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Sleep Disorder Associated with Hallucinations in Parkinson Disease
In this study with moderate clinical relevance, hallucinations in Parkinson disease were associated with REM sleep behavior disorder.
Psychotic symptoms such as hallucinations and delusions are common in Parkinson disease (PD) but may have several possible causes (e.g., medications or severe disease with dementia). In this study, the authors examined associations between hallucinations, REM sleep behavior disorder (RBD), and selected clinical features of PD.
The authors used chart reviews to identify 70 patients with hallucinations and 60 without them, after excluding patients with moderate-to-severe dementia or preexisting psychiatric conditions. Clinical interviews were performed to determine RBD. The two groups did not significantly differ with respect to demographic measures, disease duration, dopaminergic medication usage, or overall motor symptom stage and complications. However, the PD patients with hallucinations had a significantly higher rate of RBD than those without hallucinations. The authors conclude that hallucinations in PD are closely associated with RBD, but not with medications or with disease severity, as some other studies have suggested. No evaluations of other neurobehavioral symptoms or cognition were reported.
Comment: This research contributes to the literature in that the authors controlled for factors that may also cause hallucinations in PD and clearly demonstrated an association between these hallucinations and RBD. One problem with the study is the lack of detailed cognitive assessments. Further, there were no assessments for Lewy body dementia (LBD). Hallmark symptoms for LBD include cognitive impairment, parkinsonism, hallucinations, and RBD. Thus, many patients with hallucinations and PD in this study could actually have met criteria for LBD.
— Christopher I. Wright, MD, PhD
Dr. Wright is Assistant Professor of Neurology, Harvard Medical School, and Associate Neurologist, Brigham Behavioral Neurology Group, Brigham and Women's Hospital, Boston.
Published in Journal Watch Neurology October 10, 2006
Citation(s):
Benbir G et al. Features associated with the development of hallucinations in Parkinson's disease. Acta Neurol Scand 2006 Oct; 114:239-43.
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