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

J Korean Neurol Assoc > Volume 25(3); 2007 > Article

Journal of the Korean Neurological Association 2007;25(3): 312-317.

파킨슨병에서의 망상과 환각: 임상 양상과 병태생리에 관한 예비적 연구

이유진, 정선주 김성렬 이태연 이재홍 이명종

울산대학교 의과대학 신경과학교실, 서울아산병원 파킨슨병 센터

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

Eugene Lee

Center for Parkinsonism and Other Movement Disorders, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

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. KeyWords:Parkinson’s psychosis, Hallucination, Delusion, Parkinson’s disease, Dopaminergic system