Hallucinations and sleep disorders in PD: ten-year prospective longitudinal study.
OBJECTIVE
To assess prospectively progression and relationship of hallucinations and sleep disorders over a 10-year longitudinal study of patients with Parkinson disease (PD).


METHODS
Eighty-nine patients with PD were recruited to fill cells of normal sleep without hallucinations (n = 20), sleep fragmentation only (n = 20), vivid dreams/nightmares (n = 20), hallucinations with insight (n = 20), and hallucinations without insight (n = 9). At baseline, 0.5, 1.5, 4, 6, and 10 years, sleep disorders and hallucinations were assessed by standardized scales with the longitudinal data analyzed by generalized estimating equations with assumptions of linearity in time.


RESULTS
At 10 years, we could account for all subjects (27 interviewed, 61 deceased, and 1 too ill for interview). Hallucination prevalence and severity increased over time (p < 0.0001, p = 0.0001). Acting out dreams also increased over time (p = 0.001). In contrast, presence of vivid dreams/nightmares or sleep fragmentation did not increase over time. For all visits, the prevalence of sleep fragmentation did not differ between subjects with vs without hallucinations (odds ratio [OR] = 1.50, p = 0.09). However, severe sleep fragmentation was associated with concurrent hallucinations (OR 2.01, p = 0.006). The presence of hallucinations was also highly associated with concurrent vivid dreams/nightmares (OR = 2.60, p < 0.0001) and with concurrent acting out dreams (OR = 2.38, p = 0.0004). Among the baseline nonhallucinators, no sleep abnormalities at study entry predicted future development of hallucinations.


CONCLUSIONS
Hallucinations and sleep abnormalities follow very different patterns of progression in PD over 10 years. Whereas patients with hallucinations often have concurrent sleep aberrations, no sleep problem is predictive of future hallucinations.
Movement Disorders Section, Department of Neurological Sciences, Rush University Medical Center, Suite 1106, Chicago, IL 60612, USA. cgoetz@rush.edu
Christopher G
CG
Goetz
Bichun
B
Ouyang
Alice
A
Negron
Glenn T
GT
Stebbins
D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D006212:Hallucinations / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007087:Illinois; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D017741:Survivors