Objective-This study was undertaken to determine the prevalence of hallucinations and delusions in Parkinson's disease, to describe such symptoms phenomenologically, and possibly to determine factors associated with their development. In addition, the role of the visual system in relation to visual hallucinations was examined. Method-102 consecutive patients diagnosed with strictly defined Parkinson's disease were examined for the presence of hallucinations and delusions and assessed for visual acuity, cognition, depression using the geriatric depression scale, disease severity as measured by the UPDRS, and other clinical variables. Results-Of 102 consecutive patients, 29.4% (n=30) had hallucinations or delusions, four (3.9%) were determined to be psychotic due solely to delirium and were excluded from further analysis. Of the 98 remaining patients, 26.5% (n=26) had visual hallucinations. Among these, one patient also had delusions, two had auditory hallucinations, and one had gustatory hallucinations. Visual hallucinations were significantly associated with worse visual acuity, lower cognitive score, higher depression score, and worse disease severity. Hallucinations were not associated with history of psychiatric disease, dose or duration of levodopa or other antiparkinsonian medication treatment, or duration of illness. Conclusions-Visual hallucinations are common symptoms in Parkinson's disease and are most likely of multifactorial origin. Although higher doses of levodopa are known to be related clinically to hallucinations in individual patients, the results suggest that several underlying characteristics of patients with Parkinson's disease (disease severity, dementia, depression, worse visual acuity) may be more important determinants of which patients experience hallucinations. The data also provide preliminary evidence that abnormality of the visual system may be related to visual hallucinations in Parkinson's disease, as has been found in other disorders with visual hallucinations. (J Neurol Neurosurg Psychiatry 2001;70:734-738)

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The Prophy-Jet was evaluated for its effectiveness in removing plaque and stain from teeth and on its effects on the marginal gingiva. Using a randomized split-mouth design, half the mouth was treated with the Prophy-Jet and the contralateral side with a rubber cup and prophylaxis paste. The results indicated that the Prophy-Jet removes tooth plaque and stain as well as the rubber cup and prophylaxis paste method, and does so in less time. It was also found that there was some immediate soft tissue trauma following both treatment modalities, with a mean Trauma Index score of 0.23 not equal to 0.16 for the rubber cup and prophylaxis paste and 0.75 not equal to 0.37 for the Prophy-Jet. Within 6 days, the trauma index scores were not significantly different. Similar results were found for marginal gingival redness and bleeding on probing. The Prophy-Jet is an excellent alternative instrument for removal of tooth stain and dental plaque.

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The results suggest physicians should better involve patients and their families in disclosing diagnoses and information regarding dementia. The results also suggest the current AMA guidelines to inform patients their diagnosis of dementia are inadequate to address the clinical complexities of this issue.