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NEUROLOGY 2004;63:S28-S30
© 2004 American Academy of Neurology

Neurology supplements are not peer-reviewed. Information contained in Neurology supplements represent the opinions of the authors and are not endorsed by nor do they reflect the views of the American Academy of Neurology, Editor-in-Chief, or Associate Editors of Neurology.

Hallucinations and sleep disturbances in Parkinson’s disease

Jaime Kulisevsky, MD and Eliana Roldan, MD

From the Movement Disorders Unit, Neurology Department, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.

Address correspondence and reprint requests to Dr. Jaime Kulisevsky, Neurology Department, Sant Pau Hospital, Sant Antoni M. Claret 167, 08025 Barcelona, Spain; e-mail: jkulisevsky{at}hsp.santpau.es

Visual hallucinations (VHs) occur frequently in Parkinson’s disease (PD). VHs occur more frequently in elderly patients with longer duration of illness, cognitive impairment, and sleep disturbances. The relationship between the use of antiparkinsonian drugs and VHs is complicated, but most drugs used to treat parkinsonian motor symptoms induce VHs and psychosis in some PD patients. The "continuum hypothesis" proposing that medication-induced psychiatric symptoms in PD begin with drug-induced sleep disturbances, followed by vivid dreams, with progression to hallucinatory and delusional experiences has been challenged. In some patients, VHs may represent intrusion of REM sleep-related imagery into wakefulness. Improving REM sleep abnormalities in PD (e.g., stimulants, anticholinesterase inhibitors) is one strategy now being tested to improve VHs in PD.






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