Skip to main content

Advertisement

Log in

Factors associated with drug–induced visual hallucinations in Parkinson's disease

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Aims

Visual hallucinations are common in medicationtreated Parkinson's disease (PD) patients. Although their etiology is unknown several factors seem to be involved in their pathogenesis. The aim of this study was to identify possible risk factors and determine clinical characteristics associated with the development of visual hallucinations in PD.

Methods

166 consecutive patients fulfilling clinical criteria for PD were studied. During a semi–structured interview, demographic characteristics and clinical variables were recorded. Motor, cognitive and psychiatric status was also assessed. Patients with and without visual hallucinations were compared using non–parametric tests, and logistic regression was applied to significant data.

Results

During the month before evaluation 20.4% of our patients experienced visual hallucinations (11.4% benign, 9% malignant). Logistic regression analysis identified three factors independently associated with visual hallucinations: long duration of Parkinson's disease, dementia, and disease severity as measured by the UPDRS total score.

Conclusions

Our findings indicate that apart from well established risk factors such as cognitive impairment and disease duration, disease severity is also important for the development of visual hallucinations in PD. Furthermore, the presence of bradykinesia and instability, the absence of tremor and the severity of rigidity and bradykinesia (limb and axial) may act as cofactors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Aarsland D, Ballard C, Larsen JP, et al. (2001) A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia. Int J Geriatr Psychiatry 16(5):528–536

    Article  PubMed  Google Scholar 

  2. Aarsland D, Larsen JP, Cummins JL, et al. (1999) Prevalence and clinical correlates of psychotic symptoms in Parkinson disease:a community–based study. Arch Neurol 56(5):595–601

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association (1987) Diagnostic and Statistical Manual for Psychiatric Disorders. Revised third edition (ed) American Psychiatric Association. Washington, DC

  4. Barclay CL, Hildebrand K, Gray P, et al. (1997) Risk factors for the development of psychosis in Parkinson's disease. Mov Disord 12(Suppl. 1):108

    Google Scholar 

  5. Barnes J, David AS (2001) Visual hallucinations in Parkinson's disease:a review and phenomenological survey. J Neurol Neurosurg Psychiatry 70(6):727–733

    Article  PubMed  Google Scholar 

  6. Carter JH, Stewart BJ, Archbold PG, et al. (1998) Living with a person who has Parkinson's disease:the spouse's perspective by stage of disease. Parkinson's Study Group. Mov Disord 13(1):20–28

    Article  PubMed  Google Scholar 

  7. 7. Fahn S, Elton RL, Committee (1987) MotUd, Unified Parkinson's disease rating scale in Recent developments in Parkinson's disease. Macmillan healthcare information, pp 153–163

  8. Fenelon G, Mahieux F, Huon R, et al. (2000) Hallucinations in Parkinson's disease:prevalence, phenomenology and risk factors. Brain 123(Pt 4):733–745

    Article  PubMed  Google Scholar 

  9. Folstein MF, Folstein SE, McHugh PR (1975) "Mini–mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  PubMed  Google Scholar 

  10. Goetz CG, Pappert EJ, Blasucci LM, et al. (1998) Intravenous levodopa in hallucinating Parkinson's disease patients:high–dose challenge does not precipitate hallucinations. Neurology 50(2):515–517

    PubMed  Google Scholar 

  11. Goetz CG, Stebbins GT (1995) Mortality and hallucinations in nursing home patients with advanced Parkinson's disease. Neurology 45(4):669–671

    PubMed  Google Scholar 

  12. Goetz CG, Stebbins GT (1993) Risk factors for nursing home placement in advanced Parkinson's disease. Neurology 43(11):2227–2229

    PubMed  Google Scholar 

  13. Goetz CG, Vogel C, Tanner CM, et al. (1998) Early dopaminergic drug–induced hallucinations in parkinsonian patients. Neurology 51(3):811–814

    PubMed  Google Scholar 

  14. Graham JM, Grunewald RA, Sagar HJ (1997) Hallucinosis in idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry 63(4):434–440

    PubMed  Google Scholar 

  15. Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17(5):427–442

    PubMed  Google Scholar 

  16. Holroyd S (1996) Visual hallucinations in a geriatric psychiatry clinic:prevalence and associated diagnoses. J Geriatr Psychiatry Neurol 9(4):171–175

    PubMed  Google Scholar 

  17. Holroyd S, Currie L, Wooten GF (2001) Prospective study of hallucinations and delusions in Parkinson's disease. J Neurol Neurosurg Psychiatry 70(6):734–738

    Article  PubMed  Google Scholar 

  18. Hughes AJ, Daniel SE, Kilford L, et al. (1992) Accuracy of clinical diagnosis of idiopathic Parkinson's disease:a clinico–pathological study of 100 cases (see comments). J Neurol Neurosurg Psychiatry 55(3):181–184

    PubMed  Google Scholar 

  19. Inzelberg R, Kipervasser S, Korczyn AD (1998) Auditory hallucinations in Parkinson's disease. J Neurol Neurosurg Psychiatry 64(4):533–535

    PubMed  Google Scholar 

  20. Ismail MS, Richard IH (2004) A reality test:How well do we understand psychosis in Parkinson's disease? J Neuropsychiatry Clin Neurosci 16(1):8–18

    PubMed  Google Scholar 

  21. McKeith I, Mintzer J, Aarsland D, et al. (2004) Dementia with Lewy bodies. Lancet Neurol 3(1):19–28

    Article  PubMed  Google Scholar 

  22. McKeith IG, Fairbairn AF, Bothwell RA, et al. (1994) An evaluation of the predictive validity and inter–rater reliability of clinical diagnostic criteria for senile dementia of Lewy body type. Neurology 44(5):872–877

    PubMed  Google Scholar 

  23. McKeith IG, Galasko D, Kosaka K, et al. (1996) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB):report of the consortium on DLB international workshop. Neurology 47(5):1113–1124

    PubMed  Google Scholar 

  24. Morris SK, Olichney JM, Corey–Bloom J (1998) Psychosis in Dementia With Lewy Bodies. Semin Clin Neuropsychiatry 3(1):51–60

    PubMed  Google Scholar 

  25. Moskovitz C, Moses H, 3rd, Klawans HL (1978) Levodopa–induced psychosis:a kindling phenomenon. Am J Psychiatry 135(6):669–675

    PubMed  Google Scholar 

  26. Naimark D, Jackson E, Rockwell E, et al. (1996) Psychotic symptoms in Parkinson's disease patients with dementia. J Am Geriatr Soc 44(3):296–299

    PubMed  Google Scholar 

  27. Oertel WH (2000) Pergolide versus L–dopa (PELMOPET). Mov Disord. 15(Suppl. 3):4

    Google Scholar 

  28. Parkinson Study Group (2000) Pramipexole vs levodopa as initial treatment for Parkinson disease:A randomized controlled trial. Parkinson Study Group. JAMA 284(15):1931–1938

    Article  PubMed  Google Scholar 

  29. Perry EK, Marshall E, Kerwin J, et al. (1990) Evidence of a monoaminergiccholinergic imbalance related to visual hallucinations in Lewy body dementia. J Neurochem 55(4):1454–1456

    PubMed  Google Scholar 

  30. Rascol O, Brooks DJ, Korczyn AD, et al. (2000) A five–year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J Med 342(20):1484–1491

    Article  PubMed  Google Scholar 

  31. Richard IH, Papka M, Rubio A, et al. (2002) Parkinson's disease and dementia with Lewy bodies:one disease or two? Mov Disord 17(6):1161–1165

    Article  PubMed  Google Scholar 

  32. Rinne UK, Bracco F, Chouza C, et al. (1998) Early treatment of Parkinson's disease with cabergoline delays the onset of motor complications. Results of a double–blind levodopa controlled trial. The PKDS009 Study Group. Drugs 55(Suppl 1):23–30

    PubMed  Google Scholar 

  33. Sanchez–Ramos JR, Ortoll R, Paulson GW (1996) Visual hallucinations associated with Parkinson disease. Arch Neurol 53(12):1265–1268

    PubMed  Google Scholar 

  34. Schwab RS, England AC (1969) Projection technique for evaluating surgery in Parkinson's disease, in:Gillingham FD (ed) Third symposium of Parkinson's disease, IMl, Livingstone:Edinburgh, pp 152–157

  35. Shergill SS, Walker Z, Le Katona C (1998) A preliminary investigation of laterality in Parkinson's disease and susceptibility to psychosis. J Neurol Neurosurg Psychiatry 65(4):610–611

    PubMed  Google Scholar 

  36. Tanner CM, Vogel C, Goetz CG (1983) Hallucinations in Parkinson's disease:a population study. Ann Neurol 14:136

    Google Scholar 

  37. Wolters EC (1999) Dopaminomimetic psychosis in Parkinson's disease patients:diagnosis and treatment. Neurology 52(7 Suppl 3):S10–13

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Papapetropoulos MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Papapetropoulos, S., Argyriou, A.A. & Ellul, J. Factors associated with drug–induced visual hallucinations in Parkinson's disease. J Neurol 252, 1223–1228 (2005). https://doi.org/10.1007/s00415-005-0840-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-005-0840-x

Key words

Navigation