Non-visual hallucinations in Parkinson's disease: a systematic review

J Neurol. 2023 Jun;270(6):2857-2889. doi: 10.1007/s00415-022-11545-6. Epub 2023 Jan 27.


Background: Non-visual hallucinations in Parkinson's disease (PD) can be prevalent and distressing. Most existing research has however, focused on visual hallucinations as well as related risk factors. The current study thus conducted a systematic review to collate existing evidence on non-visual hallucinations in PD, focusing on their prevalence, phenomenology, and clinical-cognitive correlates.

Methods: Ninety-one relevant studies were included from a systematic search across PsycINFO APA, PubMed, and Web of Science, for peer-reviewed publications in the English language, from 1970 to the present. These comprised a mix of case (30 studies; n = 56) and group design (62 studies; n = 7346) studies, divided into three somewhat overlapping collections to address our three research foci.

Results: Prevalence estimates for hallucinations were: auditory 1.5-72.0%, olfactory 1.6-21.0%, somatic-tactile 0.4-22.5%, gustatory 1.0-15.0%, and sensed presence 0.9-73.3%. Phenomenological inquiries revealed descriptions of vivid, consuming events replete with elaborate detail, adversely affecting PD patients in different ways. Overt experiences of multisensory hallucinations were also highly variable (0.4-80%) but exceedingly common, reported by almost half of the 45 included prevalence studies. There was some evidence for modality-specific hallucination predictors, but this was largely tentative, pending robust replication.

Conclusions: Marked prevalence figures coupled with phenomenological descriptions implicating distress denote that non-visual and multisensory hallucinations in PD are of clinical significance. More direct research and clinical attention need to be devoted to the study and management of such hallucinatory experiences.

Keywords: Auditory hallucinations; Olfactory hallucinations; Parkinson’s disease; Phenomenology; Somatic-tactile hallucinations.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Cross-Sectional Studies
  • Hallucinations / epidemiology
  • Hallucinations / etiology
  • Humans
  • Parkinson Disease* / complications
  • Parkinson Disease* / epidemiology
  • Prevalence
  • Smell