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a Department of
Psychiatric Medicine, University of Virginia Health Sciences Center,
Box 880623, Charlottesville, Virginia 22908, USA, b Department of Neurology
Correspondence to: Dr S Holroyd sh4s{at}virginia.edu
Received 29 June 2000 and in revised form 23 October 2000;
Accepted 8 January
2001
OBJECTIVE
This study
was undertaken to determine the prevalence of hallucinations and
delusions in Parkinson's disease, to describe such symptoms
phenomenologically, and possibly to determine factors associated with
their development. In addition, the role of the visual system in
relation to visual hallucinations was examined.
METHOD102 consecutive
patients diagnosed with strictly defined Parkinson's disease were
examined for the presence of hallucinations and delusions and assessed
for visual acuity, cognition, depression using the geriatric depression
scale, disease severity as measured by the UPDRS, and other clinical variables.
RESULTSOf 102 consecutive patients, 29.4% (n=30) had hallucinations or delusions,
four (3.9%) were determined to be psychotic due solely to delirium and
were excluded from further analysis. Of the 98 remaining patients,
26.5% (n=26) had visual hallucinations. Among these, one patient also
had delusions, two had auditory hallucinations, and one had gustatory
hallucinations. Visual hallucinations were significantly associated
with worse visual acuity, lower cognitive score, higher depression
score, and worse disease severity. Hallucinations were not associated
with history of psychiatric disease, dose or duration of levodopa or
other antiparkinsonian medication treatment, or duration of illness.
CONCLUSIONSVisual
hallucinations are common symptoms in Parkinson's disease and are most
likely of multifactorial origin. Although higher doses of levodopa are
known to be related clinically to hallucinations in individual
patients, the results suggest that several underlying characteristics
of patients with Parkinson's disease (disease severity, dementia,
depression, worse visual acuity) may be more important determinants of
which patients experience hallucinations. The data also provide
preliminary evidence that abnormality of the visual system may be
related to visual hallucinations in Parkinson's disease, as has been
found in other disorders with visual hallucinations.
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