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From the Departments of Neurological Sciences (Drs. Goetz, Curgian, and Leurgans, and J. Wuu) and Preventive Medicine (Dr. Leurgans), Rush Medical College, and Rush College of Nursing (Dr. Curgian), Rush University, Chicago, IL.
Address correspondence and reprint requests to Dr. Christopher G. Goetz, Movement Disorders Section, Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison St., Suite 755, Chicago, IL 60612; e-mail: cgoetz{at}rush.edu
Objective: To prospectively assess the relationship of hallucinations to sleep disorders in patients with Parkinson disease (PD) over 6 years.
Background: Several studies suggest an association between hallucinations and sleep disruption, but no longitudinal study has examined their progression and relationship, nor whether sleep alterations predict future hallucinations.
Methods: Eighty-nine PD patients were recruited to fill cells of normal sleep without hallucinations (n = 20); sleep fragmentation only (n = 20); vivid dreams/nightmares (n = 20); hallucinations with insight (n = 20); hallucinations without insight (n = 9). At baseline, 6 months, 18 months, 4 years, and 6 years, sleep disorders and hallucinations were assessed by standardized scales with the longitudinal data analyzed by generalized estimating equations and other nonparametric tests.
Results: At 6 years, we could account for all subjects (49 interviewed, 40 deceased or too ill for interview). Hallucination prevalence and severity increased over time (p < 0.0001). The odds of being a hallucinator increased by a factor of 1.39 at each successive time point. Sleep disorders, however, fluctuated widely among patients and time points, with no evidence of progression in severity (p = 0.73). The prevalence of sleep fragmentation did not differ between subjects with vs without hallucinations (OR = 1.43, p = 0.13). The presence of vivid dreams/nightmares, however, was highly correlated with the concurrent presence (OR = 2.32) and severity of hallucinations (OR = 3.02, both p < 0.0001). Vivid dreams/nightmares among non-hallucinators did not predict future development of hallucinations (OR = 0.94, p = 0.51).
Conclusions: Hallucinations and global sleep disorders follow different patterns of progression in Parkinson disease and are separate behavioral abnormalities. Sleep alterations are not necessarily harbingers of hallucinations.
Received June 9, 2004. Accepted in final form September 13, 2004.
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Neurology 2005 64: 2-3.
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