Skip to main content
Top
Published in: BMC Neurology 1/2008

Open Access 01-12-2008 | Research article

A questionnaire-based (UM-PDHQ) study of hallucinations in Parkinson's disease

Authors: Spiridon Papapetropoulos, Heather Katzen, Anette Schrag, Carlos Singer, Blake K Scanlon, Daniel Nation, Alexandra Guevara, Bonnie Levin

Published in: BMC Neurology | Issue 1/2008

Login to get access

Abstract

Background

Hallucinations occur in 20–40% of PD patients and have been associated with unfavorable clinical outcomes (i.e., nursing home placement, increased mortality). Hallucinations, like other non-motor features of PD, are not well recognized in routine primary/secondary clinical practice. So far, there has been no instrument for uniform characterization of hallucinations in PD. To this end, we developed the University of Miami Parkinson's disease Hallucinations Questionnaire (UM-PDHQ) that allows comprehensive assessment of hallucinations in clinical or research settings.

Methods

The UM-PDHQ is composed of 6 quantitative and 14 qualitative items. For our study PD patients of all ages and in all stages of the disease were recruited over an 18-month period. The UPDRS, MMSE, and Beck Depression and Anxiety Inventories were used for comparisons.

Results and Discussion

Seventy consecutive PD patients were included in the analyses. Thirty-one (44.3%) were classified as hallucinators and 39 as non-hallucinators. No significant group differences were observed in terms of demographics, disease characteristics, stage, education, depressive/anxiety scores or cognitive functioning (MMSE) between hallucinators and non-hallucinators. Single mode hallucinations were reported in 20/31 (visual/14, auditory/4, olfactory/2) whereas multiple modalities were reported in 11/31 patients. The most common hallucinatory experience was a whole person followed by small animals, insects and reptiles.

Conclusion

Using the UM-PDHQ, we were able to define the key characteristics of hallucinations in PD in our cohort. Future directions include the validation of the quantitative part of the questionnaire than will serve as a rating scale for severity of hallucinations.
Appendix
Available only for authorised users
Literature
1.
go back to reference Papapetropoulos S, Mash DC: Psychotic symptoms in Parkinson's disease. From description to etiology. J Neurol. 2005, 252 (7): 753-764. 10.1007/s00415-005-0918-5.CrossRefPubMed Papapetropoulos S, Mash DC: Psychotic symptoms in Parkinson's disease. From description to etiology. J Neurol. 2005, 252 (7): 753-764. 10.1007/s00415-005-0918-5.CrossRefPubMed
2.
go back to reference Chou KL, Fernandez HH: Combating psychosis in Parkinson's disease patients: the use of antipsychotic drugs. Expert opinion on investigational drugs. 2006, 15 (4): 339-349. 10.1517/13543784.15.4.339.CrossRefPubMed Chou KL, Fernandez HH: Combating psychosis in Parkinson's disease patients: the use of antipsychotic drugs. Expert opinion on investigational drugs. 2006, 15 (4): 339-349. 10.1517/13543784.15.4.339.CrossRefPubMed
3.
go back to reference Goetz CG, Stebbins GT: Risk factors for nursing home placement in advanced Parkinson's disease. Neurology. 1993, 43 (11): 2227-2229.CrossRefPubMed Goetz CG, Stebbins GT: Risk factors for nursing home placement in advanced Parkinson's disease. Neurology. 1993, 43 (11): 2227-2229.CrossRefPubMed
4.
go back to reference Goetz CG, Stebbins GT: Mortality and hallucinations in nursing home patients with advanced Parkinson's disease. Neurology. 1995, 45 (4): 669-671.CrossRefPubMed Goetz CG, Stebbins GT: Mortality and hallucinations in nursing home patients with advanced Parkinson's disease. Neurology. 1995, 45 (4): 669-671.CrossRefPubMed
5.
go back to reference Chaudhuri KR, Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, Brown RG, Koller W, Barone P, MacPhee G, et al: International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord. 2006, 21 (7): 916-923. 10.1002/mds.20844.CrossRefPubMed Chaudhuri KR, Martinez-Martin P, Schapira AH, Stocchi F, Sethi K, Odin P, Brown RG, Koller W, Barone P, MacPhee G, et al: International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study. Mov Disord. 2006, 21 (7): 916-923. 10.1002/mds.20844.CrossRefPubMed
6.
go back to reference Fahn S, Elton RL, Members of the UPDRS development Committee: Unified Parkinson's disease rating scale. Recent developments in Parkinson's disease. 1987, Macmillan healthcare information, 153-163. Fahn S, Elton RL, Members of the UPDRS development Committee: Unified Parkinson's disease rating scale. Recent developments in Parkinson's disease. 1987, Macmillan healthcare information, 153-163.
7.
go back to reference Starkstein SE, Merello M: The unified Parkinson's disease rating scale: Validation study of the mentation, behavior, and mood section. Mov Disord. 2007, 22 (15): 2156-61. 10.1002/mds.21521.CrossRefPubMed Starkstein SE, Merello M: The unified Parkinson's disease rating scale: Validation study of the mentation, behavior, and mood section. Mov Disord. 2007, 22 (15): 2156-61. 10.1002/mds.21521.CrossRefPubMed
8.
go back to reference Friedberg G, Zoldan J, Weizman A, Melamed E: Parkinson Psychosis Rating Scale: a practical instrument for grading psychosis in Parkinson's disease. Clin Neuropharmacol. 1998, 21 (5): 280-284.PubMed Friedberg G, Zoldan J, Weizman A, Melamed E: Parkinson Psychosis Rating Scale: a practical instrument for grading psychosis in Parkinson's disease. Clin Neuropharmacol. 1998, 21 (5): 280-284.PubMed
9.
go back to reference Visser M, Verbaan D, van Rooden SM, Stiggelbout AM, Marinus J, van Hilten JJ: Assessment of psychiatric complications in Parkinson's disease: The SCOPA-PC. Mov Disord. 2007, 221 (15): 2221-8. 10.1002/mds.21696.CrossRef Visser M, Verbaan D, van Rooden SM, Stiggelbout AM, Marinus J, van Hilten JJ: Assessment of psychiatric complications in Parkinson's disease: The SCOPA-PC. Mov Disord. 2007, 221 (15): 2221-8. 10.1002/mds.21696.CrossRef
10.
go back to reference Pappert EJ, Goetz CG, Niederman FG, Raman R, Leurgans S: Hallucinations, sleep fragmentation, and altered dream phenomena in Parkinson's disease. Mov Disord. 1999, 14 (1): 117-121. 10.1002/1531-8257(199901)14:1<117::AID-MDS1019>3.0.CO;2-0.CrossRefPubMed Pappert EJ, Goetz CG, Niederman FG, Raman R, Leurgans S: Hallucinations, sleep fragmentation, and altered dream phenomena in Parkinson's disease. Mov Disord. 1999, 14 (1): 117-121. 10.1002/1531-8257(199901)14:1<117::AID-MDS1019>3.0.CO;2-0.CrossRefPubMed
11.
go back to reference Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994, 44 (12): 2308-2314.CrossRefPubMed Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J: The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994, 44 (12): 2308-2314.CrossRefPubMed
12.
go back to reference Hughes AJ, Daniel SE, Kilford L, Lees AJ: Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases [see comments]. J Neurol Neurosurg Psychiatry. 1992, 55 (3): 181-184.CrossRefPubMedPubMedCentral Hughes AJ, Daniel SE, Kilford L, Lees AJ: Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases [see comments]. J Neurol Neurosurg Psychiatry. 1992, 55 (3): 181-184.CrossRefPubMedPubMedCentral
13.
go back to reference Fahn S, Elton RL, Members of the UPDRS development Committee: Unified Parkinson's disease rating scale in Recent developments in Parkinson's disease. 1987, Macmillan healthcare information Fahn S, Elton RL, Members of the UPDRS development Committee: Unified Parkinson's disease rating scale in Recent developments in Parkinson's disease. 1987, Macmillan healthcare information
14.
go back to reference Jankovic J, McDermott M, Carter J, Gauthier S, Goetz C, Golbe L, Huber S, Koller W, Olanow C, Shoulson I, et al: Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology. 1990, 40 (10): 1529-1534.CrossRefPubMed Jankovic J, McDermott M, Carter J, Gauthier S, Goetz C, Golbe L, Huber S, Koller W, Olanow C, Shoulson I, et al: Variable expression of Parkinson's disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology. 1990, 40 (10): 1529-1534.CrossRefPubMed
15.
go back to reference Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12 (3): 189-198. 10.1016/0022-3956(75)90026-6.CrossRefPubMed
16.
go back to reference Beck AT, Steer RA, Brown GK: BDI-II Manual. San Antonio: The Psychological Corporation. 1996 Beck AT, Steer RA, Brown GK: BDI-II Manual. San Antonio: The Psychological Corporation. 1996
17.
go back to reference Visser M, Leentjens AF, Marinus J, Stiggelbout AM, van Hilten JJ: Reliability and validity of the Beck depression inventory in patients with Parkinson's disease. Mov Disord. 2006, 21 (5): 668-672. 10.1002/mds.20792.CrossRefPubMed Visser M, Leentjens AF, Marinus J, Stiggelbout AM, van Hilten JJ: Reliability and validity of the Beck depression inventory in patients with Parkinson's disease. Mov Disord. 2006, 21 (5): 668-672. 10.1002/mds.20792.CrossRefPubMed
18.
go back to reference Levin BE, Llabre MM, Weiner WJ: Parkinson's disease and depression: psychometric properties of the Beck Depression Inventory. J Neurol Neurosurg Psychiatry. 1988, 51 (11): 1401-1404.CrossRefPubMedPubMedCentral Levin BE, Llabre MM, Weiner WJ: Parkinson's disease and depression: psychometric properties of the Beck Depression Inventory. J Neurol Neurosurg Psychiatry. 1988, 51 (11): 1401-1404.CrossRefPubMedPubMedCentral
19.
go back to reference Schrag A, Barone P, Brown RG, Leentjens AF, McDonald WM, Starkstein S, Weintraub D, Poewe W, Rascol O, Sampaio C, et al: Depression rating scales in Parkinson's disease: critique and recommendations. Mov Disord. 2007, 22 (8): 1077-1092. 10.1002/mds.21333.CrossRefPubMedPubMedCentral Schrag A, Barone P, Brown RG, Leentjens AF, McDonald WM, Starkstein S, Weintraub D, Poewe W, Rascol O, Sampaio C, et al: Depression rating scales in Parkinson's disease: critique and recommendations. Mov Disord. 2007, 22 (8): 1077-1092. 10.1002/mds.21333.CrossRefPubMedPubMedCentral
20.
go back to reference Beck AT, Steer RA: Beck Anxiety Inventory Manual. San Antonio: The Psychological Corporation. 1990 Beck AT, Steer RA: Beck Anxiety Inventory Manual. San Antonio: The Psychological Corporation. 1990
21.
go back to reference Lewy FH: Die Lehre vom Tonus und die der Bewegung. Berlin. 1923 Lewy FH: Die Lehre vom Tonus und die der Bewegung. Berlin. 1923
22.
go back to reference Mojnes H: Paralysis agitans. A clinical and genetic study. Acta Psychiatr Scand. 1949, S54: Mojnes H: Paralysis agitans. A clinical and genetic study. Acta Psychiatr Scand. 1949, S54:
23.
go back to reference Schwab RS, Fabing HD, Prichard JS: Psychiatric symptoms and syndromes in Parkinson's disease. Am J Psychiatry. 1950, 107: 901-907.CrossRef Schwab RS, Fabing HD, Prichard JS: Psychiatric symptoms and syndromes in Parkinson's disease. Am J Psychiatry. 1950, 107: 901-907.CrossRef
24.
go back to reference McKeith IG: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. J Alzheimers Dis. 2006, 9 (3 Suppl): 417-423.PubMed McKeith IG: Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. J Alzheimers Dis. 2006, 9 (3 Suppl): 417-423.PubMed
25.
go back to reference Papapetropoulos S, Tuchman A, Laufer D, Mash DC: Hallucinations in multiple system atrophy. Parkinsonism Relat Disord. 2007, 13 (3): 193-194. 10.1016/j.parkreldis.2006.07.016.CrossRefPubMed Papapetropoulos S, Tuchman A, Laufer D, Mash DC: Hallucinations in multiple system atrophy. Parkinsonism Relat Disord. 2007, 13 (3): 193-194. 10.1016/j.parkreldis.2006.07.016.CrossRefPubMed
26.
go back to reference Williams DR, Warren JD, Lees AJ: Using the presence of visual hallucinations to differentiate Parkinson's disease from atypical Parkinsonism. J Neurol Neurosurg Psychiatry. 2007 Williams DR, Warren JD, Lees AJ: Using the presence of visual hallucinations to differentiate Parkinson's disease from atypical Parkinsonism. J Neurol Neurosurg Psychiatry. 2007
27.
go back to reference Ravina B, Marder K, Fernandez HH, Friedman JH, McDonald W, Murphy D, Aarsland D, Babcock D, Cummings J, Endicott J, et al: Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group. Mov Disord. 2007, 22 (8): 1061-1068. 10.1002/mds.21382.CrossRefPubMed Ravina B, Marder K, Fernandez HH, Friedman JH, McDonald W, Murphy D, Aarsland D, Babcock D, Cummings J, Endicott J, et al: Diagnostic criteria for psychosis in Parkinson's disease: report of an NINDS, NIMH work group. Mov Disord. 2007, 22 (8): 1061-1068. 10.1002/mds.21382.CrossRefPubMed
28.
go back to reference Aarsland D, Larsen JP, Cummins JL, Laake K: Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study. Arch Neurol. 1999, 56 (5): 595-601. 10.1001/archneur.56.5.595.CrossRefPubMed Aarsland D, Larsen JP, Cummins JL, Laake K: Prevalence and clinical correlates of psychotic symptoms in Parkinson disease: a community-based study. Arch Neurol. 1999, 56 (5): 595-601. 10.1001/archneur.56.5.595.CrossRefPubMed
29.
go back to reference Goetz CG, Leurgans S, Pappert EJ, Raman R, Stemer AB: Prospective longitudinal assessment of hallucinations in Parkinson's disease. Neurology. 2001, 57 (11): 2078-2082.CrossRefPubMed Goetz CG, Leurgans S, Pappert EJ, Raman R, Stemer AB: Prospective longitudinal assessment of hallucinations in Parkinson's disease. Neurology. 2001, 57 (11): 2078-2082.CrossRefPubMed
30.
go back to reference Hely MA, Morris JG, Reid WG, Trafficante R: Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005, 20 (2): 190-199. 10.1002/mds.20324.CrossRefPubMed Hely MA, Morris JG, Reid WG, Trafficante R: Sydney Multicenter Study of Parkinson's disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord. 2005, 20 (2): 190-199. 10.1002/mds.20324.CrossRefPubMed
31.
go back to reference Fenelon G, Mahieux F, Huon R, Ziegler M: Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors. Brain. 2000, 123 (Pt 4): 733-745. 10.1093/brain/123.4.733.CrossRefPubMed Fenelon G, Mahieux F, Huon R, Ziegler M: Hallucinations in Parkinson's disease: prevalence, phenomenology and risk factors. Brain. 2000, 123 (Pt 4): 733-745. 10.1093/brain/123.4.733.CrossRefPubMed
32.
go back to reference Papapetropoulos S, Argyriou AA, Ellul J: Factors associated with drug-induced visual hallucinations in Parkinson's disease. J Neurol. 2005, 252 (10): 1223-1228. 10.1007/s00415-005-0840-x.CrossRefPubMed Papapetropoulos S, Argyriou AA, Ellul J: Factors associated with drug-induced visual hallucinations in Parkinson's disease. J Neurol. 2005, 252 (10): 1223-1228. 10.1007/s00415-005-0840-x.CrossRefPubMed
33.
go back to reference Sanchez-Ramos JR, Ortoll R, Paulson GW: Visual hallucinations associated with Parkinson disease. Arch Neurol. 1996, 53 (12): 1265-1268.CrossRefPubMed Sanchez-Ramos JR, Ortoll R, Paulson GW: Visual hallucinations associated with Parkinson disease. Arch Neurol. 1996, 53 (12): 1265-1268.CrossRefPubMed
34.
go back to reference Barnes J, David AS: Visual hallucinations in Parkinson's disease: a review and phenomenological survey. J Neurol Neurosurg Psychiatry. 2001, 70 (6): 727-733. 10.1136/jnnp.70.6.727.CrossRefPubMedPubMedCentral Barnes J, David AS: Visual hallucinations in Parkinson's disease: a review and phenomenological survey. J Neurol Neurosurg Psychiatry. 2001, 70 (6): 727-733. 10.1136/jnnp.70.6.727.CrossRefPubMedPubMedCentral
35.
go back to reference Chou KL, Messing S, Oakes D, Feldman PD, Breier A, Friedman JH: Drug-induced psychosis in Parkinson disease: phenomenology and correlations among psychosis rating instruments. Clin Neuropharmacol. 2005, 28 (5): 215-219. 10.1097/01.wnf.0000180228.77802.32.CrossRefPubMed Chou KL, Messing S, Oakes D, Feldman PD, Breier A, Friedman JH: Drug-induced psychosis in Parkinson disease: phenomenology and correlations among psychosis rating instruments. Clin Neuropharmacol. 2005, 28 (5): 215-219. 10.1097/01.wnf.0000180228.77802.32.CrossRefPubMed
36.
go back to reference Goetz CG, Wuu J, Curgian L, Leurgans S: Age-related influences on the clinical characteristics of new-onset hallucinations in Parkinson's disease patients. Mov Disord. 2006, 21 (2): 267-270. 10.1002/mds.20701.CrossRefPubMed Goetz CG, Wuu J, Curgian L, Leurgans S: Age-related influences on the clinical characteristics of new-onset hallucinations in Parkinson's disease patients. Mov Disord. 2006, 21 (2): 267-270. 10.1002/mds.20701.CrossRefPubMed
37.
38.
go back to reference Sandyk R: Olfactory hallucinations in Parkinson's disease. S Afr Med J. 1981, 60 (25): 950-PubMed Sandyk R: Olfactory hallucinations in Parkinson's disease. S Afr Med J. 1981, 60 (25): 950-PubMed
39.
go back to reference Factor SA, Molho ES: Threatening auditory hallucinations and Cotard syndrome in Parkinson disease. Clin Neuropharmacol. 2004, 27 (5): 205-207. 10.1097/01.wnf.0000144040.20600.c1.CrossRefPubMed Factor SA, Molho ES: Threatening auditory hallucinations and Cotard syndrome in Parkinson disease. Clin Neuropharmacol. 2004, 27 (5): 205-207. 10.1097/01.wnf.0000144040.20600.c1.CrossRefPubMed
40.
go back to reference Aarsland D, Ballard C, Larsen JP, McKeith I: A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia. Int J Geriatr Psychiatry. 2001, 16 (5): 528-536. 10.1002/gps.389.CrossRefPubMed Aarsland D, Ballard C, Larsen JP, McKeith I: A comparative study of psychiatric symptoms in dementia with Lewy bodies and Parkinson's disease with and without dementia. Int J Geriatr Psychiatry. 2001, 16 (5): 528-536. 10.1002/gps.389.CrossRefPubMed
41.
go back to reference Marsh L, Williams JR, Rocco M, Grill S, Munro C, Dawson TM: Psychiatric comorbidities in patients with Parkinson disease and psychosis. Neurology. 2004, 63 (2): 293-300.CrossRefPubMed Marsh L, Williams JR, Rocco M, Grill S, Munro C, Dawson TM: Psychiatric comorbidities in patients with Parkinson disease and psychosis. Neurology. 2004, 63 (2): 293-300.CrossRefPubMed
42.
go back to reference Moskovitz C, Moses H, Klawans HL: Levodopa-induced psychosis: a kindling phenomenon. Am J Psychiatry. 1978, 135 (6): 669-675.CrossRefPubMed Moskovitz C, Moses H, Klawans HL: Levodopa-induced psychosis: a kindling phenomenon. Am J Psychiatry. 1978, 135 (6): 669-675.CrossRefPubMed
43.
go back to reference Meral H, Aydemir T, Ozer F, Ozturk O, Ozben S, Erol C, Cetin S, Hanoglu L, Ozkayran T, Yilsen M: Relationship between visual hallucinations and REM sleep behavior disorder in patients with Parkinson's disease. Clin Neurol Neurosurg. 2007 Meral H, Aydemir T, Ozer F, Ozturk O, Ozben S, Erol C, Cetin S, Hanoglu L, Ozkayran T, Yilsen M: Relationship between visual hallucinations and REM sleep behavior disorder in patients with Parkinson's disease. Clin Neurol Neurosurg. 2007
44.
go back to reference Sinforiani E, Zangaglia R, Manni R, Cristina S, Marchioni E, Nappi G, Mancini F, Pacchetti C: REM sleep behavior disorder, hallucinations, and cognitive impairment in Parkinson's disease. Mov Disord. 2006, 21 (4): 462-466. 10.1002/mds.20719.CrossRefPubMed Sinforiani E, Zangaglia R, Manni R, Cristina S, Marchioni E, Nappi G, Mancini F, Pacchetti C: REM sleep behavior disorder, hallucinations, and cognitive impairment in Parkinson's disease. Mov Disord. 2006, 21 (4): 462-466. 10.1002/mds.20719.CrossRefPubMed
45.
go back to reference Rothlind JC, Brandt J: A brief assessment of frontal and subcortical functions in dementia. J Neuropsychiatry Clin Neurosci. 1993, 5 (1): 73-77.CrossRefPubMed Rothlind JC, Brandt J: A brief assessment of frontal and subcortical functions in dementia. J Neuropsychiatry Clin Neurosci. 1993, 5 (1): 73-77.CrossRefPubMed
Metadata
Title
A questionnaire-based (UM-PDHQ) study of hallucinations in Parkinson's disease
Authors
Spiridon Papapetropoulos
Heather Katzen
Anette Schrag
Carlos Singer
Blake K Scanlon
Daniel Nation
Alexandra Guevara
Bonnie Levin
Publication date
01-12-2008
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2008
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-8-21

Other articles of this Issue 1/2008

BMC Neurology 1/2008 Go to the issue