Delusion and Hallucination in Parkinson's Disease: A Pilot Study of Clinical Features and Pathogenesis

Lee, Eugene; Chung, Sun Ju; Kim, Sung Reul; Lee, Tae Yeon; Lee, Jae Hong; Lee, Myoung Chong

Abstract

BACKGROUND: Although the clinical and epidemiological characteristics of delusions and visual hallucinations in Parkinson's disease (PD) have been described, the underlying etiology and pathogenesis of those neuropsychiatric manifestations in PD remains a matter of debate. The purpose of this study was to investigate whether or not delusion is in the same spectrum of dopamine related neuropsychiatric manifestations as visual hallucination is in patients with PD.
METHODS
We studied the clinical features of 13 PD patients with delusions and 32 with hallucinations. Patients with a history of psychotic symptoms before the onset of PD were excluded.
RESULTS
Age at onset of PD was younger in patients with delusions (56.3+/-8.7 years) than in those with hallucinations (63.9+/-9.2 years) (p=0.019). The level of education was higher in patients with delusions than those with hallucinations (p=0.006). Daily levodopa equivalent dosages were higher in patients with delusions (982+/-653.7 mg/day) than those with hallucinations (559+/-311.2 mg/day) (p=0.002). Dopamine agonists were more frequently used in patients with delusions than in those with hallucinations (p=0.020).
CONCLUSIONS
Compared with PD patients with hallucinations, those with delusions were associated with longer disease durations, higher levodopa-equivalent daily doses, and use of dopamine agonists. To evaluate the role of dopaminergic dysfunction for the development of delusions and hallucinations in PD patients, further well- designed prospective studies are needed.