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Both groups experienced a predominance of visual hallucinations,visions of people and animals,and vivid colors and definition.Features distinctive to the early onset hallucinating patients included visions that persisted in daytime as well as nighttime,frightening content with paranoia,and accompanying nonvisual hallucinations,either auditory,olfactory,tactile,or combinations thereof.At the 5-year follow-up,none of the early onset hallucinators had PD as their sole disorder.Four of the 12 had an underlying psychiatric illness that included hallucinations or psychosis preceding their parkinsonism by several years.In the other eight patients at the 5-year follow-up,their parkinsonism evolved to include additional signs that were no longer consistent with PD.The primary diagnoses were diffuse Lewy body disease and Alzheimer's disease(AD)with extrapyramidal signs.Patients with early drug-induced hallucinations had significantly greater placement to nursing homes and greater mortality.Early onset drug- related hallucinations are not typical of PD.Their presence should signal an investigation of two alternative diagnoses,either a comorbid psychotic illness(often unrevealed by the patient initially)or an evolving parkinsonism-plus syndrome. |
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