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D'Antonio F, Teghil A, Boccia M, Bechi Gabrielli G, Giulietti G, Conti D, Suppa A, Fabbrini A, Fiorelli M, Caramia F, Bruno G, Guariglia C, Aarsland D, Ffytche D. Distinct grey and white matter changes are associated with the phenomenology of visual hallucinations in Lewy Body Disease. Sci Rep 2024; 14:14748. [PMID: 38926597 DOI: 10.1038/s41598-024-65536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
Visual hallucinations in Lewy body disease (LBD) can be differentiated based on phenomenology into minor phenomena (MVH) and complex hallucinations (CVH). MVH include a variety of phenomena, such as illusions, presence and passage hallucinations occurring at early stages of LBD. The neural mechanisms of visual hallucinations are largely unknown. The hodotopic model posits that the hallucination state is due to abnormal activity in specialized visual areas, that occurs in the context of wider network connectivity alterations and that phenomenology of VH, including content and temporal characteristics, may help identify brain regions underpinning these phenomena. Here we investigated both the topological and hodological neural basis of visual hallucinations integrating grey and white matter imaging analyses. We studied LBD patients with VH and age matched healthy controls (HC). VH were assessed using a North-East-Visual-Hallucinations-Interview that captures phenomenological detail. Then we applied voxel-based morphometry and tract based spatial statistics approaches to identify grey and white matter changes. First, we compared LBD patients and HC. We found a reduced grey matter volume and a widespread damage of white tracts in LBD compared to HC. Then we tested the association between CVH and MVH and grey and white matter indices. We found that CVH duration was associated with decreased grey matter volume in the fusiform gyrus suggesting that LBD neurodegeneration-related abnormal activity in this area is responsible for CVH. An unexpected finding was that MVH severity was associated with a greater integrity of white matter tracts, specifically those connecting dorsal, ventral attention networks and visual areas. Our results suggest that networks underlying MVH need to be partly intact and functional for MVH experiences to occur, while CVH occur when cortical areas are damaged. The findings support the hodotopic view and the hypothesis that MVH and CVH relate to different neural mechanisms, with wider implications for the treatment of these symptoms in a clinical context.
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Affiliation(s)
- Fabrizia D'Antonio
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy.
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy.
| | - Alice Teghil
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Maddalena Boccia
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Giulia Bechi Gabrielli
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy
| | | | - Desirée Conti
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Antonio Suppa
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy
- IRCCS Neuromed Institute, Pozzilli, IS, Italy
| | - Andrea Fabbrini
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy
| | - Marco Fiorelli
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy
| | - Francesca Caramia
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy
| | - Giuseppe Bruno
- Department of Human Neuroscience, Sapienza University of Rome, Viale Dell'università 30, 00185, Rome, Italy
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Cecilia Guariglia
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, IOPPN, London, UK
| | - Dominic Ffytche
- Department of Old Age Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, IOPPN, London, UK
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2
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El Haj M, Larøi F. On hallucinations and memory: the relationship between hallucinations and autobiographical overgenerality in Alzheimer's Disease. Acta Neuropsychiatr 2024; 36:162-166. [PMID: 38369926 DOI: 10.1017/neu.2024.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVES Alzheimer's disease (AD) has been associated with autobiographical overgenerality (i.e. a tendency of patients to retrieve general rather than specific personal memories). AD has also been associated with hallucinations. We investigated the relationship between autobiographical overgenerality and hallucinations in AD. METHODS We invited 28 patients with mild AD to retrieve autobiographical memories, and we also evaluated the occurrence of hallucinations in these patients. RESULTS Analysis demonstrated significant correlations between hallucinations and autobiographical overgenerality in the patients. CONCLUSION AD patients who are distressed by hallucinations may demonstrate autobiographical overgenerality as a strategy to avoid retrieving distressing information that may be related with hallucinations. However, hallucinations as observed in our study can be attributed to other factors such as the general cognitive decline in AD.
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Affiliation(s)
- Mohamad El Haj
- CHU Nantes, Clinical Gerontology Department, Bd Jacques Monod, Nantes, France
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
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3
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Jucevičiūtė N, Balnytė R, Laucius O. Exploring the Spectrum of Visual Illusions and Other Minor Hallucinations in Patients with Parkinson's Disease in Lithuania. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:606. [PMID: 38674252 PMCID: PMC11051838 DOI: 10.3390/medicina60040606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Parkinson's disease (PD) is associated with various non-motor symptoms, including minor hallucinations, comprising visual illusions and presence and passage hallucinations. Despite their occurrence, even in newly diagnosed PD patients, data regarding the prevalence and characteristics of minor hallucinations, visual illusions in particular, remain limited. The aim of this study was to address this knowledge gap by assessing the prevalence of minor hallucinations in PD patients, with a focus on visual illusions. Materials and Methods: In this prospective pilot study, we enrolled 35 PD patients without dementia and 35 age- and gender-matched PD-unaffected individuals. Cognitive function was assessed using the Montreal Cognitive Assessment, clinical data were collected, and all subjects were assessed via questionnaires regarding 20 types of visual illusions and other minor hallucinations. Results: The prevalence of minor hallucinations was significantly higher among PD patients compared to controls (45.7% vs. 11.4%, p = 0.003). PD patients reported visual illusions and presence hallucinations more frequently than the controls (37.1% vs. 8.6% and 22.9% vs. 2.9%, p = 0.009 and p = 0.028, respectively), with no significant difference in passage hallucinations (20% vs. 8.6%, p = 0.306). In the PD group, the most frequently observed visual illusions were complex visual illusions, kinetopsia, and pelopsia; the latter was also the most common visual illusion in the control group. PD patients experiencing visual illusions were more likely to report presence hallucinations compared to patients without visual illusions (53.8% vs. 4.5%, p = 0.002); no significant differences in other clinical characteristics were found. Conclusions: Minor hallucinations are a common phenomenon among PD patients without dementia, with a higher prevalence than among healthy controls. Visual illusions are the most prevalent type of minor hallucinations, affecting more than a third of PD patients, with complex visual illusions, kinetopsia, and pelopsia being the most frequently reported types.
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Affiliation(s)
- Neringa Jucevičiūtė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, A. Mickeviciaus Str. 9, LT-44307 Kaunas, Lithuania
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Kim JS, Hong SB, Park KW, Lee ATC. Psychotic Symptoms in Patients With Major Neurological Diseases. J Clin Neurol 2024; 20:153-165. [PMID: 38433485 PMCID: PMC10921039 DOI: 10.3988/jcn.2023.0501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024] Open
Abstract
Neurological diseases often manifest with neuropsychiatric symptoms such as depression, emotional incontinence, anger, apathy and fatigue. In addition, affected patients may also experience psychotic symptoms such as hallucinations and delusions. Various factors contribute to the development of psychotic symptoms, and the mechanisms of psychosis are similar, but still differ among various neurological diseases. Although psychotic symptoms are uncommon, and have been less well investigated, they may annoy patients and their families as well as impair the patients' quality of life and increase the caregiver burden. Therefore, we need to appropriately identify and treat these psychotic symptoms in patients with neurological diseases.
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Affiliation(s)
- Jong S Kim
- Department of Neurology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Seung-Bong Hong
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keun-Woo Park
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea
| | - Allen T C Lee
- Department of Psychiatry, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Arrigoni E, Antoniotti P, Bellocchio V, Veronelli L, Corbo M, Pisoni A. Neural alterations underlying executive dysfunction in Parkinson's disease: A systematic review and coordinate-based meta-analysis of functional neuroimaging studies. Ageing Res Rev 2024; 95:102207. [PMID: 38281709 DOI: 10.1016/j.arr.2024.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 01/30/2024]
Abstract
Parkinson's Disease's (PD) neuropsychological profile is often characterized by altered performance in executive functions (EF) tasks, with a remarkable impact on patients' quality of life. To date, the available neuroimaging literature lacks conclusive evidence about neural patterns underlying EF deficits in PD. Here, we aimed to synthesize the results of PET/fMRI studies examining the differences in brain activation between PD patients and controls during EF tasks, focusing on the three main EF sub-components: cognitive flexibility, working memory, and response inhibition. We conducted a coordinate-based meta-analysis to assess the converging alterations in brain activity in PD patients compared to controls. We assessed the association between aberrant patterns of activity and the EF sub-domains. We found a significant association between hypoactivation patterns in PD converging at the level of the right inferior frontal gyrus in response inhibition tasks, whereas hypoactivation in the left inferior frontal gyrus was found in association with the cognitive flexibility domain. Our results confirm the existence of neural alterations in PD patients in relation to specific EF sub-domains.
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Affiliation(s)
- Eleonora Arrigoni
- PhD program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy; Department of Psychology, University of Milano-Bicocca, P.zza dell'Ateneo Nuovo 1, 20126 Milano, Italy.
| | - Paola Antoniotti
- PhD program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Italy; Department of Neurorehabilitation Sciences, Casa di Cura IGEA, via Dezza 48, 20144 Milano, Italy
| | - Virginia Bellocchio
- Department of Psychology, University of Milano-Bicocca, P.zza dell'Ateneo Nuovo 1, 20126 Milano, Italy
| | - Laura Veronelli
- Department of Psychology, University of Milano-Bicocca, P.zza dell'Ateneo Nuovo 1, 20126 Milano, Italy; Department of Neurorehabilitation Sciences, Casa di Cura IGEA, via Dezza 48, 20144 Milano, Italy; NeuroMi, Milan Centre for Neuroscience, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura IGEA, via Dezza 48, 20144 Milano, Italy; NeuroMi, Milan Centre for Neuroscience, Milan, Italy
| | - Alberto Pisoni
- Department of Psychology, University of Milano-Bicocca, P.zza dell'Ateneo Nuovo 1, 20126 Milano, Italy; NeuroMi, Milan Centre for Neuroscience, Milan, Italy.
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Firbank MJ, Collerton D, Morgan KD, Schumacher J, Donaghy PC, O'Brien JT, Thomas A, Taylor JP. Functional connectivity in Lewy body disease with visual hallucinations. Eur J Neurol 2024; 31:e16115. [PMID: 37909801 DOI: 10.1111/ene.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE Visual hallucinations are a common, potentially distressing experience of people with Lewy body disease (LBD). The underlying brain changes giving rise to visual hallucinations are not fully understood, although previous models have posited that alterations in the connectivity between brain regions involved in attention and visual processing are critical. METHODS Data from 41 people with LBD and visual hallucinations, 48 with LBD without visual hallucinations and 60 similarly aged healthy comparator participants were used. Connections were investigated between regions in the visual cortex and ventral attention, dorsal attention and default mode networks. RESULTS Participants with visual hallucinations had worse cognition and motor function than those without visual hallucinations. In those with visual hallucinations, reduced functional connectivity within the ventral attention network and from the visual to default mode network was found. Connectivity strength between the visual and default mode network correlated with the number of correct responses on a pareidolia task, and connectivity within the ventral attention network with visuospatial performance. CONCLUSIONS Our results add to evidence of dysfunctional connectivity in the visual and attentional networks in those with LBD and visual hallucinations.
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Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katrina daSilva Morgan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Schumacher
- Deutsches Zentrum für Neurodegenerative Erkrankungen Standort Rostock/Greifswald, Rostock, Mecklenburg-Vorpommern, Germany
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Bernardin F, Remy I, Giersch A, Schwan R, Schwitzer T, Laprevote V. Commentary: Visual Hallucinations in Psychosis: The Curious Absence of the Primary Visual Cortex. Schizophr Bull 2024; 50:1-4. [PMID: 37611909 PMCID: PMC10754165 DOI: 10.1093/schbul/sbad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Florent Bernardin
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Irving Remy
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Anne Giersch
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Raymund Schwan
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- University of Lorraine, IADI, INSERM U1254, Nancy, France
| | - Thomas Schwitzer
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- University of Lorraine, IADI, INSERM U1254, Nancy, France
| | - Vincent Laprevote
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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Cheng X, Tang Y, Vidyadhara D, Li BZ, Zimmerman M, Pak A, Nareddula S, Edens PA, Chandra SS, Chubykin AA. Impaired pre-synaptic plasticity and visual responses in auxilin-knockout mice. iScience 2023; 26:107842. [PMID: 37766983 PMCID: PMC10520332 DOI: 10.1016/j.isci.2023.107842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/06/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023] Open
Abstract
Auxilin (DNAJC6/PARK19), an endocytic co-chaperone, is essential for maintaining homeostasis in the readily releasable pool (RRP) by aiding clathrin-mediated uncoating of synaptic vesicles. Its loss-of-function mutations, observed in familial Parkinson's disease (PD), lead to basal ganglia motor deficits and cortical dysfunction. We discovered that auxilin-knockout (Aux-KO) mice exhibited impaired pre-synaptic plasticity in layer 4 to layer 2/3 pyramidal cell synapses in the primary visual cortex (V1), including reduced short-term facilitation and depression. Computational modeling revealed increased RRP refilling during short repetitive stimulation, which diminished during prolonged stimulation. Silicon probe recordings in V1 of Aux-KO mice demonstrated disrupted visual cortical circuit responses, including reduced orientation selectivity, compromised visual mismatch negativity, and shorter visual familiarity-evoked theta oscillations. Pupillometry analysis revealed an impaired optokinetic response. Auxilin-dependent pre-synaptic endocytosis dysfunction was associated with deficits in pre-synaptic plasticity, visual cortical functions, and eye movement prodromally or at the early stage of motor symptoms.
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Affiliation(s)
- Xi Cheng
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
| | - Yu Tang
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
| | - D.J. Vidyadhara
- Department of Neurology, Yale University, CT, USA
- Department of Neuroscience, Yale University, CT, USA
| | - Ben-Zheng Li
- Department of Physiology and Biophysics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Department of Electrical Engineering, University of Colorado, Denver, Denver, CO, USA
| | - Michael Zimmerman
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
- Department of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Alexandr Pak
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
| | - Sanghamitra Nareddula
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
| | - Paige Alyssa Edens
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
| | - Sreeganga S. Chandra
- Department of Neurology, Yale University, CT, USA
- Department of Neuroscience, Yale University, CT, USA
- Program in Cellular Neuroscience, Neurodegeneration and Repair, Yale University, CT, USA
| | - Alexander A. Chubykin
- Department of Biological Sciences, Purdue Institute for Integrative Neuroscience, Purdue Autism Research Center, Purdue University, West Lafayette, IN 47907, USA
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Liu Z, Lemus J, Smirnova IV, Liu W. Rehabilitation for non-motor symptoms for patients with Parkinson's disease from an α-synuclein perspective: a narrative review. EXPLORATION OF NEUROPROTECTIVE THERAPY 2023; 3:235-257. [PMID: 37920444 PMCID: PMC10621781 DOI: 10.37349/ent.2023.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 11/04/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder affecting aged population around the world. PD is characterized by neuronal Lewy bodies present in the substantia nigra of the midbrain and the loss of dopaminergic neurons with various motor and non-motor symptoms associated with the disease. The protein α-synuclein has been extensively studied for its contribution to PD pathology, as α-synuclein aggregates form the major component of Lewy bodies, a hallmark of PD. In this narrative review, the authors first focus on a brief explanation of α-synuclein aggregation and circumstances under which aggregation can occur, then present a hypothesis for PD pathogenesis in the peripheral nervous system (PNS) and how PD can spread to the central nervous system from the PNS via the transport of α-synuclein aggregates. This article presents arguments both for and against this hypothesis. It also presents various non-pharmacological rehabilitation approaches and management techniques for both motor and non-motor symptoms of PD and the related pathology. This review seeks to examine a possible hypothesis of PD pathogenesis and points to a new research direction focus on rehabilitation therapy for patients with PD. As various non-motor symptoms of PD appear to occur earlier than motor symptoms, more focus on the treatment of non-motor symptoms as well as a better understanding of the biochemical mechanisms behind those non-motor symptoms may lead to better long-term outcomes for patients with PD.
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Affiliation(s)
- Zhaoyang Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jessica Lemus
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Irina V. Smirnova
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
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10
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Collerton D, Barnes J, Diederich NJ, Dudley R, Ffytche D, Friston K, Goetz CG, Goldman JG, Jardri R, Kulisevsky J, Lewis SJG, Nara S, O'Callaghan C, Onofrj M, Pagonabarraga J, Parr T, Shine JM, Stebbins G, Taylor JP, Tsuda I, Weil RS. Understanding visual hallucinations: a new synthesis. Neurosci Biobehav Rev 2023; 150:105208. [PMID: 37141962 DOI: 10.1016/j.neubiorev.2023.105208] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023]
Abstract
Despite decades of research, we do not definitively know how people sometimes see things that are not there. Eight models of complex visual hallucinations have been published since 2000, including Deafferentation, Reality Monitoring, Perception and Attention Deficit, Activation, Input, and Modulation, Hodological, Attentional Networks, Active inference, and Thalamocortical Dysrhythmia Default Mode Network Decoupling. Each was derived from different understandings of brain organisation. To reduce this variability, representatives from each research group agreed an integrated Visual Hallucination Framework that is consistent with current theories of veridical and hallucinatory vision. The Framework delineates cognitive systems relevant to hallucinations. It allows a systematic, consistent, investigation of relationships between the phenomenology of visual hallucinations and changes in underpinning cognitive structures. The episodic nature of hallucinations highlights separate factors associated with the onset, persistence, and end of specific hallucinations suggesting a complex relationship between state and trait markers of hallucination risk. In addition to a harmonised interpretation of existing evidence, the Framework highlights new avenues of research, and potentially, new approaches to treating distressing hallucinations.
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Affiliation(s)
- Daniel Collerton
- School of Psychology, Faculty of Medical Sciences, Third Floor, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE4 5PL UK.
| | - James Barnes
- Fatima College of Health Sciences, Department of Psychology, Al Mafraq, Abu Dhabi, UAE.
| | - Nico J Diederich
- Department of Neurology, Centre Hospitalier de Luxembourg, 4, rue Barblé, L-1210 Luxembourg-City, Luxembourg.
| | - Rob Dudley
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - Dominic Ffytche
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, de Crespigny Park, London, SE5 8AF, UK.
| | - Karl Friston
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR.
| | - Christopher G Goetz
- Rush University Medical Center, Suite 755, 1725 W Harrison St, Chicago IL 60612 USA.
| | - Jennifer G Goldman
- Departments of Physical Medicine and Rehabilitation and Neurology; Shirley Ryan AbilityLab, Parkinson's Disease and Movement Disorders; Feinberg School of Medicine Northwestern University, 355 E. Erie Street, Chicago, IL 60611 USA.
| | - Renaud Jardri
- Lille University, INSERM U-1172, Centre Lille Neuroscience & Cognition, CURE platform, Fontan Hospital, CHU Lille, France.
| | - Jaime Kulisevsky
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau. C/ Mas Casanovas 90. Barcelona (08041) and Universitat Autònoma de Barcelona; CIBERNED (Network Centre for Neurodegenerative Diseases), Spain.
| | - Simon J G Lewis
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Shigetoshi Nara
- Dept. Electrical & Electronic Engineering, Okayama University, Tsushima-naka, 3-1-1, Okayama 700-8530, Japan.
| | - Claire O'Callaghan
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Marco Onofrj
- Clinica Neurologica, Department of Neuroscience, Imaging and Clinical Science, University "G.d'Annunzio" of Chieti-Pescara, via Polacchi 39,66100, Chieti, Italy.
| | - Javier Pagonabarraga
- Movement Disorders Unit, Sant Pau Hospital, Hospital Sant Pau. C/ Mas Casanovas 90. Barcelona (08041) and Universitat Autònoma de Barcelona; CIBERNED (Network Centre for Neurodegenerative Diseases), Spain.
| | - Thomas Parr
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR.
| | - James M Shine
- ForeFront Parkinson's Disease Research Clinic, 100 Mallett Street, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia.
| | - Glenn Stebbins
- Rush University Medical Center, Suite 755, 1725 W Harrison St, Chicago IL 60612 USA.
| | - John-Paul Taylor
- Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University NE4 5PL, UK.
| | - Ichiro Tsuda
- Chubu University Academy of Emerging Sciences and Center for Mathematical Science and Artificial Intelligence, Chubu University, Kasugai, Aichi 487-8501, Japan.
| | - Rimona S Weil
- Wellcome Centre for Human Neuroimaging, Queen Square Institute of Neurology, University College London, London, WC1N 3AR; Dementia Research Centre; Movement Disorders Centre, University College London, London, WC1N 3BG UK.
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11
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Shahid M, Rawls A, Ramirez V, Ryman S, Santini VE, Yang L, Sha SJ, Hall JN, Montine TJ, Lin A, Tian L, Henderson VW, Cholerton B, Yutsis M, Poston KL. Illusory Responses across the Lewy Body Disease Spectrum. Ann Neurol 2023; 93:702-714. [PMID: 36511519 PMCID: PMC10231422 DOI: 10.1002/ana.26574] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study was undertaken to study pareidolias, or perceived meaningful objects in a meaningless stimulus, in patients across the Lewy body (LB) disease spectrum, where most do not report hallucinations or delusions. METHODS We studied illusory responses on the Noise Pareidolia Task in 300 participants (38 cognitively impaired LB, 65 cognitively unimpaired LB, 51 Alzheimer disease spectrum [AD-s], 146 controls). Pairwise between-group comparisons examined how diagnosis impacts the number of illusory responses. Ordinal regression analysis compared the number of illusory responses across diagnosis groups, adjusting for age, sex, and education. Analyses were repeated after removing participants with reported hallucinations or delusions. RESULTS Cognitively impaired LB participants were 12.3, 4.9, and 4.6 times more likely than control, cognitively unimpaired LB, and AD-s participants, respectively, to endorse illusory responses. After adjusting for age, sex, and education, the probability of endorsing 1 or more illusory responses was 61% in the cognitively impaired LB group, compared to 26% in AD-s, 25% in cognitively unimpaired LB, and 12% in control participants. All results were similar after repeated analysis only in participants without hallucinations or delusions. In LB without hallucinations or delusions, 52% with mild cognitive impairment and 66.7% with dementia endorsed at least 1 illusory response. INTERPRETATION We found illusory responses are common in cognitively impaired LB patients, including those without any reported psychosis. Our data suggest that, prior to the onset of hallucinations and delusions, the Noise Pareidolia Task can easily be used to screen for unobtrusive pareidolias in all LB patients. ANN NEUROL 2023;93:702-714.
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Affiliation(s)
- Marian Shahid
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Ashley Rawls
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Veronica Ramirez
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sephira Ryman
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Translational Neuroscience, Mind Research Network, Albuquerque, NM, USA
| | - Veronica E Santini
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Laurice Yang
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Sharon J Sha
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jacob N Hall
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Neurology Center of Southern California, Temecula, CA, USA
| | - Thomas J Montine
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy Lin
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA
| | - Victor W Henderson
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology & Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Brenna Cholerton
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maya Yutsis
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Kathleen L Poston
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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12
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Non-visual hallucinations in Parkinson's disease: a systematic review. J Neurol 2023; 270:2857-2889. [PMID: 36702960 DOI: 10.1007/s00415-022-11545-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/28/2023]
Abstract
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.
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13
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de Souza Andrade T, Mello LGM, Hokazono K, Monteiro MLR. Visual Hallucinations as a Major Manifestation of Posterior Reversible Encephalopathy Syndrome: Case Report and Literature Review. Neuroophthalmology 2022; 47:117-122. [PMID: 36891408 PMCID: PMC9988333 DOI: 10.1080/01658107.2022.2153873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
We evaluated a 48-year-old woman who had visual hallucinations (VHs) as a major presenting sign of posterior reversible encephalopathy syndrome (PRES). Despite her mild loss of vision, she described various hallucinations after awakening from a comatose state days after a motorcycle collision. VHs are usually accompanied by more severe loss of vision, yet our case and literature review indicate that sudden onset of formed VHs should suggest a possible diagnosis of PRES in patients who have large fluctuations in blood pressure, renal failure, or autoimmune dysfunction, as well as in patients taking cytotoxic agents.
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Affiliation(s)
- Thais de Souza Andrade
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Guilherme Marchesi Mello
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
- Department of Specialized Medicine, Centro de Ciências da Saúde (CCS), Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Kenzo Hokazono
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Mário Luiz Ribeiro Monteiro
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
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14
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Zheng HB, Liu B, Shen J, Xie F, Ji QM, Zhu XY. Non-invasive brain stimulation for treating psychiatric symptoms in Parkinson’s disease: A systematic review and meta-analysis. J Clin Neurosci 2022; 106:83-90. [DOI: 10.1016/j.jocn.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022]
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15
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Gu R, Zhu J, Zhong M, Jiang Y, Zhu S, Wang Y, Jiang X, Shen B, Yan J, Zhang L, Pan Y. Characteristics of sleep structure in Parkinson's disease patients with hallucinations based on polysomnography. Front Neurol 2022; 13:929569. [PMID: 36388202 PMCID: PMC9663659 DOI: 10.3389/fneur.2022.929569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/10/2022] [Indexed: 04/07/2024] Open
Abstract
Hallucination is a common non-motor symptom in patients with Parkinson's disease (PD). Additionally, sleep disorders are associated with an increased risk of hallucinations in PD patients. This study aimed to examine the association between hallucination and objective sleep parameters in PD patients. We retrospectively recruited 278 PD patients who underwent polysomnography and clinical assessments and classified them into non-hallucination and hallucination groups. Hallucinations were observed in 77 older PD patients who had more severe motor symptoms and higher scores on the Non-Motor Symptoms Questionnaire (NMSQ), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) but lower scores on the Montreal Cognitive Assessment (MOCA) and PD Sleep Scale (PDSS) than PD patients without hallucinations. Analysis of the polysomnographic variables in patients with hallucinations showed that they exhibited a decrease in total sleep time, sleep efficiency (SE), rapid eye movement (REM) sleep time and slow wave sleep (SWS, N3) time and percentage but a significant increase in wake time after sleep onset (WASO), periodic limb movement index (PLMI) scores, and stage 2 NREM (N2)percentage. Logistic regression analysis revealed that higher NMSQ scores, lower MOCA scores, lower SE, and a lower percentage of N3 sleep were associated with hallucinations in PD patients. Our results suggested that PD patients with hallucinations had worse sleep quality and differences in sleep architecture (measured by polysomnography).
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Affiliation(s)
- Ruxin Gu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jun Zhu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Min Zhong
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yinyin Jiang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Sha Zhu
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yaxi Wang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Xu Jiang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Bo Shen
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Jun Yan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
- Institute of Neuropsychiatric Diseases, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Yang Pan
- Department of Geriatric Neurology, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
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16
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Tuena C, Riva G, Murru I, Campana L, Goulene KM, Pedroli E, Stramba-Badiale M. Contribution of cognitive and bodily navigation cues to egocentric and allocentric spatial memory in hallucinations due to Parkinson's disease: A case report. Front Behav Neurosci 2022; 16:992498. [PMID: 36311858 PMCID: PMC9606325 DOI: 10.3389/fnbeh.2022.992498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Parkinson's disease (PD) manifestations can include visual hallucinations and illusions. Recent findings suggest that the coherent integration of bodily information within an egocentric representation could play a crucial role in these phenomena. Egocentric processing is a key aspect of spatial navigation and is supported by the striatum. Due to the deterioration of the striatal and motor systems, PD mainly impairs the egocentric rather than the allocentric spatial frame of reference. However, it is still unclear the interplay between spatial cognition and PD hallucinations and how different navigation mechanisms can influence such spatial frames of reference. We report the case of A.A., a patient that suffers from PD with frequent episodes of visual hallucinations and illusions. We used a virtual reality (VR) navigation task to assess egocentric and allocentric spatial memory under five navigation conditions (passive, immersive, map, path decision, and attentive cues) in A.A. and a PD control group without psychosis. In general, A.A. exhibited a statistically significant classical dissociation between the egocentric and allocentric performance with a greater deficit for the former. In particular, the dissociation was statistically significant in the “passive” and “attentive cues” conditions. Interestingly in the “immersive” condition, the dissociation was not significant and, in contrast to the other conditions, trends showed better performance for egocentric than allocentric memory. Within the theories of embodiment, we suggest that body-based information, as assessed with VR navigation tasks, could play an important role in PD hallucinations. In addition, the possible neural underpinnings and the usefulness of VR are discussed.
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Affiliation(s)
- Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Cosimo Tuena
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Immacolata Murru
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luca Campana
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Karine M. Goulene
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Elisa Pedroli
- Faculty of Psychology, Università eCampus, Novedrate, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
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17
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Zhong M, Li C, Lu H, Xue D, Wang Y, Jiang Y, Zhu S, Gu R, Jiang X, Shen B, Zhu J, Zhang W, Pan Y, Yan J, Zhang L. Aberrant gray matter volume and functional connectivity in Parkinson’s disease with minor hallucination. Front Aging Neurosci 2022; 14:923560. [PMID: 36185475 PMCID: PMC9522711 DOI: 10.3389/fnagi.2022.923560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMinor hallucination (MH) is the most common psychotic symptom in Parkinson’s disease (PD); it can develop into well-structured visual hallucination (VH), suggesting that MH may be a staccato form of well-structured VH. However, it remains unclear whether the pathogenesis is the same. Therefore, the aim of this study was to investigate the altered gray matter volume (GMV) and functional connectivity (FC) of MH in PD to further understand the complex mechanisms.Materials and methodsWe included 67 PD patients who attended the outpatient clinic of Nanjing Medical University Affiliated Brain Hospital and recruited 31 healthy controls (HC). Demographic data and clinical characteristics of all subjects were recorded, and cranial structural magnetic resonance imaging (MRI) and resting-state functional MRI data were acquired. Patients were classified into the PD with MH (PD-MH) group and PD without hallucinations or delusions (PD-NH) group. Voxel-based morphometry was used to analyze the differences in GMV in the structural pattern. Seed-based FC was used to analyze the functional pattern. Gaussian random field correction was used, with voxel level P < 0.001 and cluster level P < 0.05 representing statistically significant differences. Finally, the correlation between FC values and scores on the clinical characteristics assessment scale was analyzed.ResultsIn the GMV analysis, compared to the PD-NH group, the PD-MH group had reduced GMV in the medial superior frontal gyrus (SFGmed). In the FC analysis, the FC between the SFGmed and the left middle occipital gyrus and right calcarine sulcus decreased in the PD-MH group compared with the PD-NH group, while the FC between SFGmed and the left middle temporal gyrus increased. Correlation analysis revealed that the FC values of the SFGmed and right calcarine sulcus were correlated with the assessment scores for anxiety and sleep symptoms. The FC values of the SFGmed and left middle occipital gyrus were correlated with assessment scores for rapid eye movement disorder.ConclusionThe aberrant structure and function of the default mode network and visual processing areas seems to facilitate the generation of MH in PD, as the alteration was previously found in well-structured VH, suggesting that the two hallucinations have similar pathophysiological mechanisms.
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Affiliation(s)
- Min Zhong
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Chenglin Li
- Department of Radiology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hongquan Lu
- Department of Radiology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Donghui Xue
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yaxi Wang
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yinyin Jiang
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Sha Zhu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ruxin Gu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xu Jiang
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Shen
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Zhu
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbin Zhang
- Department of Neurosurgery, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Pan
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Yan
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Li Zhang
- Department of Geriatric Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- Institute of Neuropsychiatric Diseases, Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Li Zhang,
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18
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Nara S, Fujii H, Tsukada H, Tsuda I. Visual hallucinations in dementia with Lewy bodies originate from necrosis of characteristic neurons and connections in three-module perception model. Sci Rep 2022; 12:14172. [PMID: 35986200 PMCID: PMC9391481 DOI: 10.1038/s41598-022-18313-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Mathematical and computational approaches were used to investigate dementia with Lewy bodies (DLB), in which recurrent complex visual hallucinations (RCVH) is a very characteristic symptom. Beginning with interpretative analyses of pathological symptoms of patients with RCVH-DLB in comparison with the veridical perceptions of normal subjects, we constructed a three-module scenario concerning function giving rise to perception. The three modules were the visual input module, the memory module, and the perceiving module. Each module interacts with the others, and veridical perceptions were regarded as a certain convergence to one of the perceiving attractors sustained by self-consistent collective fields among the modules. Once a rather large but inhomogeneously distributed area of necrotic neurons and dysfunctional synaptic connections developed due to network disease, causing irreversible damage, then bottom-up information from the input module to both the memory and perceiving modules were severely impaired. These changes made the collective fields unstable and caused transient emergence of mismatched perceiving attractors. This may account for the reason why DLB patients see things that are not there. With the use of our computational model and experiments, the scenario was recreated with complex bifurcation phenomena associated with the destabilization of collective field dynamics in very high-dimensional state space.
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19
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Mehraram R, Peraza LR, Murphy NRE, Cromarty RA, Graziadio S, O'Brien JT, Killen A, Colloby SJ, Firbank M, Su L, Collerton D, Taylor JP, Kaiser M. Functional and structural brain network correlates of visual hallucinations in Lewy body dementia. Brain 2022; 145:2190-2205. [PMID: 35262667 PMCID: PMC9246710 DOI: 10.1093/brain/awac094] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 12/02/2022] Open
Abstract
Visual hallucinations are a common feature of Lewy body dementia. Previous studies have shown that visual hallucinations are highly specific in differentiating Lewy body dementia from Alzheimer’s disease dementia and Alzheimer–Lewy body mixed pathology cases. Computational models propose that impairment of visual and attentional networks is aetiologically key to the manifestation of visual hallucinations symptomatology. However, there is still a lack of experimental evidence on functional and structural brain network abnormalities associated with visual hallucinations in Lewy body dementia. We used EEG source localization and network based statistics to assess differential topographical patterns in Lewy body dementia between 25 participants with visual hallucinations and 17 participants without hallucinations. Diffusion tensor imaging was used to assess structural connectivity between thalamus, basal forebrain and cortical regions belonging to the functionally affected network component in the hallucinating group, as assessed with network based statistics. The number of white matter streamlines within the cortex and between subcortical and cortical regions was compared between hallucinating and not hallucinating groups and correlated with average EEG source connectivity of the affected subnetwork. Moreover, modular organization of the EEG source network was obtained, compared between groups and tested for correlation with structural connectivity. Network analysis showed that compared to non-hallucinating patients, those with hallucinations feature consistent weakened connectivity within the visual ventral network, and between this network and default mode and ventral attentional networks, but not between or within attentional networks. The occipital lobe was the most functionally disconnected region. Structural analysis yielded significantly affected white matter streamlines connecting the cortical regions to the nucleus basalis of Meynert and the thalamus in hallucinating compared to not hallucinating patients. The number of streamlines in the tract between the basal forebrain and the cortex correlated with cortical functional connectivity in non-hallucinating patients, while a correlation emerged for the white matter streamlines connecting the functionally affected cortical regions in the hallucinating group. This study proposes, for the first time, differential functional networks between hallucinating and not hallucinating Lewy body dementia patients, and provides empirical evidence for existing models of visual hallucinations. Specifically, the outcome of the present study shows that the hallucinating condition is associated with functional network segregation in Lewy body dementia and supports the involvement of the cholinergic system as proposed in the current literature.
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Affiliation(s)
- Ramtin Mehraram
- Experimental Oto-rhino-laryngology (ExpORL) Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium.,NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK.,Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Nicholas R E Murphy
- Baylor College of Medicine, Menninger Department of Psychiatry and Behavioral Sciences, Houston, TX 77030, USA.,The Menninger Clinic, Houston, TX, 77035, USA.,Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ruth A Cromarty
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sara Graziadio
- NIHR Newcastle in vitro Diagnostics Cooperative, Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alison Killen
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Sean J Colloby
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Li Su
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK.,Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Marcus Kaiser
- Interdisciplinary Computing and Complex BioSystems (ICOS) research group, School of Computing, Newcastle University, Newcastle upon Tyne, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Austgen G, Marsh L. Cognitive dysfunction and neuropsychiatric aspects of Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:59-90. [PMID: 35248207 DOI: 10.1016/bs.pbr.2022.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Movement abnormalities, by definition, and cognitive changes, to varying extents, affect every patient with Parkinson's disease (PD) and are attributed to the underlying neurodegenerative disease. Various psychiatric disorders occur in most patients at some point over the course of PD, including in the prodromal phase. Even though psychiatric disturbances tend to aggravate motor and cognitive deficits, they are under-recognized and under-treated, and the role of the underlying neurological disease is often minimized. To provide an integrated approach to understanding neuropsychiatric aspects of PD, this chapter reviews how cognitive changes in PD relate to the common psychiatric disturbances in PD along with the prevalence, phenomenology, pathophysiology, and treatment of each.
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Affiliation(s)
- Gabriela Austgen
- Behavioral Neurology & Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Laura Marsh
- Mental Health Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Professor, Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences and Department of Neurology, Baylor College of Medicine, Houston, TX, United States.
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Tsitsipa E, Rogers J, Casalotti S, Belessiotis-Richards C, Zubko O, Weil RS, Howard R, Bisby JA, Reeves S. Selective 5HT3 antagonists and sensory processing: a systematic review. Neuropsychopharmacology 2022; 47:880-890. [PMID: 35017671 PMCID: PMC8882165 DOI: 10.1038/s41386-021-01255-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 12/04/2022]
Abstract
Ondansetron is a selective serotonin (5HT3) receptor antagonist that is under evaluation as an adjunctive treatment for schizophrenia, and a novel treatment for hallucinations in Parkinson's disease. Ondansetron reverses sensory gating deficits and improves visuoperceptual processing in animal models of psychosis, but it is unclear to what extent preclinical findings have been replicated in humans. We systematically reviewed human studies that evaluated the effects of ondansetron and other 5HT3 receptor antagonists on sensory gating deficits or sensory processing. Of 11 eligible studies, eight included patients with schizophrenia who were chronically stable on antipsychotic medication; five measured sensory gating using the P50 suppression response to a repeated auditory stimulus; others included tests of visuoperceptual function. Three studies in healthy participants included tests of visuoperceptual and sensorimotor function. A consistent and robust finding (five studies) was that ondansetron and tropisetron (5HT3 antagonist and α7-nicotinic receptor partial agonist) improved sensory gating in patients with schizophrenia. Tropisetron also improved sustained visual attention in non-smoking patients. There was inconsistent evidence of the effects of 5HT3 antagonists on other measures of sensory processing, but interpretation was limited by the small number of studies, methodological heterogeneity and the potential confounding effects of concomitant medication in patients. Despite these limitations, we found strong evidence that selective 5HT3 antagonists (with or without direct α7-nicotinic partial agonist effects) improved sensory gating. Future studies should investigate how this relates to potential improvement in neurocognitive symptoms in antipsychotic naive patients with prodromal or milder symptoms, in order to understand the clinical implications.
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Affiliation(s)
- Eirini Tsitsipa
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Jonathan Rogers
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK ,grid.415717.10000 0001 2324 5535South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX UK
| | - Sebastian Casalotti
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Clara Belessiotis-Richards
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Olga Zubko
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Rimona S. Weil
- grid.83440.3b0000000121901201Dementia Research Centre, University College London, 8-11 Queen Square, London, WC1N 3AR UK ,grid.83440.3b0000000121901201Wellcome Centre for Human Neuroimaging, University College London, 12 Queen Square, London, WC1N 3AR UK ,grid.436283.80000 0004 0612 2631Movement Disorders Consortium, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3AR UK
| | - Robert Howard
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - James A. Bisby
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T7NF, UK.
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22
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Scarioni M, Gami-Patel P, Peeters CFW, de Koning F, Seelaar H, Mol MO, van Swieten JC, Rozemuller AJM, Hoozemans JJM, Pijnenburg YAL, Dijkstra AA. Psychiatric symptoms of frontotemporal dementia and subcortical (co-)pathology burden: new insights. Brain 2022; 146:307-320. [PMID: 35136978 PMCID: PMC9825544 DOI: 10.1093/brain/awac043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/09/2021] [Accepted: 12/19/2021] [Indexed: 01/12/2023] Open
Abstract
Three subtypes of distinct pathological proteins accumulate throughout multiple brain regions and shape the heterogeneous clinical presentation of frontotemporal lobar degeneration (FTLD). Besides the main pathological subtypes, co-occurring pathologies are common in FTLD brain donors. The objective of this study was to investigate how the location and burden of (co-)pathology correlate to early psychiatric and behavioural symptoms of FTLD. Eighty-seven brain donors from The Netherlands Brain Bank cohort (2008-2017) diagnosed with FTLD were included: 46 FTLD-TAR DNA-binding protein 43 (FTLD-TDP), 34 FTLD-tau, and seven FTLD-fused-in-sarcoma (FTLD-FUS). Post-mortem brain tissue was dissected into 20 standard regions and stained for phosphorylated TDP-43, phosphorylated tau, FUS, amyloid-β, and α-synuclein. The burden of each pathological protein in each brain region was assessed with a semi-quantitative score. Clinical records were reviewed for early psychiatric and behavioural symptoms. Whole-brain clinico-pathological partial correlations were calculated (local false discovery rate threshold = 0.01). Elaborating on the results, we validated one finding using a quantitative assessment of TDP-43 pathology in the granular layer of the hippocampus in FTLD-TDP brain donors with (n = 15) and without (n = 15) hallucinations. In subcortical regions, the presence of psychiatric symptoms showed positive correlations with increased hippocampal pathology burden: hallucinations with TDP-43 in the granular layer (R = 0.33), mania with TDP-43 in CA1 (R = 0.35), depression with TDP-43 in CA3 and with parahippocampal tau (R = 0.30 and R = 0.23), and delusions with CA3 tau (R = 0.26) and subicular amyloid-β (R = 0.25). Behavioural disinhibition showed positive correlations with tau burden in the thalamus (R = 0.29) and with both TDP-43 and amyloid-β burden in the subthalamus (R = 0.23 and R = 0.24). In the brainstem, the presence of α-synuclein co-pathology in the substantia nigra correlated with disinhibition (R = 0.24), tau pathology in the substantia nigra correlated with depression (R = 0.25) and in the locus coeruleus with both depression and perseverative/compulsive behaviour (R = 0.26 and R = 0.32). The quantitative assessment of TDP-43 in the granular layer validated the higher burden of TDP-43 pathology in brain donors with hallucinations compared to those without hallucinations (P = 0.007). Our results show that psychiatric symptoms of FTLD are linked to subcortical pathology burden in the hippocampus, and hallucinations are linked to a higher burden of TDP-43 in the granular layer. Co-occurring non-FTLD pathologies in subcortical regions could contribute to configuring the clinical phenotype of FTLD.
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Affiliation(s)
- Marta Scarioni
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Priya Gami-Patel
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Carel F W Peeters
- Division of Mathematical and Statistical Methods—Biometris, Wageningen University and Research, Wageningen, The Netherlands,Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Florianne de Koning
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands,Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Harro Seelaar
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merel O Mol
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - John C van Swieten
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam University Medical Centers, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Anke A Dijkstra
- Correspondence to: Anke A. Dijkstra De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands E-mail:
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23
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Poisson A, Thobois S. Allucinazioni e morbo di Parkinson. Neurologia 2022. [DOI: 10.1016/s1634-7072(21)45999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Visual hallucinations in Lewy body disease: pathophysiological insights from phenomenology. J Neurol 2022; 269:3636-3652. [PMID: 35099586 PMCID: PMC9217885 DOI: 10.1007/s00415-022-10983-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 11/13/2022]
Abstract
Visual hallucinations (VH) in Lewy body disease (LBD) have a heterogenous phenomenology classified into minor phenomena (MVH) and complex hallucinations (CVH). Mechanisms underpinning VH and their temporal aspects are largely unknown. According to the hodotopic model, we investigated whether changes in distinct cognitive domains and neural networks in the hallucination trait underpin temporal aspects of MVH and CVH in the hallucination state. 35 LBD patients with VH underwent a complete neuropsychological evaluation and resting-state fMRI. North-East-Visual-Hallucinations-Interview was used to assess their typical VH content, duration, and frequency. We found that MVH was not associated with cognitive impairment, while CVH was associated with impairments in visuoperceptual processes, attention and visual abstract reasoning. In seed-to-seed functional connectivity (FC) analysis we identified functional couplings associated with MVH and CVH temporal severity (duration x frequency), duration and frequency. MVH severity was negatively associated with FC between early visual areas (EVA) and ventral-visual-stream regions, and negatively associated with FC between brainstem and EVA, which may be linked to LBD brainstem neuropathology. CVH duration was positively associated with FC between ventral-visual stream and salience network (SN). CVH frequency was negatively associated with FC between DMN and SN. Functional alterations in distinct visual and attentional networks and their dynamic interaction in trait LBD hallucinators are linked to both the phenomenology of state content and its temporal characteristics. Within a network, VH frequency and duration may be linked to different types of functional alterations: increased connectivity leading to sustained activity prolonging VH (duration) and decreased connectivity increasing dysregulated, spontaneous activity (frequency). These findings support the hodotopic hypothesis of VH and may reflect a link between VH phenomenology, LBD neuropathological progression and the involvement of specific neurotransmitter systems.
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25
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Diederich NJ. [Causes of visual hallucinations in Parkinson's disease]. DER NERVENARZT 2022; 93:392-401. [PMID: 34342675 PMCID: PMC9010390 DOI: 10.1007/s00115-021-01165-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Visual hallucinations (VH) have mainly been considered as late symptoms of Parkinson's disease (PD); however, minor forms of VH also occur in early stages of the disease. Initially dopaminergic overstimulation was discussed as the cause and later on VH have been considered as an early red flag of dementia in PD. OBJECTIVE The present study analyzed whether the pathophysiological concept of VH has been enlarged in recent years. MATERIAL AND METHODS Clinical, pharmacological, neuropathological as well as functional magnetic resonance imaging studies dealing with VH were reviewed. A systematic classification in monomodal and multimodal models of VH is proposed. The applicability to various forms of VH and various triggering situations is critically examined. RESULTS Reduction of the visual information input, erroneous visual processing, attention deficits, and dysfunctional connectivity between various cerebral networks have been shown. There is partial overlapping with the Lhermitte syndrome and the Charles Bonnet syndrome. No model is able to fully explain all VH variants. Not all VH have the same pathogenesis and the same poor prognosis. CONCLUSION The chain of causes underlying VH is complex and can vary from patient to patient. So far the therapeutic applications are largely unexplored; however, there is preliminary evidence that beside adjustment of the medication, improvement of visual acuity, active involvement of the partner, and possibly, individually adaptable coping strategies could be successfully implemented.
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Affiliation(s)
- Nico J. Diederich
- Abteilung für Neurologie, Centre Hospitalier de Luxembourg, 4, rue Barblé, 1210 Luxemburg-Stadt, Luxemburg
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26
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Ciobanu AM, Ionita I, Buleandra M, David IG, Popa DE, Ciucu AA, Budisteanu M. Current advances in metabolomic studies on non-motor psychiatric manifestations of Parkinson's disease (Review). Exp Ther Med 2021; 22:1010. [PMID: 34345292 PMCID: PMC8311266 DOI: 10.3892/etm.2021.10443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 12/15/2022] Open
Abstract
Life expectancy has increased worldwide and, along with it, a greater prevalence of age-dependent disorders, chronic illnesses and comorbidities can be observed. In 2019, in both Europe and the Americas, dementias ranked 3rd among the top 10 causes of death. Parkinson's disease (PD) is the second most frequent type of neurodegenerative disease. In the last decades, globally, the number of people suffering from PD has more than doubled to over 6 million. Of all the neurological disorders, PD increased with the fastest rate. This troubling trend highlights the stringent need for accurate diagnostic biomarkers, especially in the early stages of the disease and to evaluate treatment response. To gain a broad and complex understanding of the recent advances in the '-omics' research fields, electronic databases such as PubMed, Google Academic, and Science Direct were searched for publications regarding metabolomic studies on PD to identify specific biomarkers for PD, and especially PD with associated psychiatric symptomatology. Discoveries in the fields of metagenomics, transcriptomics and proteomics, may lead to an improved comprehension of the metabolic pathways involved in disease etiology and progression and contribute to the discovery of novel therapeutic targets for effective treatment options.
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Affiliation(s)
- Adela Magdalena Ciobanu
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Psychiatric Hospital, 041914 Bucharest, Romania
- Department of Neurosciences, Discipline of Psychiatry, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ioana Ionita
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Psychiatric Hospital, 041914 Bucharest, Romania
| | - Mihaela Buleandra
- Department of Analytical Chemistry, Faculty of Chemistry, University of Bucharest, 050663 Bucharest, Romania
| | - Iulia Gabriela David
- Department of Analytical Chemistry, Faculty of Chemistry, University of Bucharest, 050663 Bucharest, Romania
| | - Dana Elena Popa
- Department of Analytical Chemistry, Faculty of Chemistry, University of Bucharest, 050663 Bucharest, Romania
| | - Anton Alexandru Ciucu
- Department of Analytical Chemistry, Faculty of Chemistry, University of Bucharest, 050663 Bucharest, Romania
| | - Magdalena Budisteanu
- Laboratory of Medical Genetics, ‘Victor Babes’ National Institute of Pathology, 050096 Bucharest, Romania
- Department of Medical Genetics, Faculty of Medicine, ‘Titu Maiorescu’ University, 031593 Bucharest, Romania
- Psychiatry Research Laboratory, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
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27
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Göbel N, Möller JC, Hollenstein N, Binder A, Oechsner M, Ide J, Urwyler P, Cazzoli D, Müri RM. Face Perception and Pareidolia Production in Patients With Parkinson's Disease. Front Neurol 2021; 12:669691. [PMID: 34413822 PMCID: PMC8370466 DOI: 10.3389/fneur.2021.669691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/09/2021] [Indexed: 11/13/2022] Open
Abstract
In Parkinson's disease (PD) patients, visual misperceptions are a major problem within the non-motor symptoms. Pareidolia, i.e., the tendency to perceive a specific, meaningful image in an ambiguous visual pattern, is a phenomenon that occurs also in healthy subjects. Literature suggests that the perception of face pareidolia may be increased in patients with neurodegenerative diseases. We aimed to examine, within the same experiment, face perception and the production of face pareidolia in PD patients and healthy controls (HC). Thirty participants (15 PD patients and 15 HC) were presented with 47 naturalistic photographs in which faces were embedded or not. The likelihood to perceive the embedded faces was modified by manipulating their transparency. Participants were asked to decide for each photograph whether a face was embedded or not. We found that PD patients were significantly less likely to recognize embedded faces than controls. However, PD patients also perceived faces significantly more often in locations where none were actually present than controls. Linear regression analyses showed that gender, age, hallucinations, and Multiple-Choice Vocabulary Intelligence Test (MWT) score were significant predictors of face pareidolia production in PD patients. Montreal Cognitive Assessment (MoCA) was a significant predictor for pareidolia production in PD patients in trials in which a face was embedded in another region [F (1, 13) = 24.4, p = <0.001]. We conclude that our new embedded faces paradigm is a useful tool to distinguish face perception performance between HC and PD patients. Furthermore, we speculate that our results observed in PD patients rely on disturbed interactions between the Dorsal (DAN) and Ventral Attention Networks (VAN). In photographs in which a face is present, the VAN may detect this as a behaviourally relevant stimulus. However, due to the deficient communication with the DAN in PD patients, the DAN would not direct attention to the correct location, identifying a face at a location where actually none is present.
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Affiliation(s)
- Nicole Göbel
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jens Carsten Möller
- Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht-Sitterdorf, Switzerland.,Department of Neurology, Philipps University, Marburg, Germany
| | - Nathalie Hollenstein
- Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht-Sitterdorf, Switzerland
| | - Andreas Binder
- Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht-Sitterdorf, Switzerland
| | - Matthias Oechsner
- Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht-Sitterdorf, Switzerland
| | - Jörg Ide
- Rehaklinik Zihlschlacht, Centre for Neurological Rehabilitation, Zihlschlacht-Sitterdorf, Switzerland
| | - Prabitha Urwyler
- Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center, University of Bern, Bern, Switzerland
| | - Dario Cazzoli
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center, University of Bern, Bern, Switzerland
| | - René M Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland.,Gerontechnology and Rehabilitation Group, ARTORG Center, University of Bern, Bern, Switzerland
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28
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Nonmotor symptoms and quality of life in Parkinson's disease with different motor subtypes. Z Gerontol Geriatr 2021; 55:496-501. [PMID: 34374861 DOI: 10.1007/s00391-021-01950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the differences in the features and impact on quality of life (QOL) of nonmotor symptoms (NMS) of the tremor dominant (TD) and non-tremor dominant (NTD) subtypes of Parkinson's disease (PD) and elucidate the characteristic NMS and determinants of QOL for the subtypes. METHODS This cross-sectional study included 77 patients with PD. The NMS questionnaire was used to assess the range and prevalence of NMS. The modified Hoehn and Yahr staging and the unified PD rating scale (UPDRS) were used to assess symptom severity. Cognitive abilities were investigated using the mini-mental status examination (MMSE). Emotional state was assessed using the Hamilton depression scale (HAMD) and the Hamilton anxiety scale (HAMA) and QOL was evaluated using the Parkinson's disease questionnaire-39 (PDQ-39). RESULTS Overall, 39 (50.65%) patients were classified as the TD subtype, and 38 (49.35%) were classified as the NTD subtype. Patients with NTD subtype presented a significantly higher number of NMS total scores (P = 0.007) and significantly higher score in the cognition domain of PDQ-39 (P = 0.021) than patients with TD subtype. Patients with NTD subtype had significantly higher NMS prevalence than patients with TD subtype with constipation (P = 0.021), incomplete bowel emptying (P = 0.050), anxiety (P = 0.030), daytime sleepiness (P = 0.017) and intense vivid dreams (P = 0.016). The predictors for the NTD subtype were intense vivid dreams (P = 0.012), anxiety (P = 0.030) and constipation (P = 0.044). The UPDRS, NMS total, and MMSE scores were the determinants of QOL in patients with PD (P < 0.05). CONCLUSION The NMS is a prominent manifestation of PD. Patients with the NTD subtype had a higher prevalence of NMS than those with the TD subtype and intense vivid dreams, anxiety and constipation were characteristic of the NTD subtype. NMS is one of the important factors that determine the QOL of patients with PD especially those with the NTD subtype.
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29
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Hamedani AG. Vision loss and hallucinations: perspectives from neurology and ophthalmology. Curr Opin Neurol 2021; 34:84-88. [PMID: 33230034 DOI: 10.1097/wco.0000000000000882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to summarize the evidence for visual impairment as a risk factor for visual hallucinations in neurologic disease and recent advances in our understanding of the central visual pathways that mediate this association. RECENT FINDINGS Recent studies have described the prevalence Charles Bonnet syndrome and questioned its lack of association with cognitive impairment, used advanced neuroimaging to show that disinhibition of the occipital lobe is involved in the pathogenesis of visual hallucinations in Parkinson's disease, and demonstrated that visual impairment because of eye disease is a consistent risk factor for visual hallucinations across a number of different neurodegenerative disease populations. SUMMARY Through connections between the primary visual cortex and other brain structures, visual function is closely tied to visual hallucinations. Given that the vast majority of vision loss is caused by ophthalmic disease, much of which is preventable or treatable, the detection and treatment of vision loss in at-risk populations may reduce the burden and consequences of visual hallucinations in older adults.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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30
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Kocagoncu E, Klimovich-Gray A, Hughes LE, Rowe JB. Evidence and implications of abnormal predictive coding in dementia. Brain 2021; 144:3311-3321. [PMID: 34240109 PMCID: PMC8677549 DOI: 10.1093/brain/awab254] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/15/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
The diversity of cognitive deficits and neuropathological processes associated with dementias has encouraged divergence in pathophysiological explanations of disease. Here, we review an alternative framework that emphasizes convergent critical features of cognitive pathophysiology. Rather than the loss of ‘memory centres’ or ‘language centres’, or singular neurotransmitter systems, cognitive deficits are interpreted in terms of aberrant predictive coding in hierarchical neural networks. This builds on advances in normative accounts of brain function, specifically the Bayesian integration of beliefs and sensory evidence in which hierarchical predictions and prediction errors underlie memory, perception, speech and behaviour. We describe how analogous impairments in predictive coding in parallel neurocognitive systems can generate diverse clinical phenomena, including the characteristics of dementias. The review presents evidence from behavioural and neurophysiological studies of perception, language, memory and decision-making. The reformulation of cognitive deficits in terms of predictive coding has several advantages. It brings diverse clinical phenomena into a common framework; it aligns cognitive and movement disorders; and it makes specific predictions on cognitive physiology that support translational and experimental medicine studies. The insights into complex human cognitive disorders from the predictive coding framework may therefore also inform future therapeutic strategies.
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Affiliation(s)
- Ece Kocagoncu
- Cambridge Centre for Frontotemporal Dementia, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Laura E Hughes
- Cambridge Centre for Frontotemporal Dementia, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - James B Rowe
- Cambridge Centre for Frontotemporal Dementia, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
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31
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Pezzoli S, Cagnin A, Bussè C, Zorzi G, Fragiacomo F, Bandmann O, Venneri A. Cognitive correlates and baseline predictors of future development of visual hallucinations in dementia with Lewy bodies. Cortex 2021; 142:74-83. [PMID: 34217015 DOI: 10.1016/j.cortex.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
Visual hallucinations (VH) are common in dementia with Lewy bodies (DLB), and are among the core symptoms for its clinical diagnosis. VH have been associated with cognitive alterations, although research findings in this area are still limited. The present study aimed at investigating the cognitive correlates of VH in DLB, and the baseline neuropsychological features predicting the future development of VH. A cross sectional study compared the cognitive profile of 18 DLB patients with VH with that of 32 DLB without VH. A longitudinal study involved 34 DLB patients with no VH at baseline, among whom 17 developed VH and 17 remained without VH at follow-up. Logistic regression analyses were carried out to investigate what baseline cognitive variables independently predicted the development of VH at follow-up. DLB patients with VH had worse performance on the copy of the Rey complex figure, assessing visual construction/perception, than those without VH in the cross-sectional study (p = .001). Significant impairments in attention and visual memory delayed recall were also present. Baseline performance on the immediate prose memory was the only significant predictor of VH development in the longitudinal study (p = .03). DLB patients are more at risk of developing VH if presenting more severe immediate verbal memory impairment, and this might be related to a combination of (a) DMN-related dysfunctions, (b) impairment in medial temporal lobe-related functions, and (c) frontal abilities including long-term encoding of information and working memory. Differences between hallucinating and non-hallucinating patients in visual construction/perception, typical of DLB symptomatology, may be essential for VH to emerge in individuals with an at risk cognitive profile.
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Affiliation(s)
- Stefania Pezzoli
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | | | - Cinzia Bussè
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Giovanni Zorzi
- Department of Neurosciences, University of Padua, Padua, Italy
| | | | - Oliver Bandmann
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | - Annalena Venneri
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK; Department of Life Sciences, Brunel University London, UK.
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Pezzoli S, De Marco M, Zorzi G, Cagnin A, Venneri A. Functional Brain Connectivity Patterns Associated with Visual Hallucinations in Dementia with Lewy Bodies. J Alzheimers Dis Rep 2021; 5:311-320. [PMID: 34113787 PMCID: PMC8150258 DOI: 10.3233/adr-200288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The presence of recurrent, complex visual hallucinations (VH) is among the core clinical features of dementia with Lewy bodies (DLB). It has been proposed that VH arise from a disrupted organization of functional brain networks. However, studies are still limited, especially investigating the resting-state functional brain features underpinning VH in patients with dementia. OBJECTIVE The aim of the present pilot study was to investigate whether there were any alterations in functional connectivity associated with VH in DLB. METHODS Seed-based analyses and independent component analysis (ICA) of resting-state fMRI scans were carried out to explore differences in functional connectivity between DLB patients with and without VH. RESULTS Seed-based analyses reported decreased connectivity of the lateral geniculate nucleus, the superior parietal lobule and the putamen with the medial frontal gyrus in DLB patients with VH. Visual areas showed a pattern of both decreased and increased functional connectivity. ICA revealed between-group differences in the default mode network (DMN). CONCLUSION Functional connectivity analyses suggest dysfunctional top-down and bottom-up processes and DMN-related alterations in DLB patients with VH. This impairment might foster the generation of false visual images that are misinterpreted, ultimately resulting in VH.
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Affiliation(s)
- Stefania Pezzoli
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | - Matteo De Marco
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
| | - Giovanni Zorzi
- Department of Neuroscience and Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Annachiara Cagnin
- Department of Neuroscience and Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Annalena Venneri
- Department of Neuroscience, Medical School, University of Sheffield, Sheffield, UK
- Department of Life Sciences, Brunel University London, London, UK
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34
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Retinal ganglion cell dysfunction is correlated with disturbed visual cognition in schizophrenia patients with visual hallucinations. Psychiatry Res 2021; 298:113780. [PMID: 33567383 DOI: 10.1016/j.psychres.2021.113780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
Patients with schizophrenia have altered visual cognition and retinal functions. No studies have explored if retinal anomalies are related to visual cognition and the presence of visual hallucinations (VH). We explored functional responses of the retinal ganglion cells in schizophrenia patients with or without VH and conducted a neuropsychological evaluation to explore the links between cognition and retinal function. The VH+ group showed poorer visual cognition and we found correlations between the amplitudes of the P50 and the N95 waves and visual cognition. Our results provide arguments for a link between retinal dysfunction, impaired visual processing and VH in schizophrenia.
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35
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Calmodulin and Its Binding Proteins in Parkinson's Disease. Int J Mol Sci 2021; 22:ijms22063016. [PMID: 33809535 PMCID: PMC8001340 DOI: 10.3390/ijms22063016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023] Open
Abstract
Parkinson’s disease (PD) is a neurodegenerative disorder that manifests with rest tremor, muscle rigidity and movement disturbances. At the microscopic level it is characterized by formation of specific intraneuronal inclusions, called Lewy bodies (LBs), and by a progressive loss of dopaminergic neurons in the striatum and substantia nigra. All living cells, among them neurons, rely on Ca2+ as a universal carrier of extracellular and intracellular signals that can initiate and control various cellular processes. Disturbances in Ca2+ homeostasis and dysfunction of Ca2+ signaling pathways may have serious consequences on cells and even result in cell death. Dopaminergic neurons are particularly sensitive to any changes in intracellular Ca2+ level. The best known and studied Ca2+ sensor in eukaryotic cells is calmodulin. Calmodulin binds Ca2+ with high affinity and regulates the activity of a plethora of proteins. In the brain, calmodulin and its binding proteins play a crucial role in regulation of the activity of synaptic proteins and in the maintenance of neuronal plasticity. Thus, any changes in activity of these proteins might be linked to the development and progression of neurodegenerative disorders including PD. This review aims to summarize published results regarding the role of calmodulin and its binding proteins in pathology and pathogenesis of PD.
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Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: A Meta-Analysis of Mood Effects. Neuropsychol Rev 2021; 31:385-401. [PMID: 33606174 DOI: 10.1007/s11065-020-09467-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/22/2020] [Indexed: 12/15/2022]
Abstract
This meta-analysis examines mood changes after bilateral subthalamic deep brain stimulation (STN-DBS) in patients with Parkinson's disease (PD). Deep brain stimulation improves motor outcomes in Parkinson's disease but there appears to be conflicting reports as to subsequent mood outcomes. Pubmed, PsychINFO and SCOPUS were searched for studies assessing mood outcomes in PD patients who had undergone STN-DBS published between January 2003 and the end of January 2019. Random effects meta-analyses were conducted for all outcome groups with at least two studies homogenous in design and measure. Forty-eight studies, providing data on negative moods (such as depression, anxiety, apathy, and anger) and positive moods (pleasure and euphoria) were assessed. Results of the meta-analysis suggest that post-DBS, depression and anxiety symptoms improve and there is a reduction in negative affect, an increase in apathy, and in energy level. Although there have been reported cases of mania post-DBS surgery, the meta-analysis suggested no significant changes in symptoms of mania in the broader DBS population. Considerable heterogeneity was found and partially addressed through meta-regression and qualitative assessment of the included STN-DBS controlled studies. The major strengths of this meta-analysis, include attention to outcome validity, heterogeneity, independence of samples, and clinical utility, with the potential to improve post-operative safety through comprehensive consideration of mood and psychological adjustment. It appears that STN-DBS is a relatively safe and, in the case of mood symptomatology, an advantageous treatment of Parkinson's disease.
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37
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Fazekas P. Hallucinations as intensified forms of mind-wandering. Philos Trans R Soc Lond B Biol Sci 2020; 376:20190700. [PMID: 33308066 DOI: 10.1098/rstb.2019.0700] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
This paper argues for a novel way of thinking about hallucinations as intensified forms of mind-wandering. Starting from the observation that hallucinations are associated with hyperactive sensory areas underlying the content of hallucinatory experiences and a confusion with regard to the reality of the source of these experiences, the paper first reviews the different factors that might contribute to the impairment of reality monitoring. The paper then focuses on the sensory characteristics determining the vividness of an experience, reviews their relationship to the sensory hyperactivity observed in hallucinations, and investigates under what circumstances they can drive reality judgements. Finally, based on these considerations, the paper presents its main proposal according to which hallucinations are intensified forms of mind-wandering that are amplified along their sensory characteristics, and sketches a possible model of what factors might determine if an internally and involuntarily generated perceptual representation is experienced as a hallucination or as an instance of mind-wandering. This article is part of the theme issue 'Offline perception: voluntary and spontaneous perceptual experiences without matching external stimulation'.
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Affiliation(s)
- Peter Fazekas
- Centre for Philosophical Psychology, Universiteit Antwerpen, Antwerpen, Belgium.,Cognitive Neuroscience Research Unit, Centre of Functionally Integrative Neuroscience, Aarhus Universitet, Aarhus, Denmark
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38
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Bejr-Kasem H, Sampedro F, Marín-Lahoz J, Martínez-Horta S, Pagonabarraga J, Kulisevsky J. Minor hallucinations reflect early gray matter loss and predict subjective cognitive decline in Parkinson's disease. Eur J Neurol 2020; 28:438-447. [PMID: 33032389 DOI: 10.1111/ene.14576] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/02/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Well-structured hallucinations in Parkinson's disease (PD) are associated with poor prognosis and dementia. However, the predictive value of minor psychotic phenomena in cognitive deterioration is not well known. Cross-sectional studies have shown that PD patients with minor hallucinations have more severe cortical atrophy than non-hallucinators, but baseline and longitudinal studies addressing the evolution of these brain differences are lacking. The impact of developing minor hallucinations on cognitive impairment and cortical atrophy progression in early PD was explored. METHODS One hundred and thirty-one de novo PD patients from the Parkinson's Progression Marker Initiative for whom brain magnetic resonance imaging scans were available were included. Cognitive outcome at 5 years was compared between patients with and without minor hallucinations during follow-up. Additionally, using gray matter volume (GMV) voxel-based morphometry, cross-sectional (at baseline) and longitudinal (1- and 2-year GMV loss) structural brain differences between groups were studied. RESULTS During follow-up, 35.1% of patients developed minor hallucinations. At 5 years, these patients showed an increased prevalence of subjective cognitive decline compared to non-hallucinators (44.1% vs. 13.9%; p < 0.001), but not formal cognitive impairment. Additionally, compared to non-hallucinators, they exhibited reduced GMV at baseline in visuoperceptive areas and increased GMV loss in left temporal areas (p < 0.05 corrected). CONCLUSIONS Minor hallucinations seem to be an early clinical marker of increased neurodegeneration and are associated with mid-term subjective cognitive decline. Longer follow-up analyses would be needed to further define if these findings could reflect a higher risk of future cognitive deterioration.
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Affiliation(s)
- H Bejr-Kasem
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - F Sampedro
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Marín-Lahoz
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - S Martínez-Horta
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
| | - J Kulisevsky
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona (U.A.B.), Department of Medicine, Barcelona, Spain.,Institut d´Investigacions Biomèdiques- Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Centro de Investigación en Red-Enfermedades Neurodegenerativas (CIBERNED), Barcelona, Spain
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39
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Indrieri A, Pizzarelli R, Franco B, De Leonibus E. Dopamine, Alpha-Synuclein, and Mitochondrial Dysfunctions in Parkinsonian Eyes. Front Neurosci 2020; 14:567129. [PMID: 33192254 PMCID: PMC7604532 DOI: 10.3389/fnins.2020.567129] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Parkinson’s disease (PD) is characterized by motor dysfunctions including bradykinesia, tremor at rest and motor instability. These symptoms are associated with the progressive degeneration of dopaminergic neurons originating in the substantia nigra pars compacta and projecting to the corpus striatum, and by accumulation of cytoplasmic inclusions mainly consisting of aggregated alpha-synuclein, called Lewy bodies. PD is a complex, multifactorial disorder and its pathogenesis involves multiple pathways and mechanisms such as α-synuclein proteostasis, mitochondrial function, oxidative stress, calcium homeostasis, axonal transport, and neuroinflammation. Motor symptoms manifest when there is already an extensive dopamine denervation. There is therefore an urgent need for early biomarkers to apply disease-modifying therapeutic strategies. Visual defects and retinal abnormalities, including decreased visual acuity, abnormal spatial contrast sensitivity, color vision defects, or deficits in more complex visual tasks are present in the majority of PD patients. They are being considered for early diagnosis together with retinal imaging techniques are being considered as non-invasive biomarkers for PD. Dopaminergic cells can be found in the retina in a subpopulation of amacrine cells; however, the molecular mechanisms leading to visual deficits observed in PD patients are still largely unknown. This review provides a comprehensive analysis of the retinal abnormalities observed in PD patients and animal models and of the molecular mechanisms underlying neurodegeneration in parkinsonian eyes. We will review the role of α-synuclein aggregates in the retina pathology and/or in the onset of visual symptoms in PD suggesting that α-synuclein aggregates are harmful for the retina as well as for the brain. Moreover, we will summarize experimental evidence suggesting that the optic nerve pathology observed in PD resembles that seen in mitochondrial optic neuropathies highlighting the possible involvement of mitochondrial abnormalities in the development of PD visual defects. We finally propose that the eye may be considered as a complementary experimental model to identify possible novel disease’ pathways or to test novel therapeutic approaches for PD.
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Affiliation(s)
- Alessia Indrieri
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Institute for Genetic and Biomedical Research, National Research Council, Milan, Italy
| | - Rocco Pizzarelli
- Center for Life Nanoscience, Istituto Italiano di Tecnologia, Rome, Italy
| | - Brunella Franco
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Medical Genetics, Department of Translational Medical Science, University of Naples "Federico II", Naples, Italy
| | - Elvira De Leonibus
- Telethon Institute of Genetics and Medicine, Pozzuoli, Italy.,Institute of Biochemistry and Cellular Biology, National Research Council, Rome, Italy
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40
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Fazekas P, Nemeth G. Dreaming, Mind-Wandering, and Hypnotic Dreams. Front Neurol 2020; 11:565673. [PMID: 33162928 PMCID: PMC7581699 DOI: 10.3389/fneur.2020.565673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Abstract
Hobson's AIM theory offers a general framework for thinking about states of consciousness like wakefulness, REM dreaming and NREM mentations in terms of a state space defined by the dimensions of the level of brain activity, the source of input, and the type of neurochemical modulation. This account inspired theoretical models of other altered states of consciousness—including hypnosis—claiming that studying REM dreaming can advance our understanding of these phenomena as well. However, recent developments showed that hypnosis is not a sleep like stage, and that the REM-centric attitude toward dreaming is mistaken. At the same time, the advancement of the neuro-cognitive theory claiming that dreaming and mind-wandering are on a continuum both underlain by default-mode network activity called many aspects of the AIM theory into question. Our aim in this paper is to show that certain hypnotic states—hypnotic dreams (experiences that subjects have in a hypnotic state as a result of an explicit suggestion to have a dream)—can, nevertheless, be highly relevant for the neuro-cognitive theory, and that their comparison with dreaming and mind-wandering has the potential to advance the field in unexpected ways.
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Affiliation(s)
- Peter Fazekas
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
- Centre for Philosophical Psychology, University of Antwerp, Antwerp, Belgium
- *Correspondence: Peter Fazekas
| | - Georgina Nemeth
- Center of Functionally Integrative Neuroscience, Aarhus University, Aarhus, Denmark
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41
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Alipour A, Mozhdehfarahbakhsh A, Nouri S, Petramfar P, Tahamtan M, Kamali AM, Rao KS, Nami M. Studies on the Bottom-Up and Top-Down Neural Information Flow Alterations in Neurodegeneration. J Alzheimers Dis 2020; 78:169-183. [PMID: 32955463 DOI: 10.3233/jad-200590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A proper explanation for perceptual symptoms in neurodegenerative disorders including Alzheimer's disease and Parkinson's disease (PD) is still lacking. OBJECTIVE This study aimed at investigating the imbalance between 'bottom-up' and 'top-down' information flow (IF) and processing in PD in relation with visual hallucination symptoms. METHODS Here, we looked at bottom-up and top-down IF markers using resting state electroencephalographic (EEG) data from PD patients analyzed through three different IF measures (direct Directed Transfer Function (dDTF), full frequency Directed Transfer Function (ff-DTF), and renormalized Partial Directed Coherence (rPDC). RESULTS We observed an increased gamma band IF and a reduced beta band IF in PD patients compared to healthy controls. Additionally, we noticed a reduced theta band IF in PD patients using dDTF as a measure of IF. By source localizing the EEG activity of the PD patients and healthy controls, we looked at the alterations of IF in the prefrontal cortex of PD patients as well. CONCLUSION In line with previous studies, our results suggest that the delicate balance between bottom-up and top-down IF is disrupted in Parkinson's disease potentially contributing to the cognitive symptoms of PD patients.
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Affiliation(s)
- Abolfazl Alipour
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.,Program in Neuroscience, Indiana University, Bloomington, IN, USA
| | - Azadeh Mozhdehfarahbakhsh
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saba Nouri
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Petramfar
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Tahamtan
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - Ali-Mohammad Kamali
- DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran
| | - K S Rao
- Centre for Neuroscience, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama
| | - Mohammad Nami
- Neuroscience Laboratory, NSL (Brain, Cognition and Behavior), Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran.,DANA Brain Health Institute, Iranian Neuroscience Society-Fars Chapter, Shiraz, Iran.,Centre for Neuroscience, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Panama City, Panama.,Institute for Cognitive Science Studies-ICSS, Brain and Cognition Clinic, Tehran, Iran
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42
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Visuo-Perceptual and Decision-Making Contributions to Visual Hallucinations in Mild Cognitive Impairment in Lewy Body Disease: Insights from a Drift Diffusion Analysis. Brain Sci 2020; 10:brainsci10080540. [PMID: 32796525 PMCID: PMC7464681 DOI: 10.3390/brainsci10080540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Visual hallucinations (VH) are a common symptom in dementia with Lewy bodies (DLB); however, their cognitive underpinnings remain unclear. Hallucinations have been related to cognitive slowing in DLB and may arise due to impaired sensory input, dysregulation in top-down influences over perception, or an imbalance between the two, resulting in false visual inferences. Methods: Here we employed a drift diffusion model yielding estimates of perceptual encoding time, decision threshold, and drift rate of evidence accumulation to (i) investigate the nature of DLB-related slowing of responses and (ii) their relationship to visuospatial performance and visual hallucinations. The EZ drift diffusion model was fitted to mean reaction time (RT), accuracy and RT variance from two-choice reaction time (CRT) tasks and data were compared between groups of mild cognitive impairment (MCI-LB) LB patients (n = 49) and healthy older adults (n = 25). Results: No difference was detected in drift rate between patients and controls, but MCI-LB patients showed slower non-decision times and boundary separation values than control participants. Furthermore, non-decision time was negatively correlated with visuospatial performance in MCI-LB, and score on visual hallucinations inventory. However, only boundary separation was related to clinical incidence of visual hallucinations. Conclusions: These results suggest that a primary impairment in perceptual encoding may contribute to the visuospatial performance, however a more cautious response strategy may be related to visual hallucinations in Lewy body disease. Interestingly, MCI-LB patients showed no impairment in information processing ability, suggesting that, when perceptual encoding was successful, patients were able to normally process information, potentially explaining the variability of hallucination incidence.
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Montagnese M, Leptourgos P, Fernyhough C, Waters F, Larøi F, Jardri R, McCarthy-Jones S, Thomas N, Dudley R, Taylor JP, Collerton D, Urwyler P. A Review of Multimodal Hallucinations: Categorization, Assessment, Theoretical Perspectives, and Clinical Recommendations. Schizophr Bull 2020; 47:237-248. [PMID: 32772114 PMCID: PMC7825001 DOI: 10.1093/schbul/sbaa101] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hallucinations can occur in different sensory modalities, both simultaneously and serially in time. They have typically been studied in clinical populations as phenomena occurring in a single sensory modality. Hallucinatory experiences occurring in multiple sensory systems-multimodal hallucinations (MMHs)-are more prevalent than previously thought and may have greater adverse impact than unimodal ones, but they remain relatively underresearched. Here, we review and discuss: (1) the definition and categorization of both serial and simultaneous MMHs, (2) available assessment tools and how they can be improved, and (3) the explanatory power that current hallucination theories have for MMHs. Overall, we suggest that current models need to be updated or developed to account for MMHs and to inform research into the underlying processes of such hallucinatory phenomena. We make recommendations for future research and for clinical practice, including the need for service user involvement and for better assessment tools that can reliably measure MMHs and distinguish them from other related phenomena.
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Affiliation(s)
- Marcella Montagnese
- Neuroimaging Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Pantelis Leptourgos
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, CT
| | | | - Flavie Waters
- School of Psychological Sciences, The University of Western Australia, Perth, Australia
| | - Frank Larøi
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium,Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Renaud Jardri
- University of Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience and Cognition, Lille, France,Laboratoire de Neurosciences Cognitives et Computationnelles, ENS, INSERM U960, PSL Research University, Paris, France
| | | | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia,The Alfred Hospital, Melbourne, Australia
| | - Rob Dudley
- Gateshead Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS, Newcastle upon Tyne, UK,School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Collerton
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Prabitha Urwyler
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK,Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland,Department of Neurology, University Neurorehabilitation Unit, University Hospital Bern—Inselspital, Bern, Switzerland,To whom correspondence should be addressed; tel: +41 31 632 76 07, fax: +41 31 632 75 76, e-mail:
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44
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Zarkali A, Lees AJ, Weil RS. Flickering Stimuli Do Not Reliably Induce Visual Hallucinations in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 9:631-635. [PMID: 31227657 PMCID: PMC6700621 DOI: 10.3233/jpd-191635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Visual hallucinations are a common and often distressing feature of Parkinson's disease; they are ephemeral and capricious, making them difficult to study but tend to be more prominent in dim illumination. Flickering stimuli can induce simple hallucinations even in healthy individuals. We tested a stroboscope and an equivalent full-screen flickering stimulus in 16 participants: 7 patients with Parkinson's and habitual visual hallucinations, 6 Parkinson's patients without hallucinations and 3 controls. Both flicker sources induced varied geometrical hallucinations in 4 participants (25%) and complex hallucinations in 1 but neither induced typical Parkinson's-associated hallucinations.
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Affiliation(s)
- Angeliki Zarkali
- Dementia Research Centre, University College London, London, UK,Correspondence to: Angeliki Zarkali, Dementia Research Centre, University College London, 8-11 Queen Square,
London, WC1N 3AR, UK. Tel.: +44 07833157065; E-mail:
| | - Andrew J. Lees
- Reta Lila Weston Institute, University College London, London, UK
| | - Rimona S. Weil
- Dementia Research Centre, University College London, London, UK,Wellcome Centre for Human Neuroimaging, University College London, London, UK
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45
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Marques A, Beze S, Pereira B, Chassain C, Monneyron N, Delaby L, Lambert C, Fontaine M, Derost P, Debilly B, Rieu I, Lewis SJG, Chiambaretta F, Durif F. Visual hallucinations and illusions in Parkinson's disease: the role of ocular pathology. J Neurol 2020; 267:2829-2841. [PMID: 32447550 DOI: 10.1007/s00415-020-09925-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Whether different mechanisms, particularly ocular pathology, could lead to the emergence of visual hallucinations (VH) (defined as false perceptions with no external stimulus) versus visual illusions (VI) (defined as a misperception of a real stimulus) in Parkinson's disease (PD) remains debated. We assessed retinal, clinical and structural brain characteristics depending on the presence of VH or VI in PD. METHODS In this case-control study, we compared retinal thickness using optical coherence tomography (OCT), between PD patients with: VI (PD-I; n = 26), VH (PD-H; n = 28), and without VI or VH (PD-C; n = 28), and assessed demographic data, disease severity, treatment, anatomical and functional visual complaints, cognitive and visuo-perceptive functions and MRI brain volumetry for each group of PD patients. RESULTS Parafoveal retina was thinner in PD-H compared to PD-C (p = 0.005) and PD-I (p = 0.009) but did not differ between PD-I and PD-C (p = 0.85). Multivariate analysis showed that 1/retinal parafoveal thinning and total brain gray matter atrophy were independently associated with the presence of VH compared to PD-I; 2/retinal parafoveal thickness, PD duration, sleep quality impairment and total brain gray matter volume were independent factors associated with the presence of VH compared to PD-C; 3/anterior ocular abnormalities were the only factor independently associated with the presence of illusions compared to PD-C. CONCLUSION These findings reinforce the hypothesis that there may be different mechanisms contributing to VH and VI in PD, suggesting that these two entities may also have a different prognosis rather than simply lying along a continuous spectrum. REGISTRATION NUMBER Clinicaltrials.gov number NCT01114321.
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Affiliation(s)
- Ana Marques
- Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
| | - Steven Beze
- Ophtalmology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Department, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Carine Chassain
- Imaging Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Nathalie Monneyron
- Ophtalmology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Laure Delaby
- CMRR, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Celine Lambert
- Ophtalmology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Marie Fontaine
- Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Philippe Derost
- Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bérengère Debilly
- Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Isabelle Rieu
- Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Simon J G Lewis
- Brain and Mind Center, Parkinson's Disease Research Clinic, University of Sydney, Sydney, Australia
| | - Frédéric Chiambaretta
- Ophtalmology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Franck Durif
- Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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Feitosa-Santana C, Fernandes Costa M, Ballalai Ferraz H, Andrade LAF, Moura AL, Amaro E, Hamer RD, Fix Ventura D. Visual losses in early-onset and late-onset Parkinson's disease. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2020; 37:A285-A293. [PMID: 32400706 DOI: 10.1364/josaa.382042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/14/2020] [Indexed: 06/11/2023]
Abstract
Patients with Parkinson's disease (PD) manifest visual losses. However, it is not known whether these losses are equivalent in both early-onset (EOPD) and late-onset (LOPD) patients. We evaluated contrast sensitivity and color vision in EOPD and LOPD patients and in age-matched controls. Losses occurred in both patient groups but were more pronounced in EOPD, consistent with the notion that non-motor symptoms are affected by age of symptom onset. More studies of visual function in EOPD and LOPD patients are needed to understand how aging is related to the pathophysiology of non-motor PD symptomatology. This would permit earlier diagnosis and, perhaps, better management of the disease.
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Retinal ganglion cells dysfunctions in schizophrenia patients with or without visual hallucinations. Schizophr Res 2020; 219:47-55. [PMID: 31353068 DOI: 10.1016/j.schres.2019.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 12/16/2022]
Abstract
The electroretinogram has revealed photoreceptor, bipolar cell, and, in one prior study, retinal ganglion cell (RGC) dysfunction in schizophrenia. The structural abnormalities of the RGC are well documented in schizophrenia and such abnormalities have been associated with visual hallucinations (VH) in neurological disorders. The goals of this study were: 1) to examine the functional responses of photoreceptors and RGC in schizophrenia patients in comparison with healthy controls; and 2) to compare the extent of retinal dysfunction in schizophrenia patients with or without VH. We recorded the flash electroretinogram in scotopic and photopic conditions, and the pattern electroretinogram, in schizophrenia patients (n = 29) and healthy controls (n = 29). Schizophrenia patients were divided in two groups: schizophrenia patients with VH (VH group, n = 12) and schizophrenia patients with auditory hallucinations or no hallucinations (AHNH group, n = 17). Our results replicate previous findings regarding photoreceptor dysfunction in schizophrenia. PERG results showed a significant increase of the P50 implicit time in schizophrenia patients compared with controls (t(55) = 2.1, p < .05, d = 0.55) and a significant increase of the N95 implicit time in schizophrenia patients compared with controls (t(55) = 4.2; p < .001, d = 0.66). We found an increased rod b-wave implicit time (dark-adapted 0.01 ERG) in the VH group compared to the AHNH group and to the control group, which was associated with lifetime VH score. Our results demonstrate a slowing of RGC signaling in schizophrenia patients, which could affect the quality of visual information reaching the visual cortex. The implications of the data for understanding VH in schizophrenia are discussed.
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Neuropsychiatric aspects of Parkinson disease psychopharmacology: Insights from circuit dynamics. HANDBOOK OF CLINICAL NEUROLOGY 2020; 165:83-121. [PMID: 31727232 DOI: 10.1016/b978-0-444-64012-3.00007-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson disease (PD) is a neurodegenerative disorder with a complex pathophysiology characterized by the progressive loss of dopaminergic neurons within the substantia nigra. Persons with PD experience several motoric and neuropsychiatric symptoms. Neuropsychiatric features of PD include depression, anxiety, psychosis, impulse control disorders, and apathy. In this chapter, we will utilize the National Institutes of Mental Health Research Domain Criteria (RDoC) to frame and integrate observations from two prevailing disease constructions: neurotransmitter anomalies and circuit physiology. When there is available evidence, we posit how unified translational observations may have clinical relevance and postulate importance outside of PD. Finally, we review the limited evidence available for pharmacologic management of these symptoms.
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Walpola IC, Muller AJ, Hall JM, Andrews-Hanna JR, Irish M, Lewis SJ, Shine JM, O'Callaghan C. Mind-wandering in Parkinson's disease hallucinations reflects primary visual and default network coupling. Cortex 2020; 125:233-245. [DOI: 10.1016/j.cortex.2019.12.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/26/2019] [Accepted: 12/22/2019] [Indexed: 11/25/2022]
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Todo M. Towards the interpretation of complex visual hallucinations in terms of self-reorganization of neural networks. Neurosci Res 2020; 156:147-158. [PMID: 32112785 DOI: 10.1016/j.neures.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/25/2019] [Accepted: 12/28/2019] [Indexed: 10/24/2022]
Abstract
Patients suffering from dementia with Lewy body (DLB) often see complex visual hallucinations (CVH). Despite many pathological, clinical, and neuroimaging studies, the mechanism of CVH remains unknown. One possible scenario is that top-down information is being used to compensate for the lack of bottom-up information. To investigate this possibility and understand the underlying mathematical structure of the CVH mechanism, we propose a simple computational model of synaptic plasticity with particular focus on the effect of selective damage to the bottom-up network on self-reorganization. We show neurons that undergo a change in activity from a bottom-up to a top-down network framework during the reorganization process, which can be understood in terms of state transitions. Assuming that the pre-reorganization representation of this neuron remains after reorganization, it is possible to interpret neural response induced by top-down information as the sensation of bottom-up information. This situation might correspond to a hallucinatory situation in DLB patients. Our results agree with existing experimental evidence and provide new insights into data that have hitherto not been experimentally validated on patients with DLB.
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Affiliation(s)
- Masato Todo
- Department of Mathematics, School of Science, Hokkaido University, Sapporo, Hokkaido, Japan.
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