Parkinson's Disease Visual Hallucinations And Related Factors In Clinical Analysis

Parkinson's disease is one of the most common neurodegenerative disease mostly affecting the elderly.Its manifestations are not only characterized by motor symptoms such as bradykinesia,rest tremor,rigidity and postural reflex impairment,but also associated with a wide range of non-motor symptoms including autonomic dysfunction,sleep disturbance,pain,mood disorders,cognitive impairment,and psychotic disorders.Visual hallucinations are the most common types of psychotic disorders,affecting 8-40%of PD patients over the long term.Visual hallucinations and concurrent problems even may have a serious negative impact on quality of life of some hallucinators and their caregivers.However,to date,lots of problems such as the prevalence,nature,and risk factors about this issue are still unclear,which significantly limit clinicians' understanding and management about it.This project using published surveys and case-control study was undertaken to survey the prevalence of visual hallucinations in hospital based patients with PD,and to explore clinical features and factors associated with visual hallucinations in patients with PD.Hopefully,the current study might help to improve the knowledge about visual hallucinations and provide clues for better intervention.ObjectiveTo assess the prevalence of visual hallucinations in those outpatients with PD,and investigate its clinical features and factors associated with visual hallucinations in patients with PD.MethodsTotally,175 consecutive outpatients with PD were enrolled in this clinical research.All of them met UK Parkinson's Disease Society Brain Bank criteria with the age older than 50 yrs and duration longer than 1 year.All of them were assessed by using " Questionnaire of visual hallucinations in PD patients" during routine visits in this study.The details of gender,current age,the time at onset,the side and symptoms at onset,medical history including dosage,and response to levodopa were recorded. Each patient was assessed with Hoehn and Yahr stage(H&Y),the scores of hallucinations and cognitive function related to Unified Parkinson disease scale(UPDRS).The detailed information from hallucinators was collected regarding the time onset of their first hallucination(how long PD has been suffered when hallucinations occurred),frequency,content,pattern,severity of hallucinations(retained insight and caregiver burden levels),and hallucinatory status at nighttime(whether experience visual hallucinations at nighttime or not).The definition of the hallucinatory type was based on the description of content of hallucinations.Cumulative scores were obtained according to frequency,severity(retained insight and caregiver burden levels) and hallucinatory status at nighttime.The statistic was calculated by using SPSS 11.5 software,and univariate analysis and Logistic regression analysis were performed to determine factors that accounted for the occurrence of visual hallucinations.Results1.The prevalence of visual hallucinations in those patients with PD was 28%(49 /175).Among them,28.7%(31/108) were male and 26.9%(18/67) were female with no significant difference in gender.2.34.7%of the hallucinators experienced minor hallucinations / illusions,and 65.3%had complex visual hallucinations.The minor hallucination/illusion group and complex visual hallucination group differed significantly in cumulative scores by means of univariate analysis(P＜0.05).3.Three(6.1%) out of all the hallucinators had auditory hallucinations,two(4.1%) of them had delusions,and one(2.0%) had both auditory hallucinations and delusions.4.Univariate analysis revealed that there were significant differences in age, duration,cognition score,levodopa and pramipexole between the two groups(P＜0.05), but no difference in other respects(P＞0.05).5.Logistic regression analysis identified that visual hallucinations were closely related to cognitive impairment,duration and age,which might be the main risk factors for visual hallucinations in PD.ConclusionOur results suggest that visual hallucinations are relatively common symptoms in the patients with Parkinson's disease,which can also be accompanied by other psychotic symptoms with the main type being complex visual hallucinations.The visual hallucinations are associated with cognitive impairment,age and duration,which should be paid more attention by neurologists for those PD patients.