title: Minor hallucinations occur in drug-naive Parkinson's disease patients, even from the premotor phase.
abstract: OBJECTIVE
  The description of minor hallucinatory phenomena (presence, passage hallucinations) has widened the spectrum of psychosis in Parkinson's disease (PD). Minor hallucinatory phenomena seem to antedate the development of more severe hallucinations. Early detection of minor hallucinations may be useful for screening patients with more severe endophenotypes. Motivated by the observation of "de novo," drug-naive PD patients reporting minor hallucinations, we aimed to prospectively identify "de novo" untreated PD patients experiencing hallucinatory phenomena, and to compare their clinico-demographic characteristics with those of untreated PD patients without hallucinations and healthy controls.
  
  
  METHODS
  Screening and description of psychosis was assessed by the Movement Disorders Society Unified Parkinson's Disease Rating Scale-Part I and a structured interview covering all types of psychotic phenomena reported in PD. Clinical, neuropsychological, and demographic data of PD patients with and without psychotic phenomena were compared with those of age- and education-matched healthy controls.
  
  
  RESULTS
  Fifty drug-naive, "de novo" PD patients and 100 controls were prospectively included. Minor hallucinations were experienced in 42% (21 of 50) PD patients and 5% controls (P < 0.0001). Coexistence of passage and presence hallucinations was the most common finding. Unexpectedly, 33.3% of patients with minor hallucinations manifested these as a pre-motor symptom, starting 7 months to 8 years before first parkinsonian motor symptoms. The presence of minor hallucinations was significantly associated with presence of rapid eye movement sleep behavior disorder.
  
  
  CONCLUSIONS
  In this first study to prospectively analyze the frequency of minor hallucinatory phenomena in incident, untreated PD patients, hallucinations appeared as a frequent early non-motor symptom that may even predate the onset of parkinsonism.
authors.affiliation: Movement Disorders Unit, Neurology Department Sant Pau Hospital, Barcelona, Spain.|Universitat Autònoma de Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Pagonabarraga
authors.affiliation: Universitat Autònoma de Barcelona, Spain.|Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.|Universitat Oberta de Catalunya (UOC), Spain.
authors.forename: Saul
authors.initials: S
authors.lastname: Martinez-Horta
authors.affiliation: Universitat Autònoma de Barcelona, Spain.|Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.|Universitat Oberta de Catalunya (UOC), Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Fernández de Bobadilla
authors.affiliation: Universitat Autònoma de Barcelona, Spain.|Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Pérez
authors.affiliation: Universitat Autònoma de Barcelona, Spain.|Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Ribosa-Nogué
authors.affiliation: Universitat Autònoma de Barcelona, Spain.|Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Marín
authors.affiliation: Movement Disorders Unit, Neurology Department Sant Pau Hospital, Barcelona, Spain.|Universitat Autònoma de Barcelona, Spain.|Universitat Oberta de Catalunya (UOC), Spain.
authors.forename: Berta
authors.initials: B
authors.lastname: Pascual-Sedano
authors.affiliation: Movement Disorders Unit, Neurology Department Sant Pau Hospital, Barcelona, Spain.|Universitat Autònoma de Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: García
authors.affiliation: Movement Disorders Unit, Neurology Department Sant Pau Hospital, Barcelona, Spain.|Universitat Autònoma de Barcelona, Spain.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Gironell
authors.affiliation: Movement Disorders Unit, Neurology Department Sant Pau Hospital, Barcelona, Spain.|Universitat Autònoma de Barcelona, Spain.|Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.|Universitat Oberta de Catalunya (UOC), Spain.|Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Kulisevsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006212:Hallucinations / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018709:Statistics, Nonparametric
keywords: Parkinson's disease; REM sleep behavior disorder; drug-naive; early untreated; hallucinations; premotor