Journal of Neurology

, Volume 252, Issue 10, pp 1223–1228 | Cite as

Factors associated with drug–induced visual hallucinations in Parkinson's disease

ORIGINAL COMMUNICATION

Abstract

Aims

Visual hallucinations are common in medicationtreated Parkinson's disease (PD) patients. Although their etiology is unknown several factors seem to be involved in their pathogenesis. The aim of this study was to identify possible risk factors and determine clinical characteristics associated with the development of visual hallucinations in PD.

Methods

166 consecutive patients fulfilling clinical criteria for PD were studied. During a semi–structured interview, demographic characteristics and clinical variables were recorded. Motor, cognitive and psychiatric status was also assessed. Patients with and without visual hallucinations were compared using non–parametric tests, and logistic regression was applied to significant data.

Results

During the month before evaluation 20.4% of our patients experienced visual hallucinations (11.4% benign, 9% malignant). Logistic regression analysis identified three factors independently associated with visual hallucinations: long duration of Parkinson's disease, dementia, and disease severity as measured by the UPDRS total score.

Conclusions

Our findings indicate that apart from well established risk factors such as cognitive impairment and disease duration, disease severity is also important for the development of visual hallucinations in PD. Furthermore, the presence of bradykinesia and instability, the absence of tremor and the severity of rigidity and bradykinesia (limb and axial) may act as cofactors.

Key words

Parkinson's disease hallucinations risk factors clinical phenotype 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Aarsland D, Ballard C, Larsen JP, et al. (2001) A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia. Int J Geriatr Psychiatry 16(5):528–536CrossRefPubMedGoogle Scholar
  2. 2.
    Aarsland D, Larsen JP, Cummins JL, et al. (1999) Prevalence and clinical correlates of psychotic symptoms in Parkinson disease:a community–based study. Arch Neurol 56(5):595–601CrossRefPubMedGoogle Scholar
  3. 3.
    American Psychiatric Association (1987) Diagnostic and Statistical Manual for Psychiatric Disorders. Revised third edition (ed) American Psychiatric Association. Washington, DCGoogle Scholar
  4. 4.
    Barclay CL, Hildebrand K, Gray P, et al. (1997) Risk factors for the development of psychosis in Parkinson's disease. Mov Disord 12(Suppl. 1):108Google Scholar
  5. 5.
    Barnes J, David AS (2001) Visual hallucinations in Parkinson's disease:a review and phenomenological survey. J Neurol Neurosurg Psychiatry 70(6):727–733 CrossRefPubMedGoogle Scholar
  6. 6.
    Carter JH, Stewart BJ, Archbold PG, et al. (1998) Living with a person who has Parkinson's disease:the spouse's perspective by stage of disease. Parkinson's Study Group. Mov Disord 13(1):20–28CrossRefPubMedGoogle Scholar
  7. 7.
    7. Fahn S, Elton RL, Committee (1987) MotUd, Unified Parkinson's disease rating scale in Recent developments in Parkinson's disease. Macmillan healthcare information, pp 153–163Google Scholar
  8. 8.
    Fenelon G, Mahieux F, Huon R, et al. (2000) Hallucinations in Parkinson's disease:prevalence, phenomenology and risk factors. Brain 123(Pt 4):733–745CrossRefPubMedGoogle Scholar
  9. 9.
    Folstein MF, Folstein SE, McHugh PR (1975) "Mini–mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198CrossRefPubMedGoogle Scholar
  10. 10.
    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(2):515–517PubMedGoogle Scholar
  11. 11.
    Goetz CG, Stebbins GT (1995) Mortality and hallucinations in nursing home patients with advanced Parkinson's disease. Neurology 45(4):669–671PubMedGoogle Scholar
  12. 12.
    Goetz CG, Stebbins GT (1993) Risk factors for nursing home placement in advanced Parkinson's disease. Neurology 43(11):2227–2229PubMedGoogle Scholar
  13. 13.
    Goetz CG, Vogel C, Tanner CM, et al. (1998) Early dopaminergic drug–induced hallucinations in parkinsonian patients. Neurology 51(3):811–814PubMedGoogle Scholar
  14. 14.
    Graham JM, Grunewald RA, Sagar HJ (1997) Hallucinosis in idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 63(4):434–440PubMedGoogle Scholar
  15. 15.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442PubMedGoogle Scholar
  16. 16.
    Holroyd S (1996) Visual hallucinations in a geriatric psychiatry clinic:prevalence and associated diagnoses. J Geriatr Psychiatry Neurol 9(4):171–175PubMedGoogle Scholar
  17. 17.
    Holroyd S, Currie L, Wooten GF (2001) Prospective study of hallucinations and delusions in Parkinson's disease. J Neurol Neurosurg Psychiatry 70(6):734–738 CrossRefPubMedGoogle Scholar
  18. 18.
    Hughes AJ, Daniel SE, Kilford L, et al. (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease:a clinico–pathological study of 100 cases (see comments). J Neurol Neurosurg Psychiatry 55(3):181–184PubMedGoogle Scholar
  19. 19.
    Inzelberg R, Kipervasser S, Korczyn AD (1998) Auditory hallucinations in Parkinson's disease. J Neurol Neurosurg Psychiatry 64(4):533–535PubMedGoogle Scholar
  20. 20.
    Ismail MS, Richard IH (2004) A reality test:How well do we understand psychosis in Parkinson's disease? J Neuropsychiatry Clin Neurosci 16(1):8–18PubMedGoogle Scholar
  21. 21.
    McKeith I, Mintzer J, Aarsland D, et al. (2004) Dementia with Lewy bodies. Lancet Neurol 3(1):19–28 CrossRefPubMedGoogle Scholar
  22. 22.
    McKeith IG, Fairbairn AF, Bothwell RA, et al. (1994) An evaluation of the predictive validity and inter–rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type. Neurology 44(5):872–877PubMedGoogle Scholar
  23. 23.
    McKeith IG, Galasko D, Kosaka K, et al. (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB):report of the consortium on DLB international workshop. Neurology 47(5):1113–1124PubMedGoogle Scholar
  24. 24.
    Morris SK, Olichney JM, Corey–Bloom J (1998) Psychosis in Dementia With Lewy Bodies. Semin Clin Neuropsychiatry 3(1):51–60PubMedGoogle Scholar
  25. 25.
    Moskovitz C, Moses H, 3rd, Klawans HL (1978) Levodopa–induced psychosis:a kindling phenomenon. Am J Psychiatry 135(6):669–675PubMedGoogle Scholar
  26. 26.
    Naimark D, Jackson E, Rockwell E, et al. (1996) Psychotic symptoms in Parkinson's disease patients with dementia. J Am Geriatr Soc 44(3):296–299PubMedGoogle Scholar
  27. 27.
    Oertel WH (2000) Pergolide versus L–dopa (PELMOPET). Mov Disord. 15(Suppl. 3):4Google Scholar
  28. 28.
    Parkinson Study Group (2000) Pramipexole vs levodopa as initial treatment for Parkinson disease:A randomized controlled trial. Parkinson Study Group. JAMA 284(15):1931–1938CrossRefPubMedGoogle Scholar
  29. 29.
    Perry EK, Marshall E, Kerwin J, et al. (1990) Evidence of a monoaminergiccholinergic imbalance related to visual hallucinations in Lewy body dementia. J Neurochem 55(4):1454–1456PubMedGoogle Scholar
  30. 30.
    Rascol O, Brooks DJ, Korczyn AD, et al. (2000) A five–year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J Med 342(20):1484–1491CrossRefPubMedGoogle Scholar
  31. 31.
    Richard IH, Papka M, Rubio A, et al. (2002) Parkinson's disease and dementia with Lewy bodies:one disease or two? Mov Disord 17(6):1161–1165CrossRefPubMedGoogle Scholar
  32. 32.
    Rinne UK, Bracco F, Chouza C, et al. (1998) Early treatment of Parkinson's disease with cabergoline delays the onset of motor complications. Results of a double–blind levodopa controlled trial. The PKDS009 Study Group. Drugs 55(Suppl 1):23–30PubMedGoogle Scholar
  33. 33.
    Sanchez–Ramos JR, Ortoll R, Paulson GW (1996) Visual hallucinations associated with Parkinson disease. Arch Neurol 53(12):1265–1268PubMedGoogle Scholar
  34. 34.
    Schwab RS, England AC (1969) Projection technique for evaluating surgery in Parkinson's disease, in:Gillingham FD (ed) Third symposium of Parkinson's disease, IMl, Livingstone:Edinburgh, pp 152–157Google Scholar
  35. 35.
    Shergill SS, Walker Z, Le Katona C (1998) A preliminary investigation of laterality in Parkinson's disease and susceptibility to psychosis. J Neurol Neurosurg Psychiatry 65(4):610–611PubMedGoogle Scholar
  36. 36.
    Tanner CM, Vogel C, Goetz CG (1983) Hallucinations in Parkinson's disease:a population study. Ann Neurol 14:136Google Scholar
  37. 37.
    Wolters EC (1999) Dopaminomimetic psychosis in Parkinson's disease patients:diagnosis and treatment. Neurology 52(7 Suppl 3):S10–13PubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • S. Papapetropoulos
    • 1
    • 2
  • A. A. Argyriou
    • 2
  • J. Ellul
    • 2
  1. 1.Dept. of NeurologyUniversity of Miami, School of Medicine, Room 400433136 Miami (FL)USA
  2. 2.Dept. of NeurologyRegional University Hospital of PatrasPatrasGreece

Personalised recommendations