Aarsland D, Larsen J P, Cummins J L, Laake K
Section of Geriatric Psychiatry, Rogaland Psychiatric Hospital, Stavanger, Norway.
Arch Neurol. 1999 May;56(5):595-601. doi: 10.1001/archneur.56.5.595.
Hallucinations and delusions are frequent in patients with Parkinson disease (PD) and may have severe clinical consequences for those patients and their caregivers. However, the prevalence and clinical features of these symptoms have not been studied in a representative sample.
To study the prevalence and clinical correlates of psychosis in a population-based sample of patients with PD.
Total ascertainment of patients with PD in a defined geographical area in Norway was attempted through a detailed community study. Clinical evaluation consisted of a neurologic examination and assessments of depression and cognition. Psychosis was assessed with the thought disorder subscale of the Unified Parkinson's Disease Rating Scale.
A total of 245 patients with PD were identified, 235 (95.9%) of whom participated in this study. Twenty-three patients (9.8%) had hallucinations with insight retained, and another 14 patients (6.0%) had more severe hallucinations or delusions. Psychotic symptoms were associated with age, stage and diagnostic subgroup of PD, severity of depression, and cognitive impairment. Type, duration, and dose of antiparkinson drug therapy did not differ between those patients with PD who had or did not have psychosis. In a polychotomous logistic regression analysis, severity of depression, cognitive impairment, and impairment of activities of daily living were the only significant concomitants of psychosis.
Hallucinations and delusions are common in patients with PD. More advanced and widespread brain changes seem to increase the risk for developing psychosis in patients with PD receiving levodopa therapy.
幻觉和妄想在帕金森病（PD）患者中很常见，可能对这些患者及其照料者产生严重的临床后果。然而，这些症状的患病率和临床特征尚未在具有代表性的样本中进行研究。
研究基于人群的PD患者样本中精神病的患病率及其临床相关性。
通过一项详细的社区研究，试图全面确定挪威某一特定地理区域内的PD患者。临床评估包括神经系统检查以及抑郁和认知评估。使用统一帕金森病评定量表的思维障碍分量表对精神病进行评估。
共识别出245例PD患者，其中235例（95.9%）参与了本研究。23例患者（9.8%）有幻觉且自知力保留，另有14例患者（6.0%）有更严重的幻觉或妄想。精神病性症状与PD的年龄、分期和诊断亚组、抑郁严重程度以及认知障碍有关。有或无精神病的PD患者在抗帕金森药物治疗的类型、持续时间和剂量方面没有差异。在多分类逻辑回归分析中，抑郁严重程度、认知障碍和日常生活活动障碍是精神病仅有的显著伴随因素。
幻觉和妄想在PD患者中很常见。更广泛和更严重的脑部改变似乎会增加接受左旋多巴治疗的PD患者发生精神病的风险。
