Department of Psychiatry, Shiga University of Medical Science, Shiga, Japan.
Graduate School of Psychology, Doshisha University, Kyoto, Japan.
Acta Neurol Scand. 2022 Mar;145(3):348-359. doi: 10.1111/ane.13555. Epub 2021 Nov 23.
Minor hallucinations (MH) are psychotic symptoms that can occur anywhere between prodromal to early Parkinson's disease and after onset of motor problems. MH include visual illusions, presence hallucinations, and passage hallucinations. Isolated rapid eye movement sleep behavior disorder (RBD) is a harbinger of neurodegenerative diseases. We conducted a retrospective cohort study to investigate the clinical characteristics of isolated RBD with MH and the risk of phenoconversion.
We retrospectively analyzed the data of 36 patients with isolated RBD (four females; median age, 75.0 years). We defined cases reporting at least one minor hallucination as RBD with MH. Demographic data and cognitive function were compared between patients with and without MH, and Cox proportional hazards models estimated the risk of phenoconversion.
We included 10 (27.8%) patients with MH and 26 (72.2%) without MH. Patients with MH were older, had less dopamine transporter accumulation, more severe autonomic dysfunction, more depressive symptoms, and lower verbal fluency and symbol coding test scores than patients without MH. After follow-up (median, 2.50 years), 13.9% (5/36) of all patients developed phenoconversion (Parkinson's disease, two patients; dementia with Lewy bodies, three patients). The rate of phenoconversion was significantly higher in patients with MH (40.0% vs. 3.8%, p = .005). The Cox proportional hazards model adjusted for age, sex, and disease duration revealed that MH was a significant risk factor for phenoconversion (hazard ratio, 14.72; 95% confidence interval, 1.35-160.5).
Minor hallucinations may be utilized as early clinical markers for prodromal estimation of neurodegenerative diseases.
轻度幻觉（MH）是一种精神病症状，可出现在前驱期至帕金森病早期和运动问题出现后。MH 包括视幻觉、存在幻觉和通道幻觉。孤立性快速眼动睡眠行为障碍（RBD）是神经退行性疾病的先兆。我们进行了一项回顾性队列研究，以调查孤立性 RBD 伴 MH 的临床特征和表型转化风险。
我们回顾性分析了 36 例孤立性 RBD 患者（4 例女性；中位年龄 75.0 岁）的数据。我们将报告至少一种轻度幻觉的病例定义为 RBD 伴 MH。比较了有和无 MH 的患者的人口统计学数据和认知功能，并使用 Cox 比例风险模型估计表型转化风险。
我们纳入了 10 例（27.8%）伴 MH 的患者和 26 例（72.2%）无 MH 的患者。与无 MH 的患者相比，伴 MH 的患者年龄更大，多巴胺转运体摄取减少，自主神经功能障碍更严重，抑郁症状更明显，言语流畅性和符号编码测试评分更低。随访（中位时间 2.50 年）后，所有患者中有 13.9%（5/36）发生了表型转化（帕金森病 2 例，路易体痴呆 3 例）。伴 MH 的患者表型转化发生率显著更高（40.0%比 3.8%，p=0.005）。经年龄、性别和疾病持续时间调整的 Cox 比例风险模型显示，MH 是表型转化的显著危险因素（风险比 14.72；95%置信区间 1.35-160.5）。
轻度幻觉可能被用作神经退行性疾病前驱期评估的早期临床标志物。
