Hallucinosis in idiopathic Parkinson's disease

Abstract

Background-Hallucinosis is a complication of the treatment of idiopathic Parkinson's disease commonly thought to aZict older, chronically medicated, cognitively impaired patients. However, patients with idiopathic Parkinson's disease of short durationexperiencinghallucinosisonrelatively low doses of dopaminergic medication have been found. The aim, therefore, was to investigate the homogeneity of a population of patients with idiopathic Parkinson's disease and hallucinosis. Methods-The clinical, demographic, and cognitive correlates of hallucinosis were investigated in a sample of 129 patients with idiopathic Parkinson's disease. Results-There were two subgroups of patients with idiopathic Parkinson's disease experiencing hallucinosis. In patients with a disease duration of five years or less, hallucinosis was associated with rapid progression of the motor component of the disease but not cognitive impairment. In patients with idiopathic Parkinson's disease of longer than five years duration, hallucinosis was associated with postural instability, global cognitive impairment, and lack of depressive aVect. In all patients with idiopathic Parkinson's disease, hallucinosis was more prevalent when they were treated with a direct acting dopamine receptor agonist. Hallucinosis was not associated with age at onset of idiopathic Parkinson's disease or dosage of dopaminergic medication. Conclusion-Hallucinosis in idiopathicParkinson's disease is heterogeneous, falling into two groups. The diVerence in the pathophysiological basis of hallucinosis in these two groups of patients is discussed.

Klinik und Therapie der Parkinson-Psychose

“…Die Prävalenz psychotischer Symptome bei Parkinson-Patienten lag vor Einführung der dopaminergen Therapie bei 5-10 % [5] und wird heute mit 15-40 % [6][7][8][9][10][11][12][13][14][15] angegeben. Fénelon und Mitarbeiter untersuchten 216 ambulante Parkinson-Patienten mit einer mittleren Krankheitsdauer von 9 Jahren und fanden für Halluzinationen eine Präva-lenz von 40 % innerhalb der letzten drei Monate und eine Lebenszeitprävalenz von 46 % [12].…”

“…illusionären Verkennungen mit völlig erhaltener Einsicht bis zu schwersten paranoiden Psychosen, die wegen der dabei häufig erforderlichen starken Reduktion der Parkinson-Medikation zu einer bedrohlichen Verschlechterung der motorischen Parkinson-Symptomatik führen können. Visuelle Halluzinationen stellen die häufigste psychotische Störung bei Parkinson-Patienten dar [7,9,12]. Geformte visuelle Halluzinationen bestehen in einfachen oder detailreichen, häufig farbintensiven Bildern von Menschen oder Tieren, seltener von Objekten.…”

Thalamic Hyperperfusion in Verbal Hallucination of Parkinsonian Patients

“…Hallucinations are common symptoms in these patients. Visual hallucinations are a well recognized problem in patients with Parkinson's disease (3)(4)(5)(6), whereas auditory hallucinations are less common (7)(8)(9). As a result, information about the mechanism of auditory hallucinations in Parkinson's disease is not generally available.…”

A proposal for a semantic change in the current diagnostic criteria of Parkinson’s disease Psychosis

“…Graham et al [2], reported that 70% of their patients with hallucinations had retained insight. This seems a contradiction because psychosis is a mental disorder characterized by symptoms, such as delusions or hallucinations that indicate an impaired contact with reality [3].…”