帕金森病视幻觉及相关因素临床分析

Clinical Features of Visual Hallucination and Its Associated Factors in Parkinson’s Disease

目的:研究视幻觉在帕金森病(PD)患者中的发生率、临床表现特点及可能的相关因素。方法:选取神经内科门诊连续175例原发性PD患者为研究对象。对有幻觉的PD患者采用改良幻觉调查表问询调查,并对视幻觉出现的频率、严重度及夜间病情等进行评分。分析群体中视幻觉的发生率,通过单因素分析及Logistic回归分析等统计学方法对PD合并视幻觉的相关因素予以分析。结果:175例PD患者中无视幻觉126例(无视幻觉PD组)。存在视幻觉49例(有视幻觉PD组),发生率为28.0%。其中,男性发生率为28.7%(31/108例),女性发生率为26.9%(18/67例)。49例PD视幻觉患者中,18例(36.7%)为轻度幻觉/错觉,31例(63.3%)为复杂型视幻觉。单因素分析显示:轻度幻觉/错觉组和复杂型视幻觉组间的累计评分差异有统计学意义(P<0.05)。单因素分析结果表明视幻觉组与无视幻觉组间在认知评分、病程、年龄、是否服用左旋多巴及剂量、是否服用普拉克索的差异有统计学意义(P<0.05);Logistic回归分析显示认知损害、年龄和病程与视幻觉有密切关系,是视幻觉发生的危险因素。结论:PD患者的视幻觉主要表现为复杂型视幻觉,可与其他精神症状伴随;其发生与认知损害、年龄和病程密切相关;其病因和发生机制需要进一步研究。

Aim： To assess the prevalence of visual hallucinations in those outpatients with Parkinson＇ s disease （PD）, and investigate its clinical features and the factors associated with visual hallucinations. Methods： 175 consecutive outpatients with PD were enrolled in this clinical research. All of them were assessed by using ＂Questionnaire of visual hallucinations in PD patients＂ during routine visits in this study. The detailed information from hallucinators was collected regarding the onset, frequency, content, pattern, severity of hallucinations. The definition of the hallucinatory type was based on the description of content of hallucinations. Cumulative scores were obtained according to frequency, severity and hallucinatory status at night. The univariate analysis and Logistic regression analysis were performed to determine factors that accounted for the occurrence of visual hallucinations. Results： The prevalence of visual hallucinations in those patients with PD was 28.0%（49/175）. Among them, 28.7%（31/108）were male and 26.9%（18/67） were female. 36.7% of the hallucinators experienced minor hallucinations/illusions, and 63.3% had complex visual hallucinations. The minor hallucination/illusion group and complex visual hallucination group differed significantly in cumulative scores by means of univariate analysis（P〈0.05）. Three （6.1%） out of all the hallucinators had auditory hallucinations, two （4.1%） of them had delusions, and one （2.0%） had both auditory hallucinations and delusions. Univariate analysis revealed that there were significant differences in age, duration, cognition score, levodopa and pramipexole between the two groups（P〈0.05）, but no difference in other respects （P〉0.05）. Furthermore, Logistic regression analysis identified that visual hallucinations were closely related to cognitive impairment, duration and age, which might be the main risk factors for visual hallucinations in PD. Conclusion： Our results suggested that visual hallucinations should be relatively common symptoms in patients with PD disease, which can also be accompanied by other psychotic symptoms with the main type being complex visual hallucinations. The visual hallucinations are associated with cognitive impairment, age and duration, which should be paid more attention by neurologists.