Objective: To categorise visual hallucinations (VHs) in a cohort of newly diagnosed Parkinson’s disease (PD) patients and determine associations with clinical characteristics.

Background: Visual hallucinations are common in PD, with prevalence ranging from 27-50%. They are associated with later stages of PD and the development of dementia (PDD), which cumulatively affects up to 80% of patients. The presence of VHs can be distressing and has been associated with poorer quality of life (QoL) in both patients and caregivers. Minor hallucinations, which include a feeling of presence or passing of an entity, may occur earlier in the disease process than previously reported. However, there is a paucity of research in this area.

Methods: Newly diagnosed PD participants (n=154) were recruited as part of the Incidence of Cognitive Impairment in Cohorts with Longitudinal Evaluation in PD (ICICLE-PD) study. Participants completed a range of assessments including the Movement Disorders Society Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS III) to measure PD motor severity, the Montreal Cognitive Assessment (MoCA) as measure of global cognition, and the Parkinson’s Disease Questionnaire (PDQ-39) to assess QoL. VHs were classified using the North East Visual Hallucinations Inventory (NEVHI). Hierarchical regression was used to build predictive models of motor severity, QoL and cognition.

Results: Application of the NEVHI criteria showed 22.1% (n=34) of participants experienced recurrent VHs in the month prior to assessment. Minor VHs were the most frequently reported (64.7% of hallucinators). Complex VHs were present in 32.4% of hallucinating participants. Participants with r recurrent VH scored significantly higher for depression and daytime somnolence, had poorer MoCA scores and pooer QoL. Linear regression showed VHs predicted poorer PDQ-39 and MoCA scores (β=0.201, p=0.006 and β=-0.167, p=0.01, respectively) but not motor severity (p>0.05).

Conclusions: More than a fifth of subjects with newly diagnosed PD reported recurrent VHs. The most commonly reported VH were minor hallucinations, although a small proportion reported recurrent complex VHs. Consistent with out hypotheses, recurrent VHs were found to be a significant independent predictor of cognitive function and QoL; however, VHs were not associated with motor severity. Our findings highlight the importance of screening for VHs at diagnosis. Longitudinal assessment may help in identifying whether minor VHs early in disease progression have prognostic utility in identifying patients at risk of developing PDD and declining QoL.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/categorising-visual-hallucinations-in-early-parkinsons-disease/