Hallucinations, REM sleep, and Parkinson’s disease

Arnulf, Isabelle; Bonnet, Anne‐Marie; Damier, Philippe; Bejjani, Boulos‐Paul; Seilhean, Danielle; Derenne, Jean‐Philippe; Agid, Yves

doi:10.1212/wnl.55.2.281

Cited by 410 publications

(259 citation statements)

References 33 publications

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“…Sleep disturbance, which is characterized by excessive daytime sleepiness with frequent naps, often occurs in PD patients [6] . However, the etiology of these symptoms remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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Progressive changes of orexin system in a rat model of 6-hydroxydopamineinduced Parkinson’s disease

Cui

Li²,

Jin³

et al. 2010

Neurosci. Bull.

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Objective Sleep disturbance, which is characterized by excessive daytime sleepiness and sleep attacks, is frequently observed in patients with Parkinson's disease (PD). Loss of orexin neurons in hypothalamus and the resultant decreased level of orexin in cerebrospinal fluid (CSF) found in narcolepsy patients may also play an essential role in the pathogenesis of sleep disturbance. The present study aimed to investigate the possible changes in the orexin system during PD progression. Methods After the establishment of a rat PD model by injecting 6-hydroxydopamine (6-OHDA) into the medial forebrain bundle, the numbers of orexin-A-and tyrosine hydroxylase (TH)-positive neurons, and the levels of orexin-A fibers and orexin-A in CSF were examined by immunohistochemistry and ELISA assay, respectively. Results Compared to the TH-containing neurons that exhibited fast degeneration in response to 6-OHDA, orexin-A-containing neurons were less sensitive to 6-OHDA. The number of orexin-A-positive neurons began to decrease at day 21 after operation, and at day 49, it decreased by 30% of the initial level. The orexin-A level in CSF of PD rats did not show any obvious fluctuations compared to the control, and there was no obvious reduction in the density of orexin-A-positive fibers in brain areas such as tuberomammillary nucleus. Conclusion These results reveal for the first time the dynamic changes of orexin system during the progression of PD. This may provide valuable information for drug development to reverse the loss of orexin neurons and sleep disturbance in PD patients.

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“…Sleep disturbance, which is characterized by excessive daytime sleepiness with frequent naps, often occurs in PD patients [6] . However, the etiology of these symptoms remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…All of these symptoms are reminiscent of human narcolepsy, a sleep disorder caused by the dysfunction of orexin neurons [6] . Furthermore, many postmortem morphological studies in the function of orexin system have revealed a decreased level of orexin in CSF and reduced number of orexin neurons in PD patients [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Progressive changes of orexin system in a rat model of 6-hydroxydopamineinduced Parkinson’s disease

Cui

Li²,

Jin³

et al. 2010

Neurosci. Bull.

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“…The combination of targeted questions probing visual misperceptions with questions interrogating related symptomology, such as sleep disturbance [11,34] and attention network dysfunction [16], will allow for the prospective assessment of concomitant patterns of dysfunction associated with VH. Indeed, the results of our analysis suggest that there is a strong correlation between self-reported visual misperceptions (Q [1][2][3][4][5][6] ) and all other symptomatic categories assessed.…”

Section: Discussionmentioning

confidence: 99%

“…However, the nonresponder cohort was significantly older (mean age: 72. 6 ; n = 76); sensory misperceptions (Q 7-10 ; n = 45); and disordered thought (Q [11][12][13] ; n = 17). 15 Impaired multitasking 121 61 Q 16 Following conversation 93 47 Q 17 Day dreaming 95 48 Q 18 Vivid dreams 129 65 Q 19 REM behavior disorder 89 45 Q 20 Confusion upon waking 46 23…”

Section: Psych-q Responsesmentioning

confidence: 99%

Validation of the Psychosis and Hallucinations Questionnaire in Non‐demented Patients with Parkinson's Disease

Shine

Mills

Qiu

et al. 2015

Movement Disord Clin Pract

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People diagnosed with Parkinson's disease (PD) frequently experience visual and non-visual hallucinations often with comorbid psychosis, however, there is currently no gold standard tool for accurately assessing these symptoms. To address this problem, we designed a novel questionnaire to evaluate the presence of hallucinatory and psychotic symptoms in PD, as well as related symptoms, such as attentional dysfunction and sleep disturbance. We administered the 20-item Psychosis and Hallucinations Questionnaire (PsycH-Q) and three common questionnaire measures in a large cohort of 197 patients with idiopathic PD via a postal survey. We established concurrent validity, convergent validity, and internal consistency of the questionnaire and then assessed test-retest reliability in a subcohort of 44 patients. PsycH-Q was found to be a valid instrument when analogous items were compared across three other existing tools (Spearman's rho range: 0.34-0.64; P < 0.01). PsycH-Q demonstrated a strong relationship between self-reported hallucinations and psychosis and symptoms of the broader hallucinatory phenotype (Kendall's tau = 0.41; P < 0.01; positive predictive value = 0.97). PsycH-Q also displayed a high level of internal consistency (Cronbach's alpha = 0.900; range, 0.696-0.923) and reproducibility (intraclass correlation coefficient = 0.928). PsycH-Q is a simple, valid, self-completed instrument that reliably identifies hallucinations and psychosis in PD and has the ability to characterize related patterns of attentional and sleep impairments. As such, PsycH-Q is a highly valuable tool for use in both clinical and research settings.The evolution of psychotic symptoms is common in Parkinson's disease (PD) and not surprisingly, the presence of visual hallucinations (VH) represents a strong predictor for the development of more florid psychosis, 1 impaired quality of life, 2 and frequently leads to nursing home placement. 3,4 Patients vary in their ability to self-identify these symptoms, making accurate diagnosis and treatment problematic in both the clinical and research setting. 5 Many patients are unable to understand the medical terminology associated with these symptoms, leading to potential under-reporting. Indeed, a recent task force concluded that a novel questionnaire encompassing the broad phenomenology of the disorder would help to increase the sensitivity of the diagnosis of psychosis and VH in PD. 5,6 In addition, hallucinations in PD have consistently been shown to occur in the presence of broader phenotypic abnormalities, including problems with attention, 7-10 general cognition, 8,10 and sleep, 11-13 thus highlighting the specific domains that can be targeted to better characterize the broader phenomenology of psychosis and hallucinations in PD.In an attempt to solve these two related issues, we designed a novel self-report questionnaire-the Psychosis and Hallucinations Questionnaire (PsycH-Q). The questionnaire has been specifically written in "nonscientific" language with a focus on the phen...

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“…The presence in PD patients of narcolepsy-like features, such as daytime REM sleep intrusions associated with visual hallucinations, has led some authors to suggest that a mechanism similar to that of narcolepsy might underlie excessive daytime sleepiness (EDS) in PD (Arnulf et al, 2000). Thannickal et al (2007) demonstrated that a massive loss of orexin neurons was found in PD patients and suggested that it was a cause of the narcolepsy-like symptoms.…”

Section: Narcolepsy-like Symptomsmentioning

confidence: 99%

Possible Contribution of the Basal Ganglia Brainstem System to the Pathogenesis of Parkinson’s Disease

Takakusaki¹,

Obara²,

Okumura³

2011

Etiology and Pathophysiology of Parkinson's Disease

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Hallucinations, REM sleep, and Parkinson’s disease

Abstract: The visual hallucinations that coincide with daytime episodes of REM sleep in patients who also experience post-REM delusions at night may be dream imagery. Psychosis in patients with PD may therefore reflect a narcolepsy-like REM sleep disorder.

Cited by 410 publications

References 33 publications

Progressive changes of orexin system in a rat model of 6-hydroxydopamineinduced Parkinson’s disease

Progressive changes of orexin system in a rat model of 6-hydroxydopamineinduced Parkinson’s disease

Validation of the Psychosis and Hallucinations Questionnaire in Non‐demented Patients with Parkinson's Disease

Possible Contribution of the Basal Ganglia Brainstem System to the Pathogenesis of Parkinson’s Disease

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