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Using the presence of visual hallucinations to differentiate Parkinson’s disease from atypical Parkinsonism
  1. David R Williams (david.williams{at}med.monash.edu.au)
  1. Faculty of Medicine (Neruosciences), Monash Univeristy (Alfred Hospital Campus), Australia
    1. Jason D Warren (jwarren{at}dementia.ion.ucl.ac.uk)
    1. Dementia Research Group, UCL, United Kingdom
      1. Andrew J Lees (alees{at}ion.ucl.ac.uk)
      1. Institute of Neurology, United Kingdom

        Abstract

        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 a structured interview (Queen Square Visual Hallucination Inventory, QSVHI) capable of rapidly screening for VH in the outpatient setting.

        Methods: 177 consecutive patients from a specialist movement disorders clinic were tested (117 with PD, 5 with DLB, 22 with progressive supranuclear palsy (PSP), 9 with multiple system atrophy (MSA), 5 with vascular Parkinsonism and 19 with unclassifiable Parkinsonism (UP)), and 15 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 PD. The QSVHI identified VH in 75% of PD and 47% of UP. The specificity of VH identified by the QSVHI for PD was 91%, sensitivity was 62%, PPV was 95% and NPV 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. Amongst patients with unclassifiable or undetermined Parkinsonism, the presence of VH should be considered a red flag for underlying Lewy body pathology.

        • MSA
        • PSP
        • Parkinson's disease
        • QSVHI
        • Visual hallucinations

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