title: Relationship between hallucinations, delusions, and rapid eye movement sleep behavior disorder in Parkinson's disease.
abstract: Psychotic symptoms are the main and the most disabling "nonmotor" complications of Parkinson's disease (PD), the pathophysiology of which is poorly recognized. Polysomnographic studies have shown a relationship between visual hallucinations and rapid eye movement (REM) sleep. The objective of this study is to clarify the relationship between psychotic symptoms and REM sleep behavior disorder (RBD) in PD. In a Parkinson's disease outpatient unit, 289 consecutive subjects with idiopathic PD were administered (in the period from January to December 2002) a multiple-choice questionnaire and structured interview on sleep and mental disorders. RBD was diagnosed in accordance with the minimal diagnostic criteria of the International Classification of Sleep Disorders. Hallucinations and delusional disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The presence or absence of psychotic symptoms, of RBD, and of daytime sleepiness, as well as motor status, cognitive status, and mood were assessed. Approximately 32% (n = 92) of the subjects presented with psychotic disorders; 30% (n = 86) had experienced hallucinations; 2% (n = 6) had delusions without hallucinations. Sixty-two (72%) hallucinators reported nocturnal hallucinations. A total of 6.6% (n = 19) of the subjects complained of a delusional disorder. There were 26.6% (n = 77) of subjects who presented with RBD: 28 (36%) with onset before and 49 (63%) with onset after PD diagnosis. The presence of RBD was associated with an increased risk of manifesting hallucinations and delusions (odds ratio [OR], 2.73). Other independent clinical factors found to have an effect on psychotic disorders were cognitive impairment (OR, 3.92), disease duration (OR, 2.46), advanced age (OR, 2.34), and severity of motor symptoms (OR, 2.06). These results suggest that RBD is widely associated with psychosis in PD.
authors: Parkinson's Disease and Movement Disorders Unit, IRCCS C. Mondino Institute of Neurology, Pavia, Italy. claudio.pacchetti@mondino.it
authors: Claudio
authors: C
authors: Pacchetti
authors: Raffaele
authors: R
authors: Manni
authors: Roberta
authors: R
authors: Zangaglia
authors: Francesca
authors: F
authors: Mancini
authors: Enrico
authors: E
authors: Marchioni
authors: Cristina
authors: C
authors: Tassorelli
authors: Michele
authors: M
authors: Terzaghi
authors: Maria
authors: M
authors: Ossola
authors: Emilia
authors: E
authors: Martignoni
authors: Arrigo
authors: A
authors: Moglia
authors: Giuseppe
authors: G
authors: Nappi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003702:Delusions / Q000503:physiopathology*; D003710:Demography; D005260:Female; D006212:Hallucinations / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule / Q000706:statistics & numerical data; D008875:Middle Aged; D010300:Parkinson Disease / Q000503:physiopathology* / Q000628:therapy; D020187:REM Sleep Behavior Disorder / Q000503:physiopathology*; D012189:Retrospective Studies; D012895:Sleep, REM / Q000502:physiology*