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Hallucinations in Parkinson disease in the prelevodopa era

From the Department of Neurology, Hôpital Henri-Mondor, AP-HP, Créteil, France (G.F.); INSERM U421, Equipe Avenir, Créteil, France (G.F.); Departments of Neurological Sciences and Pharmacology, Rush University Medical Center, Chicago, IL (C.G.G.); and Institute for the History of Medicine and Medical Ethics, University of Cologne, Germany (A.K.).

Address correspondence and reprint requests to Dr. Gilles Fénelon, Service de neurologie, Hôpital Henri Mondor, F94010 Créteil Cedex, France; e-mail: gilles.fenelon{at}hmn.aphp.fr

Whether chronic hallucinations belong to the natural history of untreated Parkinson disease (PD) remains undetermined. For early authors such as Gowers or Charcot and his followers, hallucinations that occurred in the course of PD either accompanied the final phase of the disease or reflected comorbidities. However, a few authors observed that hallucinations could occur in PD patients with severe depression, confusion, or dementia. Interest in hallucinations with parkinsonism increased with the outbreak of von Economo encephalitis, as they were more frequent than in PD, provoking new pathophysiologic questions. Later studies on mental symptoms in parkinsonism were often based on series that pooled patients with PD and postencephalitic syndromes, confounding a clear analysis. It remains difficult to estimate the prevalence of hallucinations in the natural course of PD before the introduction of levodopa therapy. The lack of prospective studies, the wide early use of anticholinergics and ergots compounds, and the absence of dementia with Lewy bodies in the nosology of the time are further limitations. Even with these limitations, historical descriptions of PD from the prelevodopa era suggest that hallucinations may be part of PD itself, especially in the context of late dementia, depression, or nonspecific encephalopathy.

Disclosure: The authors report no conflicts of interest.

Received May 16, 2005. Accepted in final form October 4, 2005.

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