Fénelon G, Mahieux F, Huon R, Ziégler M
Department of Neurology, Hôpital Tenon, Paris, France.
Brain. 2000 Apr;123 ( Pt 4):733-45. doi: 10.1093/brain/123.4.733.
Hallucinations, mainly of a visual nature, are considered to affect about one-quarter of patients with Parkinson's disease. They are commonly viewed as a side-effect of antiparkinsonian treatment, but other factors may be involved. The aim of this study was to determine the phenomenology, prevalence and risk factors of hallucinations in Parkinson's disease. Two-hundred and sixteen consecutive patients fulfilling clinical criteria for Parkinson's disease were studied. Demographic and clinical variables were recorded, including motor and cognitive status, depressive symptoms and sleep-wake disturbances. Patients with and without hallucinations were compared using non-parametric tests, and logistic regression was applied to significant data. Hallucinations had been present during the previous 3 months in 39.8% of the patients, and fell into three categories: minor forms, consisting of a sensation of a presence (person), a sideways passage (commonly of an animal) or illusions were present in 25.5% of the patients (an isolated occurrence in 14.3%), formed visual hallucinations were present in 22.2% (isolated in 9.3%) and auditory hallucinations were present in 9.7% (isolated in 2.3%). Patients with minor hallucinations had a higher depression score than non-hallucinators but did not differ in other respects. Logistic regression analysis identified three factors independently predictive of formed visual hallucinations: severe cognitive disorders, daytime somnolence and a long duration of Parkinson's disease. These findings indicate that, when minor hallucinations are included, the total prevalence is much higher than previously reported. A simple side-effect of dopaminergic treatment is not sufficient to explain the occurrence of all visual hallucinations. The main risk factor in treated patients is cognitive impairment, although sleep-wake cycle disturbances, and possibly other factors related to the duration of the disease, act as cofactors.
幻觉主要为视觉性幻觉，据认为约四分之一的帕金森病患者会受到影响。它们通常被视为抗帕金森病治疗的副作用，但可能还涉及其他因素。本研究的目的是确定帕金森病患者幻觉的现象学、患病率及危险因素。对连续216例符合帕金森病临床标准的患者进行了研究。记录了人口统计学和临床变量，包括运动和认知状态、抑郁症状及睡眠-觉醒障碍。使用非参数检验对有幻觉和无幻觉的患者进行比较，并对显著数据应用逻辑回归分析。在之前3个月内，39.8%的患者出现过幻觉，幻觉分为三类：轻微形式，包括存在感（人）、侧向通过感（通常是动物）或错觉，25.5%的患者出现此类情况（单独出现的占14.3%）；成形视幻觉，22.2%的患者出现此类情况（单独出现的占9.3%）；听幻觉，9.7%的患者出现此类情况（单独出现的占2.3%）。有轻微幻觉的患者抑郁评分高于无幻觉者，但在其他方面无差异。逻辑回归分析确定了三个独立预测成形视幻觉的因素：严重认知障碍、日间嗜睡及帕金森病病程较长。这些发现表明，若包括轻微幻觉，总患病率远高于先前报道。多巴胺能治疗的单一副作用不足以解释所有视幻觉的发生。在接受治疗的患者中，主要危险因素是认知障碍，尽管睡眠-觉醒周期紊乱以及可能与疾病病程相关的其他因素起到辅助作用。
