Risk Factors in Developing Hallucinations in Parkinson’s Disease

Gülçin Benbir; Sibel Özekmekçi; Meral Çınar; Fuat Beşkardeş; Hülya Apaydın; Ethem Erginöz

Gülçin Benbir¹, Sibel Özekmekçi¹, Meral Çınar², Fuat Beşkardeş³, Hülya Apaydın¹, Ethem Erginöz⁴

¹Department Of Neurology, İstanbul University, Cerrahpasa Faculty Of Medicine, İstanbul, Turkey
²Department Of Psychiatry, İstanbul University, Cerrahpasa Faculty Of Medicine, İstanbul, Turkey
³Department Of Public Healty, İstanbul University, Cerrahpasa Faculty Of Medicine, İstanbul, Turkey
⁴Neurology Clinic, Taksim Education Hospital, İstanbul, Turkey

Keywords: Parkinson’s disease, hallucination, REM behavior disorder, motor complication, dopaminergic therapy

Abstract

OBJECTIVE: Hal lucinations are frequent non-motor

symptoms of Parkinson’s disease (PD).

METHODS: In this study, it was aimed to investigate the possible risk

factors on the emergence of hallucinations in PD.

RESULTS: Seventy hallucinating PD patients (Group 1)

and non-hallucinating 60 PD patients as control group (Group 2) were

enrolled in the study. The mean age at onset of hallucinations in Group

1 were matched with the mean age of patients at their last available visit

in Group 2. Between these two groups, the age at onset of first PD

symptom, duration of PD, Hoehn-Yahr (H&Y) staging, Unified PD Rating

Scale (UPDRS) scores, duration and mean dosage of levodopa and other

antiparkinsonian drugs, the presence of wearing-off phenomenon,

dyskinesia and rapid eye movement sleep behaviour disorder (RBD) were

evaluated.

CONCLUSION: The mean age at onset of PD symptoms in hallucinators was

higher than those of non-hallucinators (p=0.02). Although the daily

activity and motor parts of UPDRS and H&Y scores did not differ

between two groups, the UPDRS part I scores were significantly higher

in patients with hallucinations, as expected (p=0.0001). The mean

duration of PD, duration and daily doses of dopaminergic drugs did not

show any differences between the groups. Similarly, motor

complications developed in both groups with no statistical difference.

However, RBD was more frequently encountered among hallucinators

than non-hallucinators (p=0.007).

Conclusions: Hallucinations could develop during the course of PD, and

late onset of first PD symptom is associated with the emergence of

hallucinations, as well as RBD frequently found to accompany the

hallucinations in PD. However, the duration and severity of PD along

with the duration and dosage of antiparkinsonian drugs do not have a

role in the appearance of hallucinations. As data in the literature are

inconclusive, it has been suggested that the emergence of

hallucinations in PD, which has been thought to be multifactorial, may

be influenced by many factors, including especially the cognitive states.