Incidence of RBD and hallucination in patients affected by Parkinson's disease: 8-year follow-up

Abstract

We describe the 8-years follow-up of 80 patients affected by idiopathic, L-dopa-responsive Parkinson's disease. All patients were evaluated at baseline and during the follow-up with visual evoked potential, P300 event related potentials and polysomnography. The patients and their relatives compiled sleep and hallucination questionnaires. Statistical analysis was performed to evaluate if visual abnormalities, abnormal P300 recordings or sleep disturbances were linked to the development and hallucinations. Our results show that abnormal vision and abnormal P300 did not correlate with the incidence of hallucinations. However, the presence of REM sleep behavioral disorder (RBD) was significantly related to the development of hallucinations,independently of age, gender or duration of disease but dependent on the amount of dopaminoagonist treatment.

REM Sleep Behavior Disorder in Parkinson's Disease: A Questionnaire-Based Survey

“…In agreement with a number of reports, 11,13,14,[32][33][34] we found a higher frequency of hallucinations in patients with probable RBD. This finding may have different explanations:…”

Visual Hallucinations in PD and Lewy Body Dementias: Old and New Hypotheses

“…More complex hallucinations are also frequent: hallucinations of faces affect 41-47% and hallucinations of people-like figures affect between 40-71% of patients. Hallucinations in this syndrome are traditionally said to be Lilliputian in character [45], although it is now evident that, like in PD, such miniaturization appears only in a minority of CBS patients [54]. A consistently reported feature is preserved insight into the unreality of the hallucinations, but patient interactions with the hallucinations can occur and 41-59% of patient report a strong emotional salience with the occurrence of these hallucinatory phenomena.…”

“…In patients with cognitive decline as well as the incidence/prevalence of hallucinations being higher, the hallucinations are also qualitatively different, and complex interactions with hallucinatory perceptions are described due to the lack of insight into the unreal nature of perceptions [16,17,43,[54][55][56][57]. Descriptions in the literature have included the patient who interacts with "devils with blurred faces and changing size armed with blades" [16] or quarrels with the hallucinatory presence molesting his wife [58].…”

REM Sleep Behavior Disorder in Parkinson’s Disease and Dementia with Lewy Bodies

“…There are a few recent reports on RBD associated with spinocerebellar atrophy type 3 (Machado-Joseph disease). [63][64][65] As noted above, numerous cases of RBD have been reported in conjunction with MSA, 3,22,23,27,[66][67][68][69][70][71][72] PD, 3,11,22,[24][25][26][27][30][31][32][33][34][35]73 and DLB. 1,10,15,41,45,[47][48][49][50][51][52][53]55,59,60,74 Although frequency data on the presence of RSWA and RBD in the neurodegenerative disorders is based on relatively small numbers of patients thus far, the presence of each in MSA has been reported to be 90% to 95% for RSWA and 68% to 90% for RBD, 66,67 and presence of each in PD is approximately 58% for RSWA and 33% for RBD.…”