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: 5.68). 03/2005; 20(2):212-7. DOI: 10.1002/mds.20263
Source: PubMed


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.

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    • "Risk factors for VH in PD are old age, long duration of PD, cognitive dysfunction, autonomic dysfunction, and sleep-wake disturbances [1, 3, 8–11]. One study that included a considerable number of cases with minor VHs reported that ocular problems are significant risk factor for VH [3]. "
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    ABSTRACT: Visual symptoms are a common feature in patients with Parkinson's disease (PD), and retinal dopamine loss and dysfunctions in foveal vision have been described in PD patients. Because visual hallucination (VH) is a specific feature of PD which is differentiated from other parkinsonian disorders, defective visual information processing from both the central and peripheral pathways is suggested to be the pathophysiological mechanisms of VH in PD. Decreased visual acuity as well as impaired contrast sensitivity and color vision is known to be related to the appearance of VH in PD. However, these functional studies were also affected by cognitive or cortical dysfunctions; thus, structural imaging can more reliably reflect visual afferent dysfunction. Recently, optical coherence tomography (OCT) scans have been used to investigate the structural changes in the retina in vivo. Segmental measures of the vertical retinal layers by OCT provide structural evidence for retinal dopamine loss and foveal dysfunction in PD. Retinal nerve fiber layer (RNFL) thinning in PD was shown to be significantly associated with VH and correlated with PD duration and severity. Thus, there is a possibility that the retina could be a biomarker for disease progression and risk of VH in PD. A standard protocol for OCT studies in PD with more accurate measures of the retinal layers needs to be developed in the future.
    Full-text · Article · Feb 2014
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    • "This result is consistent with those of previous studies [5,15-17,25]. In addition, sleep disturbances [25,29] and rapid eye movement (REM)-sleep behavioral disturbances [17] are associated with psychosis. Arousal systems, including nor-adrenaline neurons in the locus coeruleus, serotonin neurons in the raphe nuclei, and cholinergic neurons in the basal forebrain are damaged in PD [18,30]. "
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    ABSTRACT: Psychoses such as hallucinations are a frequent non-motor problem in patients with Parkinson disease (PD) and serious psychosis requires anti-psychotic medications that worsen Parkinsonism. Although psychosis could be associated with patient-related or biological factors such as cognition, age, and severity of PD, it can also be associated with medications.Therefore we aimed to investigate patient-related and medication-related risks of psychosis requiring anti-psychotic medications (serious psychosis). A retrospective cohort of 331 PD patients was followed for 2 years. Patient-related factors associated with risk of psychosis were identified by a survival time analysis. In patients who developed psychosis, medications during the hazard period (1-14 days before psychosis) were contrasted with those during the control periods (1 and 3 months before psychosis) using a case--crossover analysis to identify medication-related risks of psychosis. Serious psychosis was detected in 52 patients and the incidence was estimated to be 116 (95% confidence interval [CI], 85-148) per 1,000 person-years. Analyses of baseline characteristics revealed the risk to be higher in patients with a modified Hoehn--Yahr stage of >=4 (hazard ratio [HR], 2.22; 95% CI, 1.11-4.40), those with a longer duration of PD (HR, 1.25; 95% CI, 1.00-1.55, per 5 years) and those with Mini-Mental State Examination scores of <=24 (HR, 2.66; 95% CI, 1.37-5.16). The case-crossover analysis revealed that anti-cholinergics use (HR, 19.7; 95% CI, 2.39-162) elevated the risk, while donepezil use reduced it (HR, 0.48; 95% CI, 0.27-0.85). Risk of psychosis was elevated by increasing severity of PD, cognitive dysfunction and duration of the disease. It was elevated by use of anti-cholinergic drugs and reduced by use of donepezil. The medication-related risk was higher in patients aged >= 70 years. In contrast, there was no significant medication-related risk in younger patients, suggesting different pathomechanisms between young and old patients.
    Full-text · Article · Oct 2013 · BMC Neurology
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    • "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. "
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    ABSTRACT: To examine the prevalence, incidence and risk factors associated with visual hallucinations (VHs) amongst people suffering from Parkinson's disease (PD). 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. 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. 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
    Full-text · Article · Jun 2013 · International Journal of Geriatric Psychiatry
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