pre-existing visual impairment.
This explains why hallucinations often evolve. In Lewy body diseases,they frequently begin as simple shapes like shadows or lights,progressing to more complex and emotionally charged scenes - a pattern mirroring the effects of increasing psychedelic doses. Pharmacists may observe this progression in patient reports over time.
Treatment Implications & The Role of Pimavanserin
Currently, pimavanserin (Nuplazid) - a 5-HT2A inverse agonist – is approved for treating psychosis associated with Parkinson’s Disease. It’s crucial to monitor for both efficacy and potential adverse effects,such as QT prolongation,particularly in elderly patients.
Though, the emerging understanding of serotonin’s role opens doors for potentially more targeted therapies. Modulating 5-HT2A receptors could offer symptom relief with fewer cognitive side effects compared to conventional antipsychotics.
Beyond medication: Patient Counseling & Destigmatization
It’s vital to remember that visual hallucinations in Parkinson’s and Dementia with Lewy Bodies aren’t always indicative of psychosis. They can occur even in cognitively intact individuals. Patient counseling plays a critical role in destigmatizing these experiences, fostering trust, and encouraging open interaction.
The Future of Research & Clinical Practice
Researchers are now advocating for real-time neuroimaging studies during active hallucinations. This will allow for a deeper understanding of the shared mechanisms at play. Pharmacists and prescribers can leverage these insights – and the existing knowledge from psychedelic research – to refine treatment strategies for lewy body disease-associated psychosis.
Ultimately, a more nuanced understanding of the brain’s visual processing and the role of serotonin promises a brighter future for those experiencing these challenging symptoms.
REFERENCE:
Heller NH, Barrett FS, Buchborn T, et al. Visual hallucinations in serotonergic psychedelics and Lewy body diseases. Schizophr bull. 2025;51(Suppl 3):S273-S291.doi:10.1093/schbul/sbaf068
About the Author:
Brianna Champagne graduated with her BS in pharmacy studies from the University of Connecticut in May 2025 and is pursuing a career in medical writing.
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