Neuropsychology Review

, Volume 28, Issue 3, pp 310–316 | Cite as

Delusions in Parkinson’s Disease: A Systematic Review of Published Cases

  • Nicola WarrenEmail author
  • Cullen O’Gorman
  • Zena Hume
  • Steve Kisely
  • Dan Siskind


Delusions in Parkinson’s disease (PD) are thought to be associated with disease progression and cognitive impairment. However, this symptom description is not consistent in the literature and there is a suggestion that different subgroups of psychotic patients occur in PD, which we aimed to clarify. Case reports were identified through a systematic search of databases (PUBMED, EMBASE, PsychInfo). Cases with isolated delusions were compared to those with both delusions and hallucinations. We identified 184 cases of delusions in PD. Delusions were primarily paranoid in nature (83%) and isolated in 50%. Those with isolated delusions had an earlier onset of PD (46 years vs 55 years), higher rates of impulse control disorders (40.2 vs 10.3%), dopamine dysregulation (29.9 vs 11.3%) and lower rates of cognitive impairment (8.0 vs 26.8%). There is unexpected heterogeneity amongst cases of delusional psychosis, that cannot adequately be explained by existing models of PD psychosis.


Parkinson’s disease Psychosis Delusion Dopamine Systematic review 



This work was conducted without financial support. Dr. Siskind is partially supported through a grant from NHMRC (ECF APP1111136).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study formal consent is not required.

Supplementary material

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ESM 1 (DOCX 27.9 kb)


  1. Aarsland, D., Larsen, J. P., Cummins, J. L., & Laake, K. (1999). Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: A community-based study. Archives of Neurology, 56(5), 595–601. Scholar
  2. Barone, P., Antonini, A., Colosimo, C., Marconi, R., Morgante, L., Avarello, T. P., et al. (2009). The PRIAMO study: A multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Movement Disorders, 24(11), 1641–1649. CrossRefPubMedGoogle Scholar
  3. Brewer, J. A., & Potenza, M. N. (2008). The neurobiology and genetics of impulse control disorders: Relationships to drug addictions. Biochemical Pharmacology, 75(1), 63–75. Scholar
  4. Cilia, R., Siri, C., Canesi, M., Zecchinelli, A. L., De Gaspari, D., Natuzzi, F., et al. (2014). Dopamine dysregulation syndrome in Parkinson's disease: From clinical and neuropsychological characterisation to management and long-term outcome. Journal of Neurology, Neurosurgery, & Psychiatry, 85(3), 311–318. Scholar
  5. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Earlbaum Associates.Google Scholar
  6. Cummings, J. L. (1985). Organic delusions: Phenomenology, anatomical correlations, and review. British Journal of Psychiatry, 146(2), 184–197. Scholar
  7. Djamshidian, A., O’Sullivan, S. S., Sanotsky, Y., Sharman, S., Matviyenko, Y., Foltynie, T., et al. (2012). Decision-making, impulsivity and addictions: Do Parkinson’s disease patients jump to conclusions? Movement Disorders, 27(9), 1137–1145. CrossRefPubMedPubMedCentralGoogle Scholar
  8. Eskow Jaunarajs, K. L., Angoa-Perez, M., Kuhn, D. M., & Bishop, C. (2011). Potential mechanisms underlying anxiety and depression in Parkinson's disease: Consequences of l-DOPA treatment. Neuroscience & Biobehavioral Reviews, 35(3), 556–564. Scholar
  9. Factor, S. A., Scullin, M. K., Sollinger, A. B., Land, J. O., Wood-Siverio, C., Zanders, L., et al. (2014). Cognitive correlates of hallucinations and delusions in Parkinson's disease. Journal of Neurological Science, 347(1–2), 316–321. CrossRefGoogle Scholar
  10. Ffytche, D. H., Creese, B., Politis, M., Chaudhuri, K. R., Weintraub, D., Ballard, C., et al. (2017a). The psychosis spectrum in Parkinson disease. Nature Reviews Neurology, 13(2), 81–95.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Ffytche, D. H., Pereira, J. B., Ballard, C., Chaudhuri, K. R., Weintraub, D., & Aarsland, D. (2017b). Risk factors for early psychosis in PD: Insights from the Parkinson's progression markers initiative. Journal of Neurology, Neurosurgery, & Psychiatry, 88(4), 325–331. Scholar
  12. Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state." a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. Scholar
  13. Forsaa, E. B., Larsen, J. P., Wentzel-Larsen, T., Goetz, C. G., Stebbins, G. T., Aarsland, D., & Alves, G. (2010). A 12-year population-based study of psychosis in Parkinson disease. Archives of Neurology, 67(8), 996–1001. CrossRefPubMedGoogle Scholar
  14. Holroyd, S., Currie, L., & Wooten, G. F. (2001). Prospective study of hallucinations and delusions in Parkinson's disease. Journal of Neurology, Neurosurgery, & Psychiatry, 70(6), 734–738. Scholar
  15. Islam, L., Piacentini, S., Soliveri, P., Scarone, S., & Gambini, O. (2015). Capgras delusion for animals and inanimate objects in Parkinson's disease: A case report. BMC Psychiatry, 15, 73. Scholar
  16. Ismail, Z., Nguyen, M.-Q., Fischer, C. E., Schweizer, T. A., Mulsant, B. H., & Mamo, D. (2011). Neurobiology of delusions in Alzheimer’s disease. Current Psychiatry Reports, 13(3), 211. Scholar
  17. Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry, 160(1), 13–23. Scholar
  18. Kish, S. J., Shannak, K., & Hornykiewicz, O. (1988). Uneven pattern of dopamine loss in the striatum of patients with idiopathic Parkinson's disease. New England Journal of Medicine, 318(14), 876–880. Scholar
  19. Kiziltan, G., Ozekmekci, S., Ertan, S., Ertan, T., & Erginoz, E. (2007). Relationship between age and subtypes of psychotic symptoms in Parkinson's disease. Journal of Neurology, 254(4), 448–452. Scholar
  20. Lee, A. H., & Weintraub, D. (2012). Psychosis in Parkinson's disease without dementia: Common and comorbid with other non-motor symptoms. Movement Disorders, 27(7), 858–863. Scholar
  21. Linazasoro, G. (2009). Dopamine dysregulation syndrome and levodopa-induced dyskinesias in Parkinson disease: Common consequences of anomalous forms of neural plasticity. Clinical Neuropharmacology, 32(1), 22–27. PubMedCrossRefGoogle Scholar
  22. Mack, J., Rabins, P., Anderson, K., Goldstein, S., Grill, S., Hirsch, E. S., et al. (2012). Prevalence of psychotic symptoms in a community-based Parkinson disease sample. American Journal of Geriatric Psychiatry, 20(2), 123–132. Scholar
  23. McKeith, I. G., Dickson, D. W., Lowe, J., Emre, M., O’Brien, J. T., Feldman, H., et al. (2005). Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium. Neurology, 65, 1863–1872. Scholar
  24. Miller, R. G., Jr. (1966). Simultaneous statistical inference: McGraw-Hill Book Co,
  25. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & Group, P. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. British Medical Journal, 339, b2535. Scholar
  26. Morgante, L., Colosimo, C., Antonini, A., Marconi, R., Meco, G., Pederzoli, M., et al. (2012). Psychosis associated to Parkinson's disease in the early stages: Relevance of cognitive decline and depression. Journal of Neurology, Neurosurgery &, Psychiatry, 83(1), 76–82. Scholar
  27. Moskovitz, C., Moses 3rd, H., & Klawans, H. L. (1978). Levodopa-induced psychosis: A kindling phenomenon. The American Journal of Psychiatry, 135(6), 669–675. Scholar
  28. Pacchetti, C., Manni, R., Zangaglia, R., Mancini, F., Marchioni, E., Tassorelli, C., et al. (2005). Relationship between hallucinations, delusions, and rapid eye movement sleep behavior disorder in Parkinson's disease. Movement Disorders, 20(11), 1439–1448. CrossRefPubMedGoogle Scholar
  29. Pagano, G., Ferrara, N., Brooks, D. J., & Pavese, N. (2016). Age at onset and Parkinson disease phenotype. Neurology, 86(15), 1400–1407. Scholar
  30. Poletti, M., & Bonuccelli, U. (2013). From aberrant salience to jumping to conclusions: Dopaminergic pathways to delusions in Parkinson disease. Journal of Clinical Psychopharmacology, 33(2), 149–151. Scholar
  31. Pringsheim, T., Jette, N., Frolkis, A., & Steeves, T. D. (2014). The prevalence of Parkinson's disease: A systematic review and meta-analysis. Movement Disorders, 29(13), 1583–1590. Scholar
  32. Ravina, B., Marder, K., Fernandez, H. H., Friedman, J. H., McDonald, W., Murphy, D., et al. (2007). Diagnostic criteria for psychosis in Parkinson's disease: Report of an NINDS, NIMH work group. Movement Disorders, 22(8), 1061–1068. CrossRefPubMedGoogle Scholar
  33. Schattner, A., Kitroser, E., & Cohen, J. D. (2016). Fatal neuroleptic malignant syndrome associated with quetiapine. Amican Journal of Therapeutics, 23(5), e1209–e1210. Scholar
  34. Sharman, M., Valabregue, R., Perlbarg, V., Marrakchi-Kacem, L., Vidailhet, M., Benali, H., Brice, A., & Lehéricy, S. (2013). Parkinson's disease patients show reduced cortical-subcortical sensorimotor connectivity. Movement Disorders, 28(4), 447–454. Scholar
  35. Son, S. J., Kim, M., & Park, H. (2016). Imaging analysis of Parkinson's disease patients using SPECT and tractography. Scientific Reports, 6, 38070. Scholar
  36. Stefanis, N., Bozi, M., Christodoulou, C., Douzenis, A., Gasparinatos, G., Stamboulis, E., et al. (2010). Isolated delusional syndrome in Parkinson's disease. Parkinsonism & Related Disorders, 16(8), 550–552. Scholar
  37. Tomlinson, C. L., Stowe, R., Patel, S., Rick, C., Gray, R., & Clarke, C. E. (2010). Systematic review of levodopa dose equivalency reporting in Parkinson's disease. Movement Disorders, 25(15), 2649–2653. Scholar
  38. Vazquez, A., Jimenez-Jimenez, F. J., Garcia-Ruiz, P., & Garcia-Urra, D. (1993). "Panic attacks" in Parkinson's disease. A long-term complication of levodopa therapy. Acta Neurologia Scandinavia, 87(1), 14–18.CrossRefGoogle Scholar
  39. Warren, N., O'Gorman, C., Lehn, A., & Siskind, D. (2017). Dopamine dysregulation syndrome in Parkinson's disease: A systematic review of published cases. Journal of Neurology, Neurosurgery, & Psychiatry.
  40. Weintraub, D., Koester, J., Potenza, M. N., Siderowf, A. D., Stacy, M., Voon, V., et al. (2010). Impulse control disorders in parkinson disease: A cross-sectional study of 3090 patients. Archives of Neurology, 67(5), 589–595. CrossRefPubMedGoogle Scholar
  41. Wickremaratchi, M. M., Ben-Shlomo, Y., & Morris, H. R. (2009). The effect of onset age on the clinical features of Parkinson's disease. European Journal of Neurology, 16(4), 450–456. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Nicola Warren
    • 1
    • 2
    Email author
  • Cullen O’Gorman
    • 1
    • 3
  • Zena Hume
    • 2
  • Steve Kisely
    • 1
    • 2
  • Dan Siskind
    • 1
    • 2
  1. 1.School of MedicineUniversity of QueenslandBrisbaneAustralia
  2. 2.Metro South Addiction and Mental Health ServiceBrisbaneAustralia
  3. 3.Department of NeurologyPrincess Alexandra HospitalBrisbaneAustralia

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