Hallucinations полностью

In Parkinson’s disease, postencephalitic parkinsonism, and Lewy body disease, there is damage to the brain stem and associated structures, as there is in peduncular hallucinosis — though the damage occurs gradually and not abruptly, as with a stroke. In all of these degenerative diseases, however, there may be hallucinations, as well as sleep, movement, and cognitive disorders. But the hallucinations are markedly different from those of CBS; they are nearly always complex rather than elementary, often multisensory, and more apt to lead to delusions, which CBS alone rarely does. The hallucinations of brain-stem origin seem to be associated with abnormalities in the acetylcholine transmitter system — abnormalities that may be aggravated by giving the patient L-dopa or similar drugs, which heighten the dopamine load on an already fragile and stressed cholinergic system.

People with ordinary Parkinson’s disease may be active and retain their intellectual powers for decades — Thomas Hobbes, the philosopher, for instance, developed “the shaking palsy” around the age of fifty, when he was completing his Leviathan, but remained intellectually intact and creative, though motorically disabled, into his nineties. But it has been increasingly recognized in the last few years that there is a more malignant form of parkinsonism, one accompanied sooner or later by dementia and by visual hallucinations even in the absence of L-dopa. Examination of the brain at autopsy in such patients may show abnormal aggregates of protein (so-called Lewy bodies) inside the nerve cells, mostly in the brain stem and basal ganglia but also in the visual association cortex. The Lewy bodies, it is conjectured, may predispose patients to visual hallucinations even before they are put on L-dopa.

Edna B. seems to have this disease, though the diagnosis of Lewy body disease cannot be made with certainty in life without doing a brain biopsy. Mrs. B. enjoyed excellent health until her mid-sixties, but in 2009 she developed some tremor in the hands, her first symptoms of parkinsonism. By the summer of 2010 her symptoms included some slowing of movement and speech as well as problems with memory and concentration — she would forget words and thoughts, lose the thread of what she was saying and thinking, and, most distressingly of all, she had hallucinations.

When I saw her in 2011, I asked her what her hallucinations were like. “Horrible!” she said. “It’s like watching a horror movie, and you’re part of it.” She saw little people (“Chuckys”) running around her bed at night; they seemed to be talking to each other, she saw their gestures and their lips move, but she could not hear any speech. On one occasion she tried to speak to them. Although they looked frightening and (she thought) had evil intentions, they never molested or approached her, though once one of them sat on her bed. But far worse were certain scenes enacted before her. “I saw my son murdered right in front of my eyes,” she told me. (“It was Darkside stuff,” her husband interpolated.) Once, when her husband visited, she said, “What are you doing here? They just had your funeral at Sacred Heart Church.” She often saw rats, and sometimes felt them in her bed. She also felt “fish” nibbling at her feet. Sometimes she had hallucinations of being part of an army marching into battle.

When I asked if she had any pleasant hallucinations, she said that she had sometimes seen people “in Hawaiian dress” in the corridor or outside her window, getting ready to play music for her, though she never actually heard any music. What she did hear, however, were various noises — especially the sound of running water. No voices. (“Good thing I didn’t have those,” she said, “or they’d think I was really crazy.”) There have been some olfactory hallucinations, too: “people around me with different kinds of scents.”