Bahar SAY, Yasemin ÜNAL, Tuğba TUNÇ, Ufuk ERGUN, Ufuk ERGÜN

Parkinson Hastalarında Halusinasyon ve Risk Faktörleri

Amaç: Halusinasyon Parkinson hastalığındaki non-motor semptomlardan biridir. Halusinasyon varlığında birçok risk faktörü rol oynayabilir. Bu çalışmada halusinasyonu olan ve olmayan Parkinson hastalarının karşılaştırılması, risk faktörlerinin belirlenmesi, sık görülen halusinasyon tiplerinin bulunması amaçlandı.Gereç ve Yöntemler: İngiltere Beyin Bankası kriterlerine gore idiopatik Parkinson hastalığı tanısı olan hastalarda halusinasyonu olan ve olmayanlar karşılaştırıldı. Metabolik, enfeksiyöz ve yapısal nedenlere bağlı psikotik semptomu olan hastalar çalışmaya dahil edilmedi. Hastalık şiddeti Birleşik Parkinson Hastalığı Değerlendirme Ölçeği ve Hoehn ve Yahr evrelemesine göre belirlendi. Kognitif durum Minimental Durum Değerlendirme testi ile değerlendirildi. Depressif duygu durum tanısı DSM-5 ile konuldu. Mevcut ise halusinasyon tanımlaması, tedavi, komorbidite, uyku bozuklukları, REM uyku davranış bozukluğu, yaş, cinsiyet, ölçek ve test skorları ile hastalık evresi kayıt edildi.Bulgular: Çalışmaya toplam 91 (59 kadın, 32 erkek) idiopatik Parkinson hastası alındı. Halusinasyonu olan grup (Grup 1) da 40 (%43.9), halusinasyonu olmayan grupta (Grup 2) 52 (%54.9) hasta vardı. Birleşik Parkinson Hastalığı Değerlendirme Ölçeği toplam skoru Grup 1 de Grup 2 ye göre anlamlı oranda yüksekti (37.83±16.65; 30.18±14.83; p=0.028). Uyku bozuklukları Grup 2 (n=14, %27.4) ile karşılaştırıldığında Grup 1’de (n=24, %60) anlamlı oranda yüksekti (p=0.007). Halusinasyon süresi Grup 1’de ortalama 24.87±56.47 aydı. 21 (%23.9) hasta görsel halusinasyon, 15 (%16.5) hasta illuzyon (minör halusinasyon) ve dört (%4.4) hasta işitsel halusinasyona sahipti.Sonuç: Parkinson hastalığında hastalık şiddeti halusinasyon varlığında etken olabilir. Halusinasyonlar uyku bozuklukları ile birlikte görülebilir. Minör halusinasyonlar sıklıkla erken evrede izlenirken, en sık görülen görsel halusinasyon her evrede izlenebilir.

Anahtar Kelimeler:

Minör halusinasyon, görsel halusinasyon, hastalık şiddeti, uyku

HALLUCINATION AND RISK FACTORS IN PATIENTS WITH PARKINSON’S DISEASE

Objective: Hallucination is one of the non-motor symptoms in Parkinson disease (PD). Several factors may affect the presence of hallucination. In the present study, we aimed to compare PD patients presenting with and without hallucinations, to determine risk factors, and to find out common hallucination types.Material and Methods: Idiopathic Parkinson patients regarding to UK Parkinson Disease Society Brain Bank with and without hallucinations were compared. The patients with psychotic symptoms due to metabolic, infectious, and structural causes were excluded. Disease severity was evaluated by Unified Parkinson Disease Rating Scale and Hoehn and Yahr staging. Cognitive status was assessed by Minimental State Examination test. Depression was diagnosed on the basis of DSM-V Tr. Description of hallucination, treatment, co-morbidity, sleep disturbances, REM sleep behavioral disorder, age, gender, scores of test and scale, stage of disease were recorded.Results: A total of 91 (59 female, 32 male) patients with idiopathic PD were enrolled. The group with hallucinations (Group 1) had 40 (43.9%) patients and the one without hallucinations (Group 2) had 51 (54.9%) patients. Total score of Unified Parkinson Disease Rating Scale was significantly higher in Group 1 than Group 2 (37.83±16.65; 30.18±14.83; p=0.028). Sleep disturbances were high in Group 1 (n=24, 60%) when compared to Group 2 (n=14, 27.4%) (p=0.007). The mean duration of hallucinations was 24.87±56.47 months in Group 1. Twenty-one patients (23.9%) had visual hallucinations; 15 (16.5%) patients had illusions (minor hallucinations); and four (4.4%) patients had auditory hallucinations.Conclusion: Disease severity in Parkinson's disease may be a factor in the presence of hallucinations. Hallucinations may also occur with sleep disorders. Minor hallucinations are frequently observed in early stages, with visual hallucinations being the most common hallucinations that may occur in every disease stage.

Keywords:

Minor hallucination, visual hallucination, disease severity, sleep,

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