Hiccups, Hypersalivation, Hallucinations in Parkinson’s Disease: New Insights, Mechanisms, Pathophysiology, and Management (original) (raw)
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European Journal of Clinical Pharmacology, 2017
Background Some reports have suggested an association between dopamine agonists and hiccups, involuntary contractions that merit full clinical attention because they can be very debilitating. Many drugs frequently used to treat hiccups are formally contraindicated in Parkinson's disease due to their liability to worsen motor symptoms, making the treatment of hiccups problematic in this disease. The objective of the present study was to analyze all spontaneous reports of hiccups from the European Pharmacovigilance Database in patients with Parkinson's disease and/or on dopaminergic drugs. Finally, we sought to identify evidence-based recommendations on the management of hiccups in Parkinson's disease. Methods We searched for all reports of hiccups in the European Pharmacovigilance Database (EudraVigilance) and calculated proportional reporting ratios for dopamine agonists and hiccups. We reviewed the literature on Parkinson's disease, dopamine agonists, and hiccups, searching for specific treatment recommendations for hiccups in this disease. Results Both rotigotine and pramipexole fulfilled the criteria to generate a safety signal. We found 32 and 13 cases of hiccups associated with dopamine agonists in EudraVigilance and the literature, respectively. There were no specific recommendations for the management of hiccups in Parkinson's disease in the clinical guidelines consulted. Conclusions We have found evidence that rotigotine and pramipexole are associated with the appearance of hiccups and that this adverse reaction occurs predominantly in males. Given the scarce information available, specific recommendations are needed in clinical guidelines for the adequate management of hiccups in Parkinson's disease.
Hallucinations in Parkinson’s disease: cross-sectional study
Acta Neurologica Belgica, 2012
The aim of this study was to estimate the prevalence and risk factors for the development of hallucinations in patients with Parkinson's disease (PD). This crosssectional study included 180 consecutive, non-demented patients with PD. Out of them, 24 patients (13%) experienced some kind of hallucinations. Visual hallucinations were present in 22/24 (90%) subjects. Univariate logistic regression analysis has shown relationship between presence of hallucinations and the following variables: age of patients (p = 0.025), PD duration (p = 0.001), duration of levodopa treatment (p = 0.001), total daily dose of levodopa (p = 0.033), presence of levodopa-induced dyskinesia (p = 0.002) and their duration (p = 0.021), and experience of nightmares (p = 0.042). Hallucinations were also associated with higher scores of the UPDRS (p = 0.001), HDRS (p = 0.001) and the NPI total score (p = 0.001), and higher H-Y stages of the disease (p = 0.001). Multivariate regression analysis has demonstrated that the duration of PD (p = 0.024) as well as NPI total score (p = 0.002) was significant independent risk factors for hallucinations in PD.
Minor hallucinations in Parkinson disease A subtle symptom with major clinical implications
Pérez Civit, Susana, 2021
Objective Psychosis is one of the most debilitating complications of Parkinson disease (PD). Although research on PD psychosis has been focused on the study of well-structured visual hallucinations (VH), currently accepted National Institute of Neurological Disorders and Stroke-National Institute of Mental Health diagnostic criteria emphasize minor hallucinations (MH) as the most common psychotic phenomena in PD. The objective of this review is to comprehensively describe the clinical and research advances on the understanding of MH and to provide future directions for obtaining further insights into their potential major implications for PD management and prognosis.
Visual plus nonvisual hallucinations in Parkinson's disease: Development and evolution over 10 years
2011
The objective of the study was to assess the development and evolution of visual and nonvisual hallucinations in patients with Parkinson's disease over 10 years. Hallucinations increase over time, but minimal attention has been placed on nonvisual domains. We studied 60 patients with Parkinson's disease who had never hallucinated at baseline and followed them over 10 years. The Rush Hallucination Inventory monitored frequency and type (visual, auditory, tactile, olfactory) of hallucinations at baseline and after 0.5, 1.5, 4, 6, and 10 years. Descriptive statistics were applied, and general estimating equation modeling assessed longitudinal risks. Over 10 years, visual hallucinations were endorsed by patients more frequently than other sensory modalities. Whereas isolated visual hallucinations dominated the early hallucination profile, visual plus nonvisual hallucinations accounted for progressively higher proportions of hallucinators over 10 years: 0.5 years, 0%; 4 years, 26%; 6 years, 47%; 10 years, 60% (odds ratio, 1.17; confidence interval, 1.01-1.37; P 5 .04). Once visual plus nonvisual hallucinations developed, the risk of continuing to have multidomain hallucinations was high (odds ratio, 3.67; confidence interval, 1.13-11.93; P 5 .03). Hallucination severity was highly associated with current visual plus nonvisual hallucinations (odds ratio, 4.06; confidence interval, 2.93-5.61; P < .0001) and the continuation of multidomain hallucinations (odds ratio, 1.58; confidence interval, 1.12-2.24; P 5 .01). Whereas visual hallucinations in isolation are classic in Parkinson's disease, nonvisual hallucinations emerge over time, and the combination of visual with nonvisual hallucinations predominates in late Parkinson's disease. To capture the breadth and severity of hallucinations in chronically hallucinating patients with Parkinson's disease, screening inventories and practice-based interviews must include questions on both visual and nonvisual components.
International Journal of Geriatric Psychiatry, 2013
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 NorthEast 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.
Minor Hallucinations Occur in Drug-Naive Parkinson's Disease Patients, Even From the Premotor Phase
Objectives: The description of minor hallucinatory phenomena (presence, passage hallucinations) has widened the spectrum of psychosis in Parkinson’s disease (PD). Minor hallucinatory phenomena seem to antedate the development of more severe hallucinations. Early detection of minor hallucinations may be useful for screening patients with more severe endophenotypes. Motivated by the observation of “de novo,” drug-naive PD patients reporting minor hallucinations, we aimed to prospectively identify “de novo” untreated PD patients experiencing hallucinatory phenomena, and to compare their clinico-demographic characteristics with those of untreated PD patients without hallucinations and healthy controls. Methods: Screening and description of psychosis was assessed by the Movement Disorders Society Unified Parkinson’s Disease Rating Scale—Part I and a structured interview covering all types of psychotic phenomena reported in PD. Clinical, neuropsychological, and demographic data of PD patients with and without psychotic phenomena were compared with those of age- and education-matched healthy controls. Results: Fifty drug-naive, “de novo” PD patients and 100 controls were prospectively included. Minor hallucinations were experienced in 42% (21 of 50) PD patients and 5% controls (P < 0.0001). Coexistence of passage and presence hallucinations was the most common finding. Unexpectedly, 33.3% of patients with minor hallucinations manifested these as a pre-motor symptom, starting 7 months to 8 years before first parkinsonian motor symptoms. The presence of minor hallucinations was significantly associated with presence of rapid eye movement sleep behavior disorder. Conclusions: In this first study to prospectively analyze the frequency of minor hallucinatory phenomena in incident, untreated PD patients, hallucinations appeared as a frequent early non-motor symptom that may even predate the onset of parkinsonism.
Acta Neurol Scand, 2007
Objective -To assess hallucinations in ParkinsonÕs disease (PD), we developed a novel practical rating scale that evaluates five items including variety, frequency, and severity of hallucinations, caregiver burden levels, and psychiatric status at nighttime. Methods -Forty-one PD patients and their caregivers were examined regarding the status of the hallucinations associated with PD. Results -As a measure of internal consistency, the Tottori University Hallucination Rating Scale (TUHARS) has a CronbachÕs a of 0.88. Mini-Mental State Examination (MMSE) and Hoehn-Yahr stage were associated with the TUHARS scores in a multivariate regression analysis. Visual hallucinations are the most common. However, half of the patients who reported visual hallucinations also had other hallucinations. The scale scores in the PD patients with dementia (PDD) group were significantly greater than in the PD patients without dementia (PDnD) group. Conclusions -TUHARS appears to be a suitable and easily administered instrument for assessment of hallucinations in PD. PD patients experienced various kinds of hallucinations. Hallucinations may have a close relationship with cognitive decline in PD patients.
Risk factors for visual hallucinations in patients with Parkinson’s disease
Neurological Research, 2015
Aim: Parkinson's disease (PD) patients frequently present visual hallucinations (VHs) that have been associated with depression, old age, and cognitive impairment. Sleep abnormalities are also related to these factors. The aim of this study is to evaluate risk factors, particularly sleep alterations, associated with VHs in PD. Methods: This is a cross-sectional evaluation of consecutive patients from a Movement Disorder's clinics. Patients were clinically evaluated, and behavioral questionnaires were applied in a face-to-face interview. Results: Among 100 PD patients (67% male, mean age 5 65.0 ¡ 10.4), VHs were present in 28% of cases; individuals with VHs had worse sleep quality (Pittsburgh Sleep Questionnaire Index) and more severe sleep disturbances [Parkinson's Disease Sleep Scale (PDSS)]. Logistic regression analysis showed that vivid dreams and Unified Parkinson's Disease Rating Scale (UPDRS) I scores (i.e., mentation, behavior, and mood symptoms) are independently associated with VHs. Our data show that the presence of vivid dreams is associated with VHs in PD and reaffirm that VHs are linked to cognitive impairment. Conclusions: Investigating vivid dreams may help the identification of VHs in PD. Identifying vivid dreams can be hard considering that patients may fail to report symptoms for the fear of the stigma associated with psychosis and dementia.