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December 11, 2001

Prospective longitudinal assessment of hallucinations in Parkinson’s disease

December 1, 2001 issue
57 (11) 2078-2082

Abstract

Objective: To monitor the evolution of hallucinations over 4 years in a stratified sample of patients with PD.
Methods: Using a modified version of the Unified PD Rating Scale (UPDRS) Thought Disorder question, the authors stratified patients into five baseline behavioral groups. They recruited up to 20 patients for each group to participate in sequential interviews (Rush Hallucination Inventory) at baseline and 6, 18, and 48 months. UPDRS motor examinations and Mini Mental State Examinations (MMSE) were obtained at baseline and 48 months. Data were analyzed with Wilcoxon rank sum tests, Mantel-Haenszel tests, and Spearman correlations. To determine features that influenced the new development of hallucinations, a cumulative logit regression model of hallucination severity over time was fit using generalized estimating equations.
Results: Based on the design stratification, 60 patients had no hallucinations at baseline (20 with no behavioral problems, 20 with sleep fragmentation, 20 with altered dream phenomena). Twenty-nine patients had hallucinations (20 with retained insight and 9 with loss of insight). At 48 months, the authors could account for all but two subjects (98% retrieval). In 4 years, the presence of hallucinations increased (33% at baseline, 44% at 18 months, and 63% at 48 months, p < 0.0001). The presence of frequent hallucinations (at least three times weekly) also increased (p = 0.0002). Having hallucinations at baseline or at any given assessment was a strong predictor at all follow-up evaluations of continued hallucinations (p < 0.0001). Hallucinations were not associated with increased mortality (χ2 = 0.59, df (1), p = 0.47). Among the 60 subjects without hallucinations at baseline, time was the only significant factor influencing the development of hallucination over 48 months. Baseline age, PD duration, sex, medications, and UPDRS or MMSE scores did not influence the incidence of hallucinations.
Conclusions: This prospective, longitudinal study documents the persistent and progressive nature of hallucinations in PD patients on chronic dopaminergic therapy. The consistent association of hallucinations with combined levodopa/agonist therapy suggests that these drugs may play a role in the pathophysiology of hallucinations.

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Information & Authors

Information

Published In

Neurology®
Volume 57Number 11December 1, 2001
Pages: 2078-2082
PubMed: 11739829

Publication History

Received: June 22, 2001
Accepted: August 24, 2001
Published in print: December 1, 2001
Published online: December 11, 2001

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Authors

Affiliations & Disclosures

C. G. Goetz, MD
From the Departments of Neurological Sciences (Dr. Goetz, Leurgans, and Stemer) and Preventive Medicine (Dr. Leurgans and Raman), Rush University, Chicago, IL; and Neurology Associates (Dr. Pappert), Austin, TX.
S. Leurgans, PhD
From the Departments of Neurological Sciences (Dr. Goetz, Leurgans, and Stemer) and Preventive Medicine (Dr. Leurgans and Raman), Rush University, Chicago, IL; and Neurology Associates (Dr. Pappert), Austin, TX.
E. J. Pappert, MD
From the Departments of Neurological Sciences (Dr. Goetz, Leurgans, and Stemer) and Preventive Medicine (Dr. Leurgans and Raman), Rush University, Chicago, IL; and Neurology Associates (Dr. Pappert), Austin, TX.
R. Raman, MS
From the Departments of Neurological Sciences (Dr. Goetz, Leurgans, and Stemer) and Preventive Medicine (Dr. Leurgans and Raman), Rush University, Chicago, IL; and Neurology Associates (Dr. Pappert), Austin, TX.
A. B. Stemer, BA
From the Departments of Neurological Sciences (Dr. Goetz, Leurgans, and Stemer) and Preventive Medicine (Dr. Leurgans and Raman), Rush University, Chicago, IL; and Neurology Associates (Dr. Pappert), Austin, TX.

Notes

Address correspondence and reprint requests to Dr. Christopher G. Goetz, Movement Disorders Section, Department of Neurological Sciences, Rush–Presbyterian–St. Luke’s Medical Center, 1725 W. Harrison St., Suite 1106, Chicago, IL 60612.

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  3. A general clinical overview of the non-motor symptoms in Parkinson’s disease: Neuropsychiatric symptoms, Translational Approaches to Unravelling Non-Motor Symptoms of Parkinson's Disease, (59-97), (2024).https://doi.org/10.1016/bs.irn.2023.11.001
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  8. Frequency and Characteristics of Psychosis in Parkinson’s Disease: A Systematic Review and Meta-Analysis, Journal of Parkinson's Disease, 12, 1, (85-94), (2022).https://doi.org/10.3233/JPD-212930
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  9. Two-year longitudinal follow-up of visual illusions and hallucinations in Parkinson’s disease, Journal of Neurology, 269, 8, (4546-4554), (2022).https://doi.org/10.1007/s00415-022-11074-2
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  10. Pharmacotherapy of Psychosis in Parkinson’s Disease, NeuroPsychopharmacotherapy, (4231-4269), (2022).https://doi.org/10.1007/978-3-030-62059-2_439
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