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Por definição, as verdadeiras alucinações são concebidas como indistinguíveis das percepções reais, excetuando o facto de que não há um estímulo. Para estes propósitos, uma percepção real ocorre no espaço objetivo externo, tem um caráter de objetividade, é recebida pela pessoa que a experiencia com uma atitude de passividade, e os elementos sensoriais são marcantes, frescos e constantes, sendo inalteráveis pela vontade própria. Na essência da distinção está o conceito de que as alucinações "verdadeiras", independentemente de qualquer outra característica, são sinal de doença mental. As alucinações, apresentaram uma incidência de 4-5% na população geral no estudo Epidemiologic Catchment Area. Estudos neuropatológicos recentes mostraram que alucinações ocorrem em sinucleinopatias e são um preditor significativo de depósitos de corpos de Lewy. Portanto, as alucinações são uma característica da doença de Parkinson e da demência com corpos de Lewy As alucinações são um sintoma não motor comum da doença de Parkinson, ocorrendo em até 44% dos pacientes. As alucinações visuais são em sua maioria complexas e cinemáticas; O insight preservado ou perturbado sobre a natureza das alucinações é um importante fator prognóstico, embora, eventualmente, todas as alucinações venham a apresentar-se num estado de insight reduzido. Teorias atuais sobre a origem das alucinações apontam para disfunção visual, overflow de sonhos e comprometimento cognitivo, mas objeções pode ser levantada para cada um dos modelos. A compreensão da origem das alucinações é necessária para o desenvolvimento de tratamentos: todas as avaliações dos tratamentos foram focadas na psicose, e somente a clozapina obteve avaliações baseadas em evidências positivas sobre a eficácia. No entanto, é provável que os inibidores de colinesterase, antipsicóticos e agentes anti-5-hidroxitriptamina3 e drogas que atuam na regulação do sono tenham efeitos diferentes e talvez opostos em diferentes tipos de alucinações, sejam eles acompanhados por insight perturbado, distúrbios do sono ou outras características psicóticas. As alucinações visuais no início do curso de uma doença demencial são mais comuns na doença de corpos de Lewy cortical do que na doença de Alzheimer. As alucinações visuais em pacientes com doença de Alzheimer estão associadas a distúrbios comportamentais graves específicos. Além disso, a ocorrência de alucinações em indivíduos com doença de Alzheimer está associada a um rápido declínio cognitivo, distúrbios da linguagem, agressão e hostilidade. Uma vez que a presença de alucinações visuais em indivíduos com doença de Parkinson prediz demência, a necessidade de instituicionalização e subsequente mortalidade, a prevenção e tratamento vigoroso de alucinações é de grande relevância nesta patologia assim como nas outras doenças neurodegenerativas. A pesquisa bibliográfica foi realizada nas seguintes bases de dados: Medline / PubMed, Medscape, E-medicine, além de diversos livros de referência sobre a especialidade. Esta pesquisa foi realizada em inglês. Após uma pesquisa detalhada, podemos apontar que as alucinações têm grande importância dado que predizem uma maior taxa de mortalidade e complicações em doenças neurodegenerativas, especialmente Parkinson. Portanto, é de suma relevância investigar melhor a fisiopatologia das alucinações, a fim de ter um tratamento eficiente para elas.
By definition, true hallucinations are conceived of as indistinguishable from real perceptions except that there is no stimulus. For these purposes, a real perception occurs in external objective space, has a character of objectivity, is received by the person experiencing it with an attitude of passivity, and the sensory elements which are full, fresh, and constant are unalterable by individual will. (1) At the heart of the distinction is the notion that ‘true’ hallucinations, irrespective of any other feature, signal serious mental illness. (1) Hallucinations, a common experience, exhibited an incidence of 4-5% in the general population in the Epidemiologic Catchment Area study. (2) Recent neuropathological studies showed that hallucinations occur in synucleinopathies and are a significant predictor of Lewy Body depositions. Therefore, hallucinations are a hallmark of Parkinson’s disease and of Dementia with Lewy bodies. (3) Hallucinations are a common non motor symptom of Parkinson’s disease (PD), occurring in as many as 44% of patients. Visual hallucinations are mostly complex and kinematic; preserved or disturbed insight on the nature of hallucinations is a major prognostic factor, although eventually all hallucinations will present with reduced insight. (3,4) Current theories on the origin of hallucinations point to visual dysfunction, dream overflow, and cognitive impairment, yet objection can be raised on each one of the models. Understanding of the origin of hallucinations is required in order to develop treatments: all treatments evaluations were focused in general on psychosis, and only clozapine obtained positive evidence-based ratings on efficacy. (3,4) However, it is likely that cholinesterase inhibitors, antipsychotics and anti-5-hydroxytryptamine3 agents and drugs acting on sleep regulation will have different and perhaps opposite effects on different types of hallucinations, whether they are accompanied by disturbed insight, sleep disorders or other psychotic features. (3) Visual hallucinations early in the course of a dementing illness are more common in cortical Lewy body disease than in Alzheimer's disease. Visual hallucinations in persons with Alzheimer's disease are associated with specific serious behavioral disturbances. Additionally, the occurrence of hallucinations in individuals with Alzheimer's disease is associated with rapid cognitive decline, receptive language disorders, aggression, and hostility. (2) Since the presence of visual hallucinations in individuals with Parkinson’s disease predicts dementia, permanent nursing home placement, and subsequent mortality, prevention and vigorous treatment of hallucinations is needed. (2,4,5) The literature search was performed using the following databases: Medline/PubMed, Medscape, E-medicine as well as several reference books on the specialty. This research was conducted in English. After a detailed research we can point out that hallucinations have greater importance as they predict mortality and complications in neurodegenerative disease especially Parkinson’s. Therefore, it is of the utmost relevance to further investigate the pathophysiology of the hallucinations in order to have an efficient treatment for them.
By definition, true hallucinations are conceived of as indistinguishable from real perceptions except that there is no stimulus. For these purposes, a real perception occurs in external objective space, has a character of objectivity, is received by the person experiencing it with an attitude of passivity, and the sensory elements which are full, fresh, and constant are unalterable by individual will. (1) At the heart of the distinction is the notion that ‘true’ hallucinations, irrespective of any other feature, signal serious mental illness. (1) Hallucinations, a common experience, exhibited an incidence of 4-5% in the general population in the Epidemiologic Catchment Area study. (2) Recent neuropathological studies showed that hallucinations occur in synucleinopathies and are a significant predictor of Lewy Body depositions. Therefore, hallucinations are a hallmark of Parkinson’s disease and of Dementia with Lewy bodies. (3) Hallucinations are a common non motor symptom of Parkinson’s disease (PD), occurring in as many as 44% of patients. Visual hallucinations are mostly complex and kinematic; preserved or disturbed insight on the nature of hallucinations is a major prognostic factor, although eventually all hallucinations will present with reduced insight. (3,4) Current theories on the origin of hallucinations point to visual dysfunction, dream overflow, and cognitive impairment, yet objection can be raised on each one of the models. Understanding of the origin of hallucinations is required in order to develop treatments: all treatments evaluations were focused in general on psychosis, and only clozapine obtained positive evidence-based ratings on efficacy. (3,4) However, it is likely that cholinesterase inhibitors, antipsychotics and anti-5-hydroxytryptamine3 agents and drugs acting on sleep regulation will have different and perhaps opposite effects on different types of hallucinations, whether they are accompanied by disturbed insight, sleep disorders or other psychotic features. (3) Visual hallucinations early in the course of a dementing illness are more common in cortical Lewy body disease than in Alzheimer's disease. Visual hallucinations in persons with Alzheimer's disease are associated with specific serious behavioral disturbances. Additionally, the occurrence of hallucinations in individuals with Alzheimer's disease is associated with rapid cognitive decline, receptive language disorders, aggression, and hostility. (2) Since the presence of visual hallucinations in individuals with Parkinson’s disease predicts dementia, permanent nursing home placement, and subsequent mortality, prevention and vigorous treatment of hallucinations is needed. (2,4,5) The literature search was performed using the following databases: Medline/PubMed, Medscape, E-medicine as well as several reference books on the specialty. This research was conducted in English. After a detailed research we can point out that hallucinations have greater importance as they predict mortality and complications in neurodegenerative disease especially Parkinson’s. Therefore, it is of the utmost relevance to further investigate the pathophysiology of the hallucinations in order to have an efficient treatment for them.