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Abstract
Non-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood. Systematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods. Searches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3-14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates. AH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.
Highlights
Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) are neurodegenerative diseases associated with α-synuclein dysfunction
To investigate whether some of the observed heterogeneity could be explained by moderator variables, such as study quality score, mean age of disease onset or method of hallucination assessment, we constructed meta-regression models for those meta-analyses comprised of sufficient study numbers (LBD and PD but not DLB)
We report that auditory hallucinations (AH) and visual hallucinations (VH) present in a significant proportion of PD and DLB cases, with both forms of hallucination being more prevalent in DLB
Summary
Parkinson’s disease (PD) and dementia with Lewy bodies (DLB) are neurodegenerative diseases associated with α-synuclein dysfunction. Estimates suggest PD prevalence is 1% in people over 60 (De Lau and Breteler, 2006), while DLB has a prevalence of 0.4% in people over 65 (Vann Jones and O’Brien, 2014) Both conditions are characterised by motor dysfunction but non-motor features contribute extensively to their presentation and disease burden. Hallucinations can be induced by medications such as anticholinergics (Celesia and Wanamaker, 1972), dopamine agonists (Baker et al, 2009) and a range of medications modulating diverse neurochemical pathways (Porteous and Ross, 1956; Lees et al, 1977; Gondim et al, 2010; Friedman et al, 2011; Wand, 2012) This presents challenges to determining the causes and nature of AH in PD and DLB. We aimed to assess the types of AH in both conditions and compared their prevalence with that of VH, which are more commonly investigated
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