Journal of Neurology

, Volume 254, Issue 4, pp 448–452

Relationship between age and subtypes of psychotic symptoms in Parkinson's disease

  • Günes Kiziltan
  • Sibel Özekmekçi
  • Sibel Ertan
  • Turan Ertan
  • Ethem Erginöz



Psychotic symptoms (PS) in Parkinson's disease (PD) usually develop as a side effect of the dopaminergic therapy and consist of hallucinations and delusions. We observed that PD patients who developed delusions tend to be younger than those with hallucinations and we aimed to investigate the validity of this observation.


The medical records of 127 PD patients with PS were reviewed and 76 patients who were on treatment with dopamine agonists with or without levodopa at the time of developing PS were included. Patients were stratified into 3 groups according to the subtypes of PS: patients with solely hallucinations (n = 46), solely delusions (n = 18), and both types (n = 12). The groups were compared with respect to the age-at-onset of PD and PS, duration of PD, Activities of Daily Living (ADL) and motor subscale scores of Unified PD Rating Scale (UPDRS), and levodopa equivalent dose of the dopaminergic agents administered at the time of PS onset.


The mean age-atonset of PD and PS was significantly younger (p = 0.0001) in patients with delusions (49 and 55.9 years) than those with hallucinations (61.9 and 68.9 years). The same parameters were also significantly different (p = 0.002 and p = 0.001, respectively) between the groups of patients with concurrent delusions and hallucinations (51.7 and 57.2 years) and those with only hallucinations. ADL and motor subscale scores were higher in patients with hallucinations (p = 0.016 and p = 0.013) compared with those noted in patients with delusions despite similar disease duration. The mean levodopa equivalent doses of the dopaminergic agents administered at the time of onset of PS did not differ between the groups.


This study supported an association of delusions with younger onset of both PD and psychosis as compared with hallucinations. However, additional factors related to this association remain to be elucidated.

Key words

Parkinson's disease age psychosis hallucination delusion 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Poewe W (2003) Psychosis in Parkinson's disease. Mov Disord 18(suppl 6):S80–S87PubMedCrossRefGoogle Scholar
  2. 2.
    Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE, The 056 Study Group (2000) A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. N Engl J Med 342:1484–1491PubMedCrossRefGoogle Scholar
  3. 3.
    Wolters EC (1999) Dopaminomimetic psychosis in Parkinson's disease patients. Neurology 52(suppl 3):S10–S13PubMedGoogle Scholar
  4. 4.
    Bodis-Wollner I (2003) Neuropsychological and perceptual defects in Parkinson's disease. Parkinsonism Relat Disord 9:S83–S89PubMedCrossRefGoogle Scholar
  5. 5.
    Holroyd S, Currie L, Wooten GF (2001) Prospective study of hallucinations and delusions in Parkinson's disease. J Neurol Neurosurg Psychiatry 70:734–748PubMedCrossRefGoogle Scholar
  6. 6.
    Inzelberg R, Kipervasser S, Korczyn AD (1998) Auditory hallucinations in Parkinson's disease. J Neurol Neurosurg Psychiatry 64:533–535PubMedGoogle Scholar
  7. 7.
    Tanner CM, Vogel C, Goetz CG, Klawans HL (1983) Hallucinations in Parkinson's disease: a populational study [abstract]. Ann Neurol 14:136Google Scholar
  8. 8.
    Aarsland D, Larsen JP, Lim NG, et al. (1999) Range of neuropsychiatric disturbances in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 67:492–496PubMedGoogle Scholar
  9. 9.
    Fenelon G, Mahieux F, Huon R, Ziegler M (2000) Hallucinations in Parkinson's disease. Prevalence, phenomenology and risk factors. Brain 123:733–745PubMedCrossRefGoogle Scholar
  10. 10.
    Aarsland D, Larsen JP, Cummings JL, Laake K (1999) Prevalence and clinical correlates of psychotic symptoms in Parkinson's disease: a communitybased study. Arch Neurol 56:595–601PubMedCrossRefGoogle Scholar
  11. 11.
    Sanchez-Ramos JR, Ortoll R, Paulson GW (1996) Visual hallucinations associated with Parkinson's disease. Arch Neurol 53:1265–1268PubMedGoogle Scholar
  12. 12.
    Moskowitz C, Moses H, Klawans HL (1978) Levodopa-induced psychosis: a kindling phenomenon. Am J Psychiatry 135:669–675Google Scholar
  13. 13.
    Goetz CG (1999) Hallucinations in Parkinson's disease: the clinical syndrome. Adv Neurol 80:419–423PubMedGoogle Scholar
  14. 14.
    Factor SA, Feustel PJ, Friedman JH, et al. (2003) Longitudinal outcome of Parkinson's disease with psychosis. Neurology 60:1756–1761PubMedGoogle Scholar
  15. 15.
    Khan NL, Graham E, Critchley P, et al. (2003) Parkin disease: a phenotypic study of a large case series. Brain 126:1279–1292PubMedCrossRefGoogle Scholar
  16. 16.
    Barnes J, David AS (2001) Visual hallucinations in Parkinson's disease: a review and phenomenology survey. J Neurol Neurosurg Psychiatry 70:727–733PubMedCrossRefGoogle Scholar
  17. 17.
    Papapetropoulos S, Argyriou AA, Ellul J (2005) Factors associated with drug induced visual hallucinations in Parkinson's disease. J Neurol 252:1223–1228PubMedCrossRefGoogle Scholar
  18. 18.
    Graham JM, Grunewald RA, Sagar HJ (1997) Hallucinosis in idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 63:434–440PubMedGoogle Scholar
  19. 19.
    de Maindreville AD, Fenelon G, Mahieux F (2005) Hallucinations in Parkinson's disease: A follow-up study. Mov Disord 20:212–217PubMedCrossRefGoogle Scholar
  20. 20.
    Klein C, Kömpf D, Pulkowski U, Moser A, Vieregge P (1997) A study of visual hallucinations in patients with Parkinson's disease. J Neurol 244:371–377PubMedCrossRefGoogle Scholar
  21. 21.
    Giladi N, Treves TA, Paleacu D, et al. (2000) Risk factors for dementia, depression and psychosis in longstanding Parkinson's disease. J Neural Transm 107:59–71PubMedCrossRefGoogle Scholar
  22. 22.
    Buttner T, Kuhn W, Muller T, Heinze T, Puhl C, Przuntek H (1996) Chromatic and achromatic visual evoked potentials in Parkinson's disease. Electroencephalogr Clin Neurophysiol 100:443–447PubMedGoogle Scholar
  23. 23.
    Diederich NJ, Goetz CG, Raman R, Pappert EJ, Leurgans S, Piery V (1998) Poor visual discrimination and visual hallucinations in Parkinson's disease. Clin Neuropharmacol 21:289–295PubMedGoogle Scholar
  24. 24.
    Goetz CG, Leurgans S, Pappert EJ, Raman R, Stemer AB (2001) Prospective longitudinal assessment of hallucinations in Parkinson's disease. Neurology 57:2078–2082PubMedGoogle Scholar
  25. 25.
    Özekmekçi S, Ertan S, Kiziltan G, Ertan T, Erginöz E (2004) Relationship between age and type of psychotic symptoms in Parkinson's disease [abstract]. Mov Disord 19(suppl 9):S154–S155Google Scholar
  26. 26.
    Hughes AJ, Daniel SE, Kilford L, Lees AJ (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico- pathological study of 100 cases. J Neurol Neurosurg Psychiatry 55:181–184CrossRefGoogle Scholar
  27. 27.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. APA, Washington DCGoogle Scholar
  28. 28.
    Fahn S, Elton RS, members of the UPDRS Development Committee (1987) Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent Developments in Parkinson's disease. NJ: Macmillan, Florham Park, pp 153–163Google Scholar
  29. 29.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442PubMedCrossRefGoogle Scholar
  30. 30.
    Goetz CG, Blasucci L, Stebbins GT (1999) Switching dopamine agonists in advanced Parkinson's disease. Is rapid titration preferable to slow? Neurology 52:1227–1229PubMedGoogle Scholar
  31. 31.
    Grosset K, Needleman F, Macphee G, Grosset D (2004) Switching from ergot to nonergot dopamine agonists in Parkinson's disease: A clinical series and five-drug dose conversion table. Mov Disord 19:1370–1374PubMedCrossRefGoogle Scholar
  32. 32.
    Goetz GG, Wuu J, Curgian LM, Leurgans S (2005) Hallucinations and sleep disorders in PD. Neurology 64:81–86PubMedCrossRefGoogle Scholar
  33. 33.
    Lindholm E, Ekholm B, Shaw S, et al. (2001) A schizophrenia-susceptibility locus at 6q25, in one of the world's largest reported pedigrees. Am J Hum Genet 69:96–105PubMedCrossRefGoogle Scholar
  34. 34.
    Cannas A, Spissu A, Floris GL, et al. (2001) Chronic delusional hallucinatory psychosis in early-onset Parkinson's disease: drug-induced complication or sign of an idiopathic psychiatric illness? Neurol Sci 22:53–54PubMedCrossRefGoogle Scholar
  35. 35.
    Moser A, Hagenah J, Kompf D (2003) Hallucinations in Parkinson's disease. Nervenarzt 74:376–386PubMedCrossRefGoogle Scholar
  36. 36.
    Bailbe M, Karolewicz S, Neau JP, Dumas P, Gil R; et l'association des neurologues du Poito-Charentes (2002) Hallucinations, delusions, and nocturnal events in 152 Parkinson's patients: a regional survey. Rev Neurol (Paris)158:203–210Google Scholar
  37. 37.
    Goetz CG, Tanner CM, Klawans HL (1982) Pharmacology of hallucinations induced by long-term drug therapy. Am J Psychiatry 139:494–497PubMedGoogle Scholar
  38. 38.
    Parkinson Study Group (2000) Pramipexole vs. levodopa as initial treatment for Parkinson's disease. JAMA 284:1931–1938CrossRefGoogle Scholar
  39. 39.
    Oertel WH, Wolters E, Sampaio C, et al. (2006) Pergolide Versus Levodopa Monotherapy in Early Parkinson's Disease Patients: The PELMOPET Study. Mov Disord 21:343–353PubMedCrossRefGoogle Scholar
  40. 40.
    Goetz CG, Pappert EJ, Blasucci LM, et al. (1998) Intravenous levodopa in hallucinating Parkinson's disease patients: high dose challenge does not precipitate hallucinations. Neurology 50:515–517PubMedGoogle Scholar
  41. 41.
    Merims D, Shabtai H, Korczyn AD, Peretz C, Weizman N, Giladi N (2004) Antiparkinsonian medication is not a risk factor for the development of hallucinations in Parkinson's disease. J Neural Transm 111:1447–1453PubMedCrossRefGoogle Scholar
  42. 42.
    Ballard C, Piggott M, Johnson M, et al. (2000) Delusions associated with elevated muscarinic binding in dementia with Lewy bodies. Ann Neurol 48:868–876PubMedCrossRefGoogle Scholar
  43. 43.
    Teaktong T, Piggott MA, McKeith IG, Perry RH, Ballard CG, Perry EK (2005) Muscarinic M2 and M4 receptors in anterior cingulate cortex: relation to neuropsychiatric symptoms in dementia with Lewy bodies. Behav Brain Res 161:299–305PubMedCrossRefGoogle Scholar
  44. 44.
    Graham JM, Sagar HJ (1999) A datadriven approach to the study of heterogeneity in idiopathic Parkinson's disease: identification of three distinct subtypes. Mov Disord 14:10–20PubMedCrossRefGoogle Scholar
  45. 45.
    Gasparoli E, Delibori D, Polesello G, et al. (2002) Clinical predictors in Parkinson's disease. Neurol Sci 23(suppl 2):S77–S78PubMedCrossRefGoogle Scholar

Copyright information

© Steinkopff-Verlag 2007

Authors and Affiliations

  • Günes Kiziltan
    • 1
  • Sibel Özekmekçi
    • 1
  • Sibel Ertan
    • 1
  • Turan Ertan
    • 2
  • Ethem Erginöz
    • 3
  1. 1.Dept. of NeurologyUniversity of Istanbul, Cerrahpasa Faculty of MedicineIstanbulTurkey
  2. 2.Dept. of PsychiatryUniversity of Istanbul, Cerrahpasa Factulty of MedicineIstanbulTurkey
  3. 3.Community Medicine CenterUniversity of Istanbul, Cerrahpasa Faculty of MedicineIstanbulTurkey

Personalised recommendations