Frontal dysfunction contributes to the genesis of hallucinations in non-demented Parkinsonian patients

Int J Geriatr Psychiatry. 2005 Jul;20(7):668-73. doi: 10.1002/gps.1339.

Abstract

Background: Hallucinations occur in patients with Parkinson's disease (PD) with reported prevalence ranging from 8% to 40%. Hallucinations are significantly associated with dementia in PD, but little is known about possible distinctive cognitive features of non-demented PD patients who develop hallucinations.

Objective: The aim of the study was to assess selected cognitive abilities in non-demented PD patients with and without hallucinations in order to identify specific neuropsychological correlates of such phenomena.

Methods: Forty-eight consecutive patients with PD and Mini Mental State Examination (MMSE) > or = 23 were examined for the presence of hallucinations and assessed on standardized neuropsychological tasks for semantic and phonological fluency, verbal learning and logical abstract thinking; disease severity was staged according to Hoehn and Yahr scale.

Results: Fourteen (29.2%) of 48 patients experienced hallucinations. There was no difference between hallucinators and non-hallucinators on demographic variables, disease severity and dose of any pharmacological treatment. Disease duration was significantly longer in hallucinator vs non-hallucinator patients (p = 0.02). Patients with hallucinations scored significantly lower than patients without hallucinations only on verbal learning-immediate recall task (p = 0.0324), and semantic and phonological fluency tasks (p = 0.0005 and p = 0.0036, respectively).

Conclusions: Our results suggest that PD patients with hallucinations show reduced performance on tasks that explore executive functioning as compared with non-hallucinators. Therefore, executive dysfunction may be considered as a risk factor for the development of hallucinations in non-demented PD patients.

MeSH terms

  • Aged
  • Cognition Disorders / psychology*
  • Dementia / psychology
  • Female
  • Frontal Lobe / physiopathology*
  • Hallucinations / etiology*
  • Hallucinations / psychology
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neuropsychological Tests
  • Parkinson Disease / physiopathology
  • Parkinson Disease / psychology*
  • Psychiatric Status Rating Scales
  • Semantics
  • Verbal Learning