Document Detail


Using the presence of visual hallucinations to differentiate Parkinson's disease from atypical parkinsonism.
MedLine Citation:
PMID:  17872984     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Visual hallucinations (VH) occur frequently in Parkinson's disease (PD) and dementia with Lewy bodies (DLB) and are much less common in other bradykinetic rigid syndromes. Pathological series suggest that the presence of VH is highly specific for Lewy body pathology. To address the issue of diagnosis in patients with parkinsonism, we developed instructions for a structured interview (Queen Square Visual Hallucination Inventory (QSVHI)), capable of rapidly screening for VH in the outpatient setting. METHODS: 181 consecutive patients from a specialist movement disorders clinic were tested (115 with PD, 23 with progressive supranuclear palsy (PSP), 9 with multiple system atrophy (MSA), 5 with vascular parkinsonism, 19 with unclassifiable parkinsonism (UP) and 8 others), and 15 selected patients from other clinics and 14 neurologically normal controls. The characteristics of hallucinators and non-hallucinators were compared and the sensitivity, specificity and predictive values of VH for a clinical diagnosis of PD calculated. RESULTS: Screening questions identified VH in only 38% of patients with PD. The QSVHI identified VH in 75% of patients with PD and 47% of those with UP. The specificity of VH identified by the QSVHI for PD was 91%, sensitivity was 62%, positive predictive value was 95% and negative predictive value was 48%. CONCLUSIONS: The QSVHI appears to be a sensitive method for identifying VH in a movement disorders clinic. VH occurred predominantly in PD and very rarely in PSP and MSA. Among patients with unclassifiable or undetermined parkinsonism, the presence of VH should be considered a red flag for underlying Lewy body pathology.
Authors:
D R Williams; J D Warren; A J Lees
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Publication Detail:
Type:  Journal Article     Date:  2007-09-14
Journal Detail:
Title:  Journal of neurology, neurosurgery, and psychiatry     Volume:  79     ISSN:  1468-330X     ISO Abbreviation:  J. Neurol. Neurosurg. Psychiatr.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-19     Completed Date:  2008-05-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985191R     Medline TA:  J Neurol Neurosurg Psychiatry     Country:  England    
Other Details:
Languages:  eng     Pagination:  652-5     Citation Subset:  IM    
Affiliation:
Faculty of Medicine, Neurosciences, Monash University, Alfred Hospital Campus, Commercial Rd, Melbourne 3004, Australia. david.williams@med.monash.edu.au
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Ambulatory Care
Cross-Sectional Studies
Diagnosis, Differential
England
Female
Hallucinations / diagnosis*,  epidemiology
Humans
Interview, Psychological
Lewy Body Disease / diagnosis,  epidemiology
Male
Mass Screening
Middle Aged
Multiple System Atrophy / diagnosis,  epidemiology
Neurologic Examination
Parkinson Disease / diagnosis*,  epidemiology
Parkinsonian Disorders / diagnosis*,  epidemiology
Psychometrics / statistics & numerical data
Questionnaires
Reproducibility of Results
Supranuclear Palsy, Progressive / diagnosis,  epidemiology

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