Objective: To evaluate the relationship between the presence of dementia and hallucinations in the eldest patients with PD.
Design:Dementia and psychosis are the most common neuropsychiatric disturbances in late stage of Parkinson's disease (PD). Both of them in association with PD emerge as important clinical and diagnostic problems. Sometimes it is difficult to recognize differences between PD with dementia and Dementia with Lewy Bodies.
Materials and Methods: Two groups of PD patients aged 70-85 years, with good response to L-dopa, were examined. The first group was formed of PD patients with dementia (25 patients; 12 males, 13 females) whereas the second group included PD patients without cognitive impairment (12 patients; 5 males, 7 females). Cognitive functions were executed by means of the Mini Mental State Examination (MMSE). Dementia was recognized according to ICD-10 and DSM-IV criteria. The diagnosis of hallucinations was performed by psychiatric interview. The Unified Parkinson's Disease Rating Scale (UPDRS) and Modified Hoen &Yahr Staging (H-Y Staging) were used to quantify the severity of PD. All patients were on L-dopa therapy.
Results:Patients with dementia were older at time of study as well as the onset of PD compared to PD patients without dementia. Demented PD patients had more severe extrapyramidal signs according to UPDRS part III as well as H-Y Staging than non-demented subjects. We found no association between the presence of dementia and the duration of disease, the total daily dose of levodopa, and the concomitant use of multiple anti-parkinsonian medications in our parkinsonian patients. 75% of demented PD patients had a clinical history of hallucinations in the last 2 years vs. 45% of non-demented patients. The most frequent type of hallucinations were visual. 92% of hallucinating PD patients had only visual hallucinations and 8% of hallucinating PD patients had both visual and auditory hallucinations. No patient reported auditory hallucinations unaccompanied by visual hallucinations.
Conclusion: Dementia was significantly associated with age at onset of PD, age at the time of study and severity of disease in our patients. Hallucinations were significantly associated with dementia in our cases. Visual hallucinations were the most common type of psychatric symptom in our patients.
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