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

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.

Minor Phenomena in Parkinson’s Disease–Prevalence, Associations, and Risk of Developing Psychosis

“…The prevalence of illusions, passage phenomena, feeling of presence, or any minor phenomenon was high in participants with and without PD, but as expected was significantly higher in the PD group. Among those with PD, the overall prevalence of minor phenomena (43%) and isolated minor phenomena (18%) was consistent with other studies that have reported a 20%–45% prevalence 2,6–12 and 12%–28% prevalence, 2,8,11,12,15 respectively. In our study, the most commonly reported type of minor phenomenon was passage phenomena (38%), followed by illusions (14%), and feeling of presence (10%), whereas other studies have reported 8%–38% prevalence for passage phenomena, 4%–27% for illusions, and 4%–33% for feeling of presence.…”

“…In our study, the most commonly reported type of minor phenomenon was passage phenomena (38%), followed by illusions (14%), and feeling of presence (10%), whereas other studies have reported 8%-38% prevalence for passage phenomena, 4%-27% for illusions, and 4%-33% for feeling of presence. 2,7,8,11,15,16 The wide range in prevalence estimates likely reflects methodological differences, including disease and treatment characteristics of the study sample (eg, some excluded individuals with cognitive impairment or antipsychotic medication use), methods of ascertainment, time periods under evaluation, and definitions (eg, some studies narrowly defined passage phenomena as the perception of a person or animal). Our study was unique in that it also systematically assessed the prevalence of non-visual illusions.…”

“…Similarly, other studies have not found any correlation between levodopa equivalent daily dosage and the presence of minor phenomena. 2,11 Thus, while neither PD nor the use of PD medications are necessary or sufficient for minor phenomena to occur, the use of medications with anticholinergic properties might potentially increase the likelihood of experiencing minor phenomena. More than 80% reported no relationship between the experience of minor phenomena and timing of PD medications, suggesting that they do not represent a dopaminergic medication peak dose or OFF phenomenon.…”

“…4,5 Minor phenomena -including passage phenomena, feeling of presence, and illusionsoccur in 20%-45% of individuals with PD. 2,[6][7][8][9][10][11][12] Passage phenomena refer to the false perception of movement in the peripheral vision. Feeling of presence refers to the sensation of a nearby presence when there is none.…”

Characteristics of sleep structure in Parkinson's disease patients with hallucinations based on polysomnography

“…Among our PD patients, the presence of hallucinations was significantly associated with older age, more severe motor and non-motor symptoms, such as HY stage, UPDRS-III score, depression, anxiety, impaired cognition and sleep disturbances. Multivariate analysis identified two clinical variables, the NMSQ score and MOCA score, as independent risk factors for hallucinations, supported by the results of similar studies ( 4 , 27 ). Overall, as PD progressed, the motor symptoms became more severe and non-motor symptoms, including hallucinations and sleep disturbances, became more complex.…”