Minor hallucinations in Parkinson disease A subtle symptom with major clinical implications (original) (raw)
Related papers
Hallucinations and the spectrum of psychosis in Parkinson's disease
Journal of the Neurological Sciences, 2017
Hallucinations and psychosis can be a part of Parkinson's disease and are considered to be a nonmotor symptom or a neuropsychiatric complication of the disease. Hallucinations of different modalities and delusions can occur beyond the common visual hallucinations. The various types of hallucinations and psychotic symptoms comprising the spectrum of Parkinson's disease psychosis is the subject of this review article.
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 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.
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.
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.
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.
SAGE Open, 2015
Background Research estimates that visual hallucinations (VHs) occur in patients who have Parkinson's disease (PD) with a prevalence that ranges from 8% to 40%, (Barnes & David, 2001) and give rise to an extremely common and often distressing psychiatric disturbance in patients (Aarsland et al., 1999). Although the exact cognitive mechanisms that are necessary for VHs to occur have not yet been determined, many different lines of evidence are emerging, indicating that hallucinations show a relationship with sleep disturbances and cognitive disruption (
A questionnaire-based (UM-PDHQ) study of hallucinations in Parkinson's disease
BMC …, 2008
Background: Hallucinations occur in 20-40% of PD patients and have been associated with unfavorable clinical outcomes (i.e., nursing home placement, increased mortality). Hallucinations, like other non-motor features of PD, are not well recognized in routine primary/secondary clinical practice. So far, there has been no instrument for uniform characterization of hallucinations in PD. To this end, we developed the University of Miami Parkinson's disease Hallucinations Questionnaire (UM-PDHQ) that allows comprehensive assessment of hallucinations in clinical or research settings. Methods: The UM-PDHQ is composed of 6 quantitative and 14 qualitative items. For our study PD patients of all ages and in all stages of the disease were recruited over an 18-month period. The UPDRS, MMSE, and Beck Depression and Anxiety Inventories were used for comparisons. Results and Discussion: Seventy consecutive PD patients were included in the analyses. Thirtyone (44.3%) were classified as hallucinators and 39 as non-hallucinators. No significant group differences were observed in terms of demographics, disease characteristics, stage, education, depressive/anxiety scores or cognitive functioning (MMSE) between hallucinators and nonhallucinators. Single mode hallucinations were reported in 20/31 (visual/14, auditory/4, olfactory/2) whereas multiple modalities were reported in 11/31 patients. The most common hallucinatory experience was a whole person followed by small animals, insects and reptiles. Conclusion: Using the UM-PDHQ, we were able to define the key characteristics of hallucinations in PD in our cohort. Future directions include the validation of the quantitative part of the questionnaire than will serve as a rating scale for severity of hallucinations.
Multi-Modal Hallucinations and Cognitive Function in Parkinson’s Disease
Dementia and Geriatric Cognitive Disorders, 2010
Background/Aims: Hallucinations have been linked to a constellation of cognitive deficits in Parkinson’s disease (PD), but it is not known whether multi-modal hallucinations are associated with greater neuropsychological dysfunction. Methods: 152 idiopathic PD patients were categorized based on the presence or absence of hallucinations and then were further subdivided into visual-only (VHonly; n = 35) or multi-modal (VHplus; n = 12) hallucination groups. All participants underwent detailed neuropsychological assessment. Results: Participants with hallucinations performed more poorly on select neuropsychological measures and exhibited more mood symptoms. There were no differences between VHonly and VHplus groups. Conclusions: PD patients with multi-modal hallucinations are not at greater risk for neuropsychological impairment than those with single-modal hallucinations.