Publication date: Jul 05, 2025

Few studies have examined the association between cardiovascular autonomic failure and minor hallucinations in patients with Parkinson’s disease (PD). The aim of this study was to clarify this association. The subjects were 133 patients with PD without well-structured visual hallucinations. Visual illusory responses were evaluated using the noise pareidolia test. Cardiac I-metaiodobenzylguanidine (I-MIBG) uptake and neurogenic orthostatic hypotension (nOH) and supine hypertension (nSH) on head-up tilt-table testing were examined in association with the incidence of pareidolia. Fifty-one (38%) patients had pareidolia. nOH (β = 0. 220, p = 0. 008), cognitive impairment (β = -0. 228, p = 0. 028), and longer symptom duration (β = 0. 273, p = 0. 006) were associated with an increased incidence of pareidolia independently of age, sex, motor severity, levodopa-equivalent dose, and anticholinergic and cholinesterase inhibitor use. An increased incidence of pareidolia was also associated with nSH (β = 0. 214, p = 0. 009), while no such association was found with cardiac I-MIBG uptake. Patients with severe nOH or nSH tended to have a higher incidence of pareidolia than those with mild nOH (p = 0. 063) or nSH (p 

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