Objective: To report a series of twelve patients with Parkinson’s disease (PD) who experienced auditory musical hallucinations (AMH).

Background: Hallucinations occur in 20-40% of patients with PD and are most commonly visual, although hallucinations in other sensory modalities have been described. Auditory hallucinations have been reported in <10% of PD patients, typically of human voices, with musical hallucinations considered rare [1] [2]. Hearing loss, female gender, advanced age, psychiatric conditions, cognitive disorders, and neurologic disease have been associated with musical hallucinations, although the relative importance of these factors in PD patients with AMH is not clear [3] [4].

Method: A retrospective chart review was performed to obtain demographics, clinical features, and descriptive features of the hallucinations.

Results: Half of the patients were female, and half were male. At time of AMH onset, mean age was 71.5 years old (range 57 to 84), mean disease duration 8.42 years (range 4 to 14), and mean MDS-UPDRS III motor score 49.7 (range 28 to 67).  Mean Montreal Cognitive Assessment (MoCA) score was 24.7/30 (range 19 to 28).  Half of the patients had AMH in the absence of visual hallucinations, while half also had visual hallucinations. More than half (58%) of patients had hearing loss. Most patients (75%) had anxiety and/or depression, with four patients on antidepressant or anxiolytic medication. There were no consistent findings on MRI Brain, although of note, one patient had severe global atrophy and subcortical white matter T2 hyperintensities, and one patient had prior left temporoparietal stroke. Average LEDD at onset of AMH was 908.75 mg (range 0-2375); two patients were levodopa naïve at onset of AMH, and one patient had had DBS for 8 years.  Only one patient was also on dopamine agonist at time of onset. Three patients were also on amantadine, one of whom developed AMH after starting the medication. Description of auditory musical hallucinations varied, but several common themes were Christmas carols, patriotic songs, drums, choral music, and prominent bass voice. Three heard music only on top of an environmental (white) noise.

Conclusion: Common features among AMH were Christmas carols, patriotic songs, and choral music with prominent bass voice. Half of the included patients had isolated AMH and no visual hallucinations.

Table 1

References: [1] Fénelon, G., Mahieux, F., Huon, R., & Ziégler, M. (2000). Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain, 123(4), 733-745.
[2] Inzelberg, R., Kipervasser, S., & Korczyn, A. D. (1998). Auditory hallucinations in Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry, 64(4), 533-535.
[3] Evers, S., & Ellger, T. (2004). The clinical spectrum of musical hallucinations. Journal of the neurological sciences, 227(1), 55-65.
[4] Fischer, E., Marchie, A., & Norris, M. (2004). Musical and auditory hallucinations: a spectrum. Psychiatry and Clinical Neurosciences, 58(1), 96-98.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/auditory-musical-hallucinations-in-parkinsons-disease-a-case-series/