Risk factors for somnolence, edema, and hallucinations in early Parkinson disease

Biglan, Kevin; Holloway, Robert G.; McDermott, Michael P.; Richard, Irene Hegeman

doi:10.1212/01.wnl.0000265593.34438.00

Cited by 111 publications

(85 citation statements)

References 45 publications

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“…The finding by Biglan et al that the risk of hallucinations was increased in those with greater comorbid disease burden supports the idea that increasing comorbidities with age are partly responsible for the increased risk of psychosis in older PD patients. 23 In summary, psychosis in PD is associated with a more advanced and severe disease burden, both related and unrelated to PD pathology, as evidenced by its association with greater disease duration and increased age of onset.…”

Section: Age Duration Of Disease and Disease Severitymentioning

confidence: 96%

“…Psychosis is consistently more common in PD patients with dementia, 7,9,11,[19][20][21] and cognitive impairment is a risk factor for later developing hallucinations. 9,22,23 Based on this, many studies have evaluated whether certain cognitive domains are preferentially impaired in PD patients with visual hallucinations. Executive impairment is most consistently reported to be impaired in psychotic patients with PD, 24,25 even in those without dementia.…”

Section: Cognitive and Visual Impairmentmentioning

confidence: 99%

“…Studies have shown that older age of onset is associated with increased risk of hallucinations. 13,23,41 In addition to its association with increased risk of hallucinations, advanced age at onset is an independent risk factor for more rapid motor decline and greater disability as measured by the UPDRS Part II and Schwab and England Scale. 44 Potential explanations for the association between age and psychosis in PD are the age-related increase in visual impairment, burden of comorbid illness, and presence of other cerebral pathologies associated with age, i.e.…”

Section: Age Duration Of Disease and Disease Severitymentioning

confidence: 99%

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Risk Factors for Psychosis in Parkinson’s Disease

Barrett

2017

US Endocrinology

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Psychosis is a characteristic neuropsychiatric symptom of Parkinson's disease (PD) that is common and associated with worse outcomes. The purpose of this article is to review identified risk factors for visual hallucinations in PD, the most common manifestation of psychosis. With the possible exception of dopamine agonists, antiparkinsonian medications are only considered modifiers of psychosis in PD. Dementia in PD has consistently been shown to be associated with psychosis, and executive dysfunction and impairment in visual processing appear to play a role in its pathogenesis. The association of psychosis with disorders of sleep-wake dysregulation and autonomic dysfunction supports the involvement of brainstem dysfunction in PD psychosis. Despite many studies evaluating genetic risk factors for hallucinations, GBA mutations are the only variants consistently reported to be associated with an increased risk of hallucinations in PD. Lastly, psychosis in PD is associated with a more severe disease burden, both related and unrelated to PD pathology. Any explanatory model of psychosis in PD must incorporate pharmacological, neuroanatomic, pathological, and genetic factors before there can be a complete understanding of this common and disabling neuropsychiatric symptom. KeywordsParkinson's disease, psychosis, hallucinations, risk factor, dementia, rapid eye movement (REM) sleep behavior disorder Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. had minor hallucinations prior to PD motor symptom onset.3 In addition to being common, psychosis is also associated with worse outcomes: increased institutionalization, 4 decreased quality of life, 5 and increased mortality. Considering its prevalence and association with worse outcomes, many studies have sought to identify risk factors for psychosis, specifically visual hallucinations. These efforts have contributed to an improved understanding of this disabling neuropsychiatric symptom. Some risk factors, i.e. cognitive impairment and rapid eye movement (REM) sleep behavior disorder (RBD), may be integral to the mechanism by which psychotic symptoms emerge and have contributed to development of explanatory models of psychotic symptoms in PD. Other risk factors likely represent correlations arising from concomitant pathology in areas not involved in psychosis but occurring at a similar disease stage. Lastly, multiple studies have helped to clarify the relationship between antiparkinsonian medications, especially dopaminergic medications, and psychosis in PD.The purpose of this article is to review risk factors fo...

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Section: Age Duration Of Disease and Disease Severitymentioning

confidence: 96%

Section: Cognitive and Visual Impairmentmentioning

confidence: 99%

Section: Age Duration Of Disease and Disease Severitymentioning

confidence: 99%

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Risk Factors for Psychosis in Parkinson’s Disease

Barrett

2017

US Endocrinology

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“…But psychotic symptoms occur in non-dements as well, even when patients have been followed for many years after onset (personal observation). Other risk factors reported include reduced vision [28] for VH, age, duration of ill-ness, REM sleep behavior disorder [30], dopamine agonists, axial rigidity subtype [31][32][33]. One study of 48 subjects found that non-demented hallucinators differed from non-hallucinators by having reduced executive dysfunction including verbal learning-immediate recall and verbal fluency tasks [34].…”

Section: Introductionmentioning

confidence: 99%

Parkinson Disease Psychosis: Update

Friedman

2013

Behavioural Neurology

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Abstract. Psychotic symptoms are common in drug treated patients with Parkinson's disease (PD). Visual hallucinations occur in about 30% and delusions, typically paranoid in nature, occur in about 5%. These problems, particularly the delusions, cause great distress for patient and caregivers, and are among the most important precipitants for nursing home placement. Psychotic symptoms carry a poor prognosis. They often herald dementia, and are associated with increased mortality. These symptoms often abate with medication reductions, but this may not be tolerated due to worsened motor function. Only clozapine has level A evidence to support its use in PD patients with psychosis (PDP), whether demented or not. While quetiapine has been recommended by the American Academy of Neurology for "consideration," double blind placebo controlled trials have demonstrated safety but not efficacy. Other antipsychotic drugs have been reported to worsen motor function and data on the effectiveness of cholinesterase inhibitors is limited. PDP remains a serious problem with limited treatment options.

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“…The estimated prevalence of hallucinatio ns ranges from -10% to 48%, and the prevalence of delusions ranges from 3% to 80%.1-9 Risk factors for the development of psychotic symptoms include cognitive impairment, dementia, age >65 years, advanced disease (>6 years' duration), advanced PO (Unified Parkinson Disease Rating Scale [UPDRS] score >44.5), presence of sleep disorders, concomitant depression, ocular dysfunction, fumily history of dementia, use of dopamine agonists, and axial parkinsonism. 1 Q-- 13 Recently, Ravina et aJl4 developed diagnostic criteria for psychosis in PD. The characteristic symptoms include ~l of the following: illusions, false sense of presence, hallucinations, and delusions.…”

Section: Introductionmentioning

confidence: 99%

Management of hallucinations and psychosis in Parkinson's disease

Eng

Welty

2010

The American Journal of Geriatric Pharmacotherapy

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Abstract:BACKGROUND: Hallucinations and psychosis are common in patients with Parkinson's disease (PD), with reported prevalences of up to 48% and 80%, respectively. However, few randomized, double-blind, placebo-controlled trials evaluating the treatment options have appeared in the literature. The studies that have been published were complicated by lack of agreement on the diagnosis of psychosis in PD, poor completion rates, mixed populations that included dementia, and other issues. Several reviews, guidelines, and consensus statements have sought to establish standards for treating these symptoms of PD. In 2006, the American Academy of Neurology (AAN) published a practice guideline (based on articles published up to 2004) for management of depression, psychosis, and dementia in patients with PD. Since then, a number of relevant studies have been published. OBJECTIVE: The purpose of this article was to review data that have appeared in the literature since publication of the AAN guideline regarding the management of hallucinations and psychosis in PD. METHODS: A literature search of the PubMed, CINAHL, and PsychInfo databases was conducted for human studies published in English from January 2004 to June 2010. All clinical studies were included except case reports and case series. Studies with <20 participants were also excluded. Search terms included psychosis, hallucinosis, hallucination, delusion, Parkinson, atypical antipsychotic, neuroleptic, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, and ziprasidone. RESULTS: Thirteen studies were included in the review: 3 studies of clozapine, 7 studies of quetiapine, 2 head-to-head trials comparing quetiapine and clozapine, and 1 noncomparative trial of clozapine or quetiapine interventions. Most of the studies included participants with a mean age in the early to mid 70s and a mean duration of PD typically >10 years. CONCLUSIONS: Results of the identified studies suggested that patients with PD might benefit from long-term clozapine therapy. Results of the quetiapine studies were conflicting. However, no statistically significant difference in effectiveness was found between quetiapine and clozapine in comparative trials. The significance of the differences in treatment responses between patients with dementia and those without dementia remains unclear, and it was not possible to draw conclusions for or against other atypical antipsychotics because of insufficient evidence. Further studies are needed to address the methodologic issues in the current trials and to assess safety issues in larger cohorts. Eng, Marty L. and Welty, Timothy E. (1999) Management of Hallucinations and Psychosis in Parkinson's Disease. Am J Geriat Pharm. 8(4), 316-330. PMID: 20869621. Publisher's official version:

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Risk factors for somnolence, edema, and hallucinations in early Parkinson disease

Cited by 111 publications

References 45 publications

Risk Factors for Psychosis in Parkinson’s Disease

Risk Factors for Psychosis in Parkinson’s Disease

Parkinson Disease Psychosis: Update

Management of hallucinations and psychosis in Parkinson's disease

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