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Case-Control Study

Christopher G. Goetz, MD; Paul F. Burke, MD; Sue Leurgans, PhD; Elizabeth Berry-Kravis, MD; Lucy M. Blasucci, RN; Rema Raman, MS; Lili Zhou, MD

Arch Neurol. 2001;58:209-213.

Background  Visual hallucinations in Parkinson disease (PD) occur in approximately one third of patients treated long-term with dopaminergic medications. In Alzheimer disease, hallucinations and psychosis have been linked to increased representations of B2/B2 homozyogotes for the dopamine receptor gene DRD1 and 1/1 or 2/2 homozygotes for DRD3. In addition, a previous study of PD patients with and without hallucinations did not show differences in D2 and D3 polymorphisms, although careful case-control matching was not performed. Another study linked the apolipoprotein E4 (APOE4) allele to hallucinations in PD.

Objective  To determine whether the frequency of dopamine receptor genetic variants and APOE alleles in patients with PD with and without chronic visual hallucinations resembles the pattern previously documented in patients with Alzheimer disease.

Methods  We conducted a case-control study of 44 patients with PD and chronic hallucinations and 44 patients with PD who had never hallucinated. Cases and controls were matched for current age and medications. DNA was isolated from blood samples and assayed for DRD1, DRD2, DRD3, DRD4, and APOE polymorphisms. Receptor polymorphisms were genotyped by polymerase chain reaction. Genotypes in hallucinators and nonhallucinators were compared using Mantel-Haenszel tests stratified by pair, and allele frequencies were compared using Wilcoxon signed rank tests within pairs.

Results  Neither D1 receptor genotypes (P = .37) nor allele frequencies (P = .38) differed, and there was no predominance of B2/B2 homozygotes in the hallucinators. For D3, there was a higher frequency of allele 2 (P = .047), but there was no significant difference between frequencies of homozygotes vs heterozygotes (P = .39) as reported in Alzheimer disease. D4 receptor distribution of long and short alleles did not differ between the 2 patient groups, and there were too few C alleles (3 of 86) to compare D2 allele genotypes or frequencies. For APOE, 12 cases and 12 controls carried E4 alleles (P>.99).

Conclusions  With careful case-control matching, visual hallucinations in PD are not associated with the pattern seen for patients with Alzheimer disease and visual hallucinations. Furthermore, there was no association between hallucinations and APOE. Similar methods using larger sample sizes might be adapted to test whether specific dopaminergic receptor genetic variants are associated with visual hallucinations in PD. Based on our data, the DRD3 allele 2 may merit further study.

From the Departments of Neurological Sciences (Drs Goetz, Burke, Leurgans, and Berry-Kravis and Ms Blasucci), Pharmacology (Dr Goetz), Preventive Medicine (Dr Leurgans and Ms Raman), and Pediatrics (Drs Berry-Kravis and Zhou), Rush University/Rush-Presbyterian-St Luke's Medical Center, Chicago, Ill.

Corresponding author: Christopher G. Goetz, MD, Department of Neurological Sciences, Rush University/Rush-Presbyterian-St Luke's Medical Center, 1725 W Harrison St, Chicago, IL 60612.

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