Article

Hallucinations in Parkinson's disease: A follow-up study

Hôpital Henri Mondor (Hôpitaux Universitaires Henri Mondor), Créteil, Île-de-France, France
Movement Disorders (Impact Factor: 5.63). 03/2005; 20(2):212-7. DOI: 10.1002/mds.20263
Source: PubMed

ABSTRACT To study prevalence of hallucinations in patients with Parkinson's disease (PD) during a 1-year period, and identify factors predictive of the onset of hallucinations in patients who were hallucination-free at baseline, 141 unselected outpatients with PD were evaluated prospectively for a set of demographic, clinical, and therapeutic variables and the presence of hallucinations during the previous 3 months. Patient groups were compared with nonparametric tests, and logistic regression was applied to significant data. Follow-up data were available for 127 patients. The hallucination prevalence rates (%) at the first and second evaluation were, respectively, 41.7 and 49.6 for hallucinations of all types (NS), 29.1 and 40.2 for minor hallucinations (i.e., presence or passage hallucinations, and illusions) (P = 0.02), 22.8 and 21.2 for formed visual hallucinations (NS), and 8.7 and 8.7 for auditory hallucinations (NS). Hallucinations rarely started or ceased during the study. The most labile forms were minor hallucinations, which developed in 20% of patients and ceased in 9%. During follow-up, 15% of patients started to hallucinate. Three factors, all present at the first evaluation, independently predicted the onset of hallucinations in patients previously free of hallucinations at baseline (odds ratio; 95% confidence interval): severe sleep disturbances (14.3; 2.5-80.9), ocular disorders (9.1; 1.6-52.0), and a high axial motor score (5.7; 1.2-27.4). Hallucinations have a chronic course in most parkinsonian patients. Factors predicting the onset of hallucinations point to a role of extranigral brainstem involvement and a nonspecific, facilitating role of ocular disorders.

0 Followers
  • Source
    • "This study goes further than cross-sectional studies by reporting the frequency and history of VHs in PD over a 4-year period. Prevalence of VHs of 50–55% in each study year corroborates wider findings for the prevalence of VHs (Doe de Maindreville et al., 2005; Diederich et al., 2009). However, when analysing longitudinal data, it becomes clear that VHs affect more PD patients than commonly assumed in cross-sectional studies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE: To examine the prevalence, incidence and risk factors associated with visual hallucinations (VHs) amongst people suffering from Parkinson's disease (PD). METHODS: We recruited 513 patients with PD from movement disorder and PD clinics within three sites in the UK. Patients were interviewed using a series of standardised clinical rating scales at baseline, 12, 24 and 36 months. Data relating to VHs were collected using the North-East Visual Hallucinations Interview. Prevalence rates for VHs at each assessment were recorded. Associations were determined using multiple regression analysis. RESULTS: Cross-sectional prevalence rates for VHs at baseline, 12, 24 and 36 months indicated VHs in approximately 50% of patients. A cumulative frequency of 82.7% of cases at the end of the study period exhibited VHs. The incidence rate for VHs was 457 cases per 1000 population. Longer disease duration, greater impairment in activities of daily living and higher rates of anxiety were most commonly associated with VHs. No factors predictive of VHs could be ascertained. CONCLUSIONS: When examined longitudinally, VHs affect more patients than is commonly assumed in cross-sectional prevalence studies. Clinicians should routinely screen for VHs throughout the disease course. Disease duration, impairment in activities of daily living and anxiety presented as co-morbidities associated with VHs in PD, and therefore those presenting with VHs should be screened for anxiety disorder and vice versa. Copyright © 2012 John Wiley & Sons, Ltd.
    International Journal of Geriatric Psychiatry 06/2013; 28(6). DOI:10.1002/gps.3869 · 3.09 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduzione Una recente review [1] ha proposto un nuovo modello integrativo per l'origine delle Allucinazioni Visive (AV) nella Malattia di Parkinson (PD). Questo modello suggerisce che le AV croniche potrebbero riflettere una percezione interna/esterna disturbata, dipendente da deterioramento visivo e da disfunzione del sistema di controllo per il sonno con movimenti rapidi degli occhi (REM). Il nuovo modello destituisce parzialmente la precedente ipotesi che la AV potrebbero dipendere da una iperattività dei recettori dopaminergici mesolimbici, attraverso un meccanismo simile a quello usato per spiegare i sintomi positivi della schizofrenia [2-4]. La review sottolinea studi che mostrano che la dose e la durata della terapia dopami-nergica non sono fattori di rischio maggiori per allucinazioni [1,5] a che le AV non sono precipitate né semplicemente correlate ad alti livelli di L-Dopa o a improvvisi cambia-menti nei suoi livelli plasmatici. Un recente studio di follow-up a breve termine [6] e uno studio di prevalenza [7] con-fermano che i fattori indipendenti che predicono le AV in pazienti con PD non sono aumentati dalla terapia dopaminergica ma dai disordini del sonno e dai disturbi visivi. Di conseguenza piuttosto che spiegare le AV con un meccanismo che coinvolga la via mesolimbica, le più recenti scoperte ed ipotesi si focalizzano sul danno visivo, che pro-babilmente riflette una disfunzione dopaminergica retinica, e su anomalie sonno/vigi-lanza, che probabilmente riflettono del sistema ponto-genicolo-occipitale che regola il sonno REM. La review che propone il nuovo modello integrativo, pubblicata dopo che abbiamo presentato al meeting sui Disturbi Mentali nella Malattia di Parkinson i nostri due studi sulle origini separate delle AN nella PD, ci ha sollecitato a riesaminare in questo artico-lo le nostre scoperte.
Show more