Fénelon Gilles
Service de neurologie, Hôpital Henri Mondor, Créteil.
Psychol Neuropsychiatr Vieil. 2006 Dec;4 Spec No 1:S17-24.
About one third of patients with Parkinson's disease (PD) experience hallucinations, mostly of a complex visual type, less often auditory or tactile. Minor hallucinatory phenomena, including sense of presence, passage hallucinations and visual illusions are frequent. Hallucinations primarily occur in a context of clear sensorium in patients with longstanding PD. They are more frequent in the evening or during the night. Insight in the hallucinatory nature of the phenomenon may be retained, partial, fluctuating, or abolished. An altered insight is common when cognitive impairment is present, and may be associated with delusions and (or) delusional misidentifications. Pharmacological factors such as dopaminergic treatment clearly trigger or increase the occurence of hallucinations in PD. However, in the recent years, emphasis has been made on disease-related factors including cognitive impairment, diurnal somnolence, visual disorders (either contrast and color discrimination impairment due to PD, or coincident ocular disorders), long duration of PD, late onset, severe axial impairment and autonomic dysfunction. The pathophysiology of hallucinations of PD is poorly understood but is likely to be multifactorial. The first steps of the treatment consist in giving information and reassurance to the patient and his/her caregiver, re-evaluating the antiparkinsonian treatment and associated medications, and evaluating the patient for mood disorder, visual impairment, and cognitive impairment. Cholinesterase inhibitors, when prescribed for associated cognitive impairment, may be beneficial on hallucinations. In the more severe forms, clozapine has been proved to be safe and effective.
约三分之一的帕金森病（PD）患者会出现幻觉，多数为复杂的视觉型幻觉，较少出现听觉或触觉幻觉。轻微的幻觉现象，包括存在感、视幻觉和视错觉很常见。幻觉主要发生在病程较长的PD患者意识清晰的情况下。它们在傍晚或夜间更为频繁。患者可能仍能认识到幻觉现象的本质，也可能只是部分认识、认识情况波动或完全无法认识。当存在认知障碍时，认识改变很常见，且可能与妄想和（或）妄想性错认有关。多巴胺能治疗等药理学因素显然会引发或增加PD患者幻觉的发生。然而，近年来，人们将重点放在了与疾病相关的因素上，包括认知障碍、日间嗜睡、视觉障碍（PD导致的对比度和颜色辨别障碍或并发的眼部疾病）、PD病程长、发病晚、严重的轴性损害和自主神经功能障碍。PD幻觉的病理生理学尚不清楚，但可能是多因素的。治疗的第一步包括向患者及其护理人员提供信息并给予安慰，重新评估抗帕金森病治疗及相关药物，以及评估患者是否存在情绪障碍、视力损害和认知障碍。当为相关认知障碍开具胆碱酯酶抑制剂时，可能对幻觉有益。对于更严重的情况，已证明氯氮平安全有效。
