Clinical Characteristics of Minor Hallucinations in Chinese Parkinson's Disease Patients.

Yu Zhang,Zi En Zhang,Zhen Guo Liu,Guo Yong Zhang,Xiao Bo Zhu,Jing Gan

doi:10.3389/fnagi.2021.723405

Abstract

BackgroundPsychotic symptoms are common in Parkinson's disease (PD). However, the clinical characteristics of PD psychosis (PDP) have been rarely reported in Chinese PD patients. We aimed to categorize PDP in a PD cohort and its relationship to other clinical characteristics.MethodsA total of 149 Chinese PD patients were consecutively enrolled, and idiopathic PD patients were recruited in the study. The symptoms of PDP were assessed with the enhanced Scale for the Assessment of Positive Symptoms in PD. Then, the patients were classified into a PD-control group, isolated minor hallucination (MH) group, and complex MH group, and clinical and demographic data of different groups were compared.ResultsParkinson's disease psychosis was present in 40.3% (60/149) of our patients. The most common PDPs were MHs, present in 32.9% (49 of 149) of the cohort. Compared to patients without MHs, patients with MHs were older, had a longer disease duration, a higher levodopa equivalent daily dose, more severe motor symptoms, dyskinesia, a higher rate of rapid eye movement sleep behavior disorders, frontal lobe function impairments, and a higher percentage of cognitive impairment. Logistic regression analysis showed that advanced Hoehn-Yahr stage [odds ratio (OR): 2.697, p = 0.007)] and frontal lobe function impairment (OR: 0.684, p = 0.003) were independent risk factors for MHs.ConclusionMHs were frequent non-motor symptoms in PD patients. It was associated with increased motor and non-motor symptom burdens and reduced quality of life. MHs have been called “minor,” but they have major clinical and prognostic implications and need early screening.

Highlights

Parkinson’s disease (PD) psychosis (PDP) is one of the debilitating non-motor symptoms (NMSs) of PD
PD, Parkinson’s disease; MHs, minor hallucinations; UPDRS, Unified Parkinson’s disease rating scale; Frontal Assessment Battery (FAB), frontal assessment battery; Minimum Mental State Examination (MMSE), mini-mental state examination; Parkinson’s Disease Sleep Scale (PDSS), Parkinson’s disease sleep scale; RBDQ-HK, rapid eye movement sleep behavior disorder questionnaire Hong Kong; Hamilton Depression Scale (HAMD), Hamilton depression scale; Parkinson’s Disease Questionaire-39 score (PDQ-39), 39-item Parkinson’s disease questionnaire; LEDD, levodopa equivalent daily dose. aData were performed for group differences with the chi-squared test. bData were performed for group differences with ANOVA
PD, Parkinson’s disease; MHs, minor hallucinations; UPDRS, Unified Parkinson’s disease rating scale; FAB, frontal assessment battery; MMSE, mini-mental state examination; PDSS, Parkinson’s disease sleep scale; RBDQ-HK, rapid eye movement sleep behavior disorder questionnaire Hong Kong; HAMD, Hamilton depression scale; PDQ-39, 39-item Parkinson’s disease questionnaire; LEDD, levodopa equivalent daily dose. aData were performed for group differences with the chi-squared test. bData were performed for group differences with t-test

Summary

Introduction

Parkinson’s disease (PD) psychosis (PDP) is one of the debilitating non-motor symptoms (NMSs) of PD. There is a spectrum of PDP symptoms, including minor hallucinations (MHs), hallucinations of various sensory modalities (visual, auditory, olfactory, gustatory, and tactile hallucinations), and delusions (Frei and Truong, 2017). Minor hallucinations (MHs) include misperceptions as a sense of presence, passage, and illusions. It is considered the mildest and earliest form of PDP. PD patients could have one or more minor hallucinations (isolated MHs) or have minor hallucinations along with other sensory modality hallucinations (complex MHs) (Fenelon et al, 2000; Frei and Truong, 2017; Kulick et al, 2018). A previous study reported that PD patients with MHs more closely resembled patients with hallucinations or delusions (Kulick et al, 2018). The clinical characteristics of PD psychosis (PDP) have been rarely reported in Chinese PD patients. We aimed to categorize PDP in a PD cohort and its relationship to other clinical characteristics

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Discussion

Conclusion