When a Parkinson's disease patient starts to hallucinate.
Visual hallucinations are a typical feature of Lewy body parkinsonism and occur in some 40% of patients with Parkinson's disease. Age and cognitive decline are the most important intrinsic risk factors, but hallucinosis is often triggered by comorbid conditions such as infection and dehydration. The single most important trigger, however, is exposure to CNS drugs, in particular antiparkinsonian agents. While hallucinosis and psychosis can be triggered by amantadine and anticholinergics, they are more commonly experienced after changes in dopaminergic medication. Dopamine agonists have greater potential to induce hallucinosis compared with L-dopa. Attempting to reduce antiparkinsonian drugs is an important part in the management of these patients, but atypical neuroleptics like clozapine or quetiapine are frequently necessary. Visual hallucinations in Parkinson's disease patients with dementia can also be improved by treatment with the cholinesterase inhibitor rivastigmine.
Poewe
Werner
W
Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. werner.poewe@i-med.ac.at
D000978:Antiparkinson Agents / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects; D006212:Hallucinations / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D020961:Lewy Body Disease / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications* / Q000188:drug therapy*; D011618:Psychotic Disorders / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors
D000978:Antiparkinson Agents; D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D018491:Dopamine Agonists