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Liu A, Hefley B, Escandon P, Nicholas SE, Karamichos D. Salivary Exosomes in Health and Disease: Future Prospects in the Eye. Int J Mol Sci 2023; 24:ijms24076363. [PMID: 37047335 PMCID: PMC10094317 DOI: 10.3390/ijms24076363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Exosomes are a group of vesicles that package and transport DNA, RNA, proteins, and lipids to recipient cells. They can be derived from blood, saliva, urine, and/or other biological tissues. Their impact on several diseases, such as neurodegenerative, autoimmune, and ocular diseases, have been reported, but not fully unraveled. The exosomes that are derived from saliva are less studied, but offer significant advantages over exosomes from other sources, due to their accessibility and ease of collection. Thus, their role in the pathophysiology of diseases is largely unknown. In the context of ocular diseases, salivary exosomes have been under-utilized, thus creating an enormous gap in the literature. The current review discusses the state of exosomes research on systemic and ocular diseases and highlights the role and potential of salivary exosomes as future ocular therapeutic vehicles.
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Affiliation(s)
- Angela Liu
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Brenna Hefley
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Sarah E. Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX 76107, USA
- Correspondence: ; Tel.: +1-817-735-2101
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Sasaki C, Yokoi K, Takahashi H, Hatakeyama T, Obara K, Wada C, Hirayama K. Visual illusions in Parkinson's disease: an interview survey of symptomatology. Psychogeriatrics 2022; 22:38-48. [PMID: 34617361 PMCID: PMC9293438 DOI: 10.1111/psyg.12771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/31/2021] [Accepted: 09/18/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Several types of visual illusions can occur in Parkinson's disease (PD). However, the prevalence and types of specific illusions experienced by patients with PD remain unclear. This study aimed to investigate the types of illusions. METHODS A questionnaire of visual illusions was developed through a literature review in consultation with clinicians and neurologists. Based on the questionnaire, 40 consecutive patients with PD were asked a series of Yes/No questions regarding 20 types of visual illusions since the onset of PD. If participants answered 'Yes', they were then asked to detail their experience(s). RESULTS In total, 30 patients with PD had experienced visual illusions since disease onset; among them, 25 were still experiencing them at the time of the study. The most commonly observed illusion types were dysmorphopsia, complex visual illusions, metachromatopsia, and diplopia. Other observed illusions included textural illusions, macropsia, micropsia, teleopsia, pelopsia, kinetopsia, akinetopsia, Zeitraffer/Zeitlupen phenomena, tilt illusion, upside-down illusion, and palinopsia. Additionally, aberrant perception of surface orientation (inclination) was reported, which is yet to be reported in association with any disease. Visual illusions had detrimental effects on the patients' daily lives in some cases. CONCLUSIONS Systematic interviews regarding the incidence and details of visual illusions experienced by patients with PD could offer important information regarding their quality of life.
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Affiliation(s)
- Chinami Sasaki
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan.,National Hospital Organization Akita Hospital, Akita, Japan.,National Hospital Organization Miyagi Hospital, Yamamoto, Japan
| | - Kayoko Yokoi
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | | | | | - Koji Obara
- National Hospital Organization Akita Hospital, Akita, Japan
| | - Chizu Wada
- National Hospital Organization Akita Hospital, Akita, Japan
| | - Kazumi Hirayama
- Yamagata Prefectural University of Health Sciences, Yamagata, Japan
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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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4
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Santos García D, Naya Ríos L, de Deus Fonticoba T, Cores Bartolomé C, García Roca L, Feal Painceiras M, Martínez Miró C, Canfield H, Jesús S, Aguilar M, Pastor P, Cosgaya M, García Caldentey J, Caballol N, Legarda I, Hernández Vara J, Cabo I, López Manzanares L, González Aramburu I, Ávila Rivera MA, Gómez Mayordomo V, Nogueira V, Puente V, Dotor J, Borrué C, Solano Vila B, Álvarez Sauco M, Vela L, Escalante S, Cubo E, Carrillo Padilla F, Martínez Castrillo JC, Sánchez Alonso P, Alonso Losada MG, López Ariztegui N, Gastón I, Kulisevsky J, Blázquez Estrada M, Seijo M, Rúiz Martínez J, Valero C, Kurtis M, de Fábregues O, González Ardura J, Alonso Redondo R, Ordás C, López Díaz LM, McAfee D, Martinez-Martin P, Mir P. Diplopia Is Frequent and Associated with Motor and Non-Motor Severity in Parkinson's Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up. Diagnostics (Basel) 2021; 11:diagnostics11122380. [PMID: 34943619 PMCID: PMC8700703 DOI: 10.3390/diagnostics11122380] [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: 11/23/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background and objective: Diplopia is relatively common in Parkinson’s disease (PD) but is still understudied. Our aim was to analyze the frequency of diplopia in PD patients from a multicenter Spanish cohort, to compare the frequency with a control group, and to identify factors associated with it. Patients and Methods: PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort were included in this longitudinal prospective study. The patients and controls were classified as “with diplopia” or “without diplopia” according to item 15 of the Non-Motor Symptoms Scale (NMSS) at V0, V1 (1-year ± 15 days), and V2 for the patients and at V0 and V2 for the controls. Results: The frequency of diplopia in the PD patients was 13.6% (94/691) at V0 (1.9% in controls [4/206]; p < 0.0001), 14.2% (86/604) at V1, and 17.1% (86/502) at V2 (0.8% in controls [1/124]; p < 0.0001), with a period prevalence of 24.9% (120/481). Visual hallucinations at any visit from V0 to V2 (OR = 2.264; 95%CI, 1.269–4.039; p = 0.006), a higher score on the NMSS at V0 (OR = 1.009; 95%CI, 1.012–1.024; p = 0.015), and a greater increase from V0 to V2 on the Unified Parkinson’s Disease Rating Scale–III (OR = 1.039; 95%CI, 1.023–1.083; p < 0.0001) and Neuropsychiatric Inventory (OR = 1.028; 95%CI, 1.001–1.057; p = 0.049) scores were independent factors associated with diplopia (R2 = 0.25; Hosmer and Lemeshow test, p = 0.716). Conclusions: Diplopia represents a frequent symptom in PD patients and is associated with motor and non-motor severity.
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Affiliation(s)
- Diego Santos García
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (L.N.R.); (C.C.B.); (L.G.R.); (M.F.P.); (C.M.M.); (H.C.)
- Correspondence: ; Tel.: +34-646-173-341
| | - Lucía Naya Ríos
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (L.N.R.); (C.C.B.); (L.G.R.); (M.F.P.); (C.M.M.); (H.C.)
| | | | - Carlos Cores Bartolomé
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (L.N.R.); (C.C.B.); (L.G.R.); (M.F.P.); (C.M.M.); (H.C.)
| | - Lucía García Roca
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (L.N.R.); (C.C.B.); (L.G.R.); (M.F.P.); (C.M.M.); (H.C.)
| | - Maria Feal Painceiras
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (L.N.R.); (C.C.B.); (L.G.R.); (M.F.P.); (C.M.M.); (H.C.)
| | - Cristina Martínez Miró
- CHUAC, Complejo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain; (L.N.R.); (C.C.B.); (L.G.R.); (M.F.P.); (C.M.M.); (H.C.)
| | - Hector Canfield
- CHUF, Complejo Hospitalario Universitario de Ferrol, 15006 A Coruña, Spain;
| | - Silvia Jesús
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Miquel Aguilar
- Hospital Universitari Mutua de Terrassa, 08221 Terrassa, Barcelona, Spain; (M.A.); (P.P.)
| | - Pau Pastor
- Hospital Universitari Mutua de Terrassa, 08221 Terrassa, Barcelona, Spain; (M.A.); (P.P.)
| | | | | | - Nuria Caballol
- Consorci Sanitari Integral, Hospital Moisés Broggi, 08970 Sant Joan Despí, Barcelona, Spain;
| | - Inés Legarda
- Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain;
| | - Jorge Hernández Vara
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.V.); (O.d.F.)
| | - Iria Cabo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | - Isabel González Aramburu
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - María A. Ávila Rivera
- Consorci Sanitari Integral, Hospital General de L’Hospitalet, L’Hospitalet de Llobregat, 08906 Barcelona, Spain;
| | | | | | | | - Julio Dotor
- Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain;
| | | | - Berta Solano Vila
- Institut d’Assistència Sanitària (IAS)—Institut Català de la Salut, 17190 Girona, Spain;
| | | | - Lydia Vela
- Fundación Hospital de Alcorcón, 28922 Madrid, Spain;
| | - Sonia Escalante
- Hospital de Tortosa Verge de la Cinta (HTVC), Tortosa, 43500 Tarragona, Spain;
| | - Esther Cubo
- Complejo Asistencial Universitario de Burgos, 09006 Burgos, Spain;
| | | | | | | | - Maria G. Alonso Losada
- Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo (CHUVI), 36213 Vigo, Spain;
| | | | - Itziar Gastón
- Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Jaime Kulisevsky
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
- Hospital de Sant Pau, 08041 Barcelona, Spain
| | | | - Manuel Seijo
- Complejo Hospitalario Universitario de Pontevedra (CHOP), 36071 Pontevedra, Spain; (I.C.); (M.S.)
| | | | | | | | - Oriol de Fábregues
- Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain; (J.H.V.); (O.d.F.)
| | | | | | | | - Luis M. López Díaz
- Complejo Hospitalario Universitario de Orense (CHUO), 32005 Orense, Spain;
| | - Darrian McAfee
- University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Pablo Martinez-Martin
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
| | - Pablo Mir
- Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología Clínica, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (S.J.); (P.M.)
- CIBERNED (Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas), 28031 Madrid, Spain; (I.G.A.); (J.K.); (P.M.-M.)
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Savitt J, Aouchiche R. Management of Visual Dysfunction in Patients with Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2021; 10:S49-S56. [PMID: 32741840 PMCID: PMC7592686 DOI: 10.3233/jpd-202103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Parkinson’s disease (PD) is a movement disorder with many symptoms responsive to treatment with dopamine agonists, anti-cholinergics and the dopamine precursor, levodopa. The cardinal features of PD include tremor, rigidity, bradykinesia, and postural instability. There also are non-motor features that include sleep disorders, cognitive and affective dysfunction, hyposmia, pain and dysautonomia (constipation, bloating, orthostasis, urinary symptoms, sexual dysfunction, dysphagia). Among these non-motor features are signs and symptoms of visual system impairment that range from subtle examination findings to those causing severe disability. In this review we describe common PD-related abnormalities in the visual system, how they present, and potential treatments.
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Affiliation(s)
- Joseph Savitt
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Rachid Aouchiche
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Neuro-Ophthalmology, Baltimore, MD, USA
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Naumann W, Gogarten J, Schönfeld S, Klostermann F, Marzinzik F, Schindlbeck KA. Diplopia in Parkinson's disease: Indication of a cortical phenotype with cognitive dysfunction? Acta Neurol Scand 2021; 144:440-449. [PMID: 34096617 DOI: 10.1111/ane.13479] [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: 01/08/2021] [Revised: 04/18/2021] [Accepted: 05/14/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Visual disturbances are increasingly recognized as common non-motor symptoms in Parkinson's disease (PD). In PD patients, intermittent diplopia has been found to be associated with the presence of visual hallucinations and the Parkinson's psychosis spectrum. Here, we investigated whether diplopia in PD is associated with other non-motor traits and cognitive impairment. METHODS We investigated 50 non-demented PD patients with and without intermittent diplopia and 24 healthy controls for visual disturbances, as well as motor and non-motor symptoms. All participants underwent a neuropsychological test battery; visuospatial abilities were further evaluated with subtests of the Visual Object and Space Perception Battery (VOSP). The two PD patient groups did not differ significantly in age, symptom duration, motor symptom severity, frequency of visual hallucinations, or visual sensory efficiency. RESULTS PD patients with diplopia reported more frequent non-motor symptoms including more subjective cognitive problems and apathy without changes in global cognition measures compared to those without diplopia. PD patients with diplopia had greater impairment in several tests of visuospatial function (pentagon copying p = .002; number location p = .001; cube analysis p < .02) and object perception (p < .001) compared to PD patients without diplopia and healthy controls. By contrast, no consistent group differences were observed in executive function, memory, or language. CONCLUSIONS PD patients with diplopia have a greater non-motor symptom burden and deficits in visuospatial function compared to PD patients without diplopia. PD patients with diplopia might be prone to a cortical phenotype with cognitive decline and apathy associated with worse prognosis.
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Affiliation(s)
- Wanda Naumann
- Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Jacob Gogarten
- Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Shideh Schönfeld
- Department of Ophthalmology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Fabian Klostermann
- Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Frank Marzinzik
- Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
| | - Katharina A. Schindlbeck
- Department of Neurology Charité–Universitätsmedizin Berlin Berlin Germany
- Center for Neurosciences The Feinstein Institute for Medical Research Manhasset NY USA
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7
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Abstract
Illusions and hallucinations are commonly encountered in both daily life and clinical practice. In this chapter, we review definitions and possible underlying mechanisms of these phenomena and then review what is known about specific conditions that are associated with them, including ophthalmic causes, migraine, epilepsy, Parkinson's disease, and schizophrenia. We then discuss specific syndromes including the Charles Bonnet syndrome, visual snow syndrome, Alice in Wonderland syndrome, and peduncular hallucinosis. The scientific study of illusions and hallucinations has contributed significantly to our understanding of how eye and brain process vision and contribute to perception. Important concepts are the distinction between topologic and hodologic mechanisms underlying hallucinations and the involvement of attentional networks. This chapter examines the various ways in which pathological illusions and hallucinations might arise in relation to the phenomenology and known pathology of the various conditions associated with them.
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Affiliation(s)
- Clare L Fraser
- Department of Ophthalmology, Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, and Australian National University Medical School, Canberra, Australia
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8
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Borm CDJM, Smilowska K, de Vries NM, Bloem BR, Theelen T. How I do it: The Neuro-Ophthalmological Assessment in Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2020; 9:427-435. [PMID: 30958314 PMCID: PMC6597980 DOI: 10.3233/jpd-181523] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Visual disorders like double vision, dry eyes, and visual field deficits are common but frequently missed in Parkinson’s disease. Here, we aim to increase awareness for these visual disorders in Parkinson patients by discussing several common problems that can be easily diagnosed using comprehensive history taking and a basic neuro-ophthalmological examination. We offer practical guidance for the patient interview and physical exam that can facilitate a timelier recognition of visual disorders. Such recognition has immediate therapeutic relevance, because Parkinson patients are strongly dependent on an adequate vision, for example to optimally benefit from visual cueing strategies.
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Affiliation(s)
- Carlijn D J M Borm
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Katarzyna Smilowska
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Nienke M de Vries
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Parkinson Center Nijmegen (ParC) Nijmegen, The Netherlands
| | - Thomas Theelen
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Ophthalmology, Nijmegen, The Netherlands
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9
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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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10
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Patel RS, Bhela J, Tahir M, Pisati SR, Hossain S. Pimavanserin in Parkinson's Disease-induced Psychosis: A Literature Review. Cureus 2019; 11:e5257. [PMID: 31572642 PMCID: PMC6760879 DOI: 10.7759/cureus.5257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pimavanserin was approved for treating Parkinson’s disease (PD) psychosis, based upon 21 completed studies. This review article is to understand PD psychosis and assess the efficacy and safety of pimavanserin. A literature search was carried out using the keyword “pimavanserin” and cross-referencing it with PD, psychosis, efficacy, safety and clinical trial. Participants in pimavanserin group were associated with a 5.79-point decrease in symptoms for PD psychosis (SAPS-PD) scale compared to the 2.73-point decrease seen in the placebo group (P < .001). There were statistically significant improvements in the persecutory delusions, ideas of reference, and global ratings of delusions in pimavanserin group. Pimavanserin was well tolerated with no significant adverse events or worsening of motor function. Pimavanserin at 34 mg daily was shown to be effective for PD-induced psychosis in past clinical trials.
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Affiliation(s)
| | | | - Muhammad Tahir
- Internal Medicine, Penn Medicine Lancaster General Hospital, Lancaster, USA
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11
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Diplopia in Parkinson’s disease: visual illusion or oculomotor impairment? J Neurol 2019; 266:2457-2464. [DOI: 10.1007/s00415-019-09430-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
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12
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Mueller C, Rajkumar AP, Wan YM, Velayudhan L, Ffytche D, Chaudhuri KR, Aarsland D. Assessment and Management of Neuropsychiatric Symptoms in Parkinson's Disease. CNS Drugs 2018; 32:621-635. [PMID: 30027401 DOI: 10.1007/s40263-018-0540-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neuropsychiatric symptoms are highly prevalent in Parkinson's disease and associated with decreased quality of life and adverse health outcomes. In this review, the assessment and management of common neuropsychiatric symptoms are discussed: depression, anxiety, psychosis, cognitive impairment, dementia and apathy. Validated assessment scales are now available for the majority of symptoms. Balancing dopaminergic therapy plays an important role in their management as increasing doses of dopaminergic agents might address depression and anxiety related to 'off' phases, non-motor fluctuations and apathy, while dose reduction might alleviate psychotic symptoms. More targeted treatment is possible through medications utilising different pathways. Although efficacy profiles of individual agents require further exploration, antidepressants as a drug class have shown utility in depression and anxiety in Parkinson's disease. Psychological therapies, especially cognitive behavioural approaches, are effective. Pimavanserin allows the treatment of psychosis in Parkinson's disease without directly affecting the dopaminergic and cholinergic system. The cholinergic system is currently the only target in Parkinson's disease dementia, and antagonists of this system, as are many psychotropic drugs, need to be used with caution. Management of apathy largely relies on non-pharmacological strategies adapted from dementia care, with antidepressants being ineffective and the role of stimulant therapy needing further evaluation.
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Affiliation(s)
- Christoph Mueller
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Anto P Rajkumar
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Yi Min Wan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Latha Velayudhan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Dominic Ffytche
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kallol Ray Chaudhuri
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, SE5 8AF, UK
- Stavanger University Hospital, Stavanger, Norway
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13
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Abstract
PURPOSE OF REVIEW This article discusses visual disorders in both Parkinson disease (PD) and other Parkinsonian disorders. It is organized largely by the anatomical site of pathology and emphasizes practical treatments. Targeted treatment options include medications, surgery, occupational, and physical therapies as well as optical aids. RECENT FINDINGS The causes of visual complaints in Parkinson disease and other similar disorders are being more clearly identified. A new medication approved specifically to treat hallucinations in PD now is available. There is increased understanding of the important role that an ophthalmologist can play in the care of these patients. Finally, research and therapeutic development are unmet needs in accessing and treating visual complaints in PD and Parkinsonian disorders. A better understanding of Parkinson-related visual complaints and of available treatment options is important to optimize patient safety and quality of life. Vision impairment leads to difficulties in many common activities including reading, ambulating, and driving. Falls and injuries, made more likely because of impaired vision, result in an early loss of independence. Awareness of the problem, patient education, ophthalmologic care, selected therapeutics, physical therapy, and occupational therapy are crucial to maximizing quality of life in these patients.
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Affiliation(s)
- Joseph Savitt
- Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street 3rd Floor, Baltimore, MD, 21201, USA.
| | - Michaela Mathews
- Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, MD, USA
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14
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Schindlbeck KA, Schönfeld S, Naumann W, Friedrich DJ, Maier A, Rewitzer C, Klostermann F, Marzinzik F. Characterization of diplopia in non-demented patients with Parkinson's disease. Parkinsonism Relat Disord 2017; 45:1-6. [DOI: 10.1016/j.parkreldis.2017.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/19/2017] [Accepted: 09/28/2017] [Indexed: 11/16/2022]
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15
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Abstract
Parkinson disease psychosis (PDP) is a common phenomenon in Parkinson disease (PD) patients treated with dopaminergic drugs, and is associated with high morbidity and mortality. It also correlates with depression and dementia, and can contribute to considerable caregiver stress and burnout. While symptoms can be relieved by decreasing doses or number of anti-PD medications, this may lead to an unacceptable worsening of motor function. When general medical or psychiatric conditions have been ruled out, and decreasing dopaminergic agents is not effective in treating psychosis, therapies include atypical antipsychotics, primarily clozapine and quetiapine. Of these, clozapine is effective but is associated with a poor side-effect profile and the necessity for frequent blood draws. Clinicians prefer quetiapine for its theoretically better safety profile, although there is no evidence for efficacy in treating psychosis. All atypical antipsychotics are associated with increased mortality in this patient population. Cholinesterase inhibitors can ameliorate psychosis symptoms. The serotonin 5-HT2A receptor inverse agonist pimavanserin was recently approved by the US FDA for the treatment of PDP and may prove to be a more targeted therapy without the downsides of atypical antipsychotics.
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16
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Schapira AHV, Chaudhuri KR, Jenner P. Non-motor features of Parkinson disease. Nat Rev Neurosci 2017; 18:435-450. [PMID: 28592904 DOI: 10.1038/nrn.2017.62] [Citation(s) in RCA: 1048] [Impact Index Per Article: 149.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Many of the motor symptoms of Parkinson disease (PD) can be preceded, sometimes for several years, by non-motor symptoms that include hyposmia, sleep disorders, depression and constipation. These non-motor features appear across the spectrum of patients with PD, including individuals with genetic causes of PD. The neuroanatomical and neuropharmacological bases of non-motor abnormalities in PD remain largely undefined. Here, we discuss recent advances that have helped to establish the presence, severity and effect on the quality of life of non-motor symptoms in PD, and the neuroanatomical and neuropharmacological mechanisms involved. We also discuss the potential for the non-motor features to define a prodrome that may enable the early diagnosis of PD.
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Affiliation(s)
- Anthony H V Schapira
- Department of Clinical Neurosciences, University College London (UCL) Institute of Neurology, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | - K Ray Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, King's College London, Camberwell Road, London SE5 9RS, UK
| | - Peter Jenner
- Neurodegenerative Diseases Research Group, Institute of Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, Newcomen Street, London SE1 1UL, UK
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17
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Ocular and visual disorders in Parkinson's disease: Common but frequently overlooked. Parkinsonism Relat Disord 2017; 40:1-10. [PMID: 28284903 DOI: 10.1016/j.parkreldis.2017.02.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 11/23/2022]
Abstract
Patients with Parkinson's disease (PD) often compensate for their motor deficits by guiding their movements visually. A wide range of ocular and visual disorders threatens the patients' ability to benefit optimally from visual feedback. These disorders are common in patients with PD, yet they have received little attention in both research and clinical practice, leading to unnecessary - but possibly treatable - disability. Based on a literature search covering 50 years, we review the range of ocular and visual disorders in patients with PD, and classify these according to anatomical structures of the visual pathway. We discuss six common disorders in more detail: dry eyes; diplopia; glaucoma and glaucoma-like visual problems; impaired contrast and colour vision; visuospatial and visuoperceptual impairments; and visual hallucinations. In addition, we review the effects of PD-related pharmacological and surgical treatments on visual function, and we offer practical recommendations for clinical management. Greater awareness and early recognition of ocular and visual problems in PD might enable timely instalment of tailored treatments, leading to improved patient safety, greater independence, and better quality of life.
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18
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Ffytche DH, Creese B, Politis M, Chaudhuri KR, Weintraub D, Ballard C, Aarsland D. The psychosis spectrum in Parkinson disease. Nat Rev Neurol 2017; 13:81-95. [PMID: 28106066 PMCID: PMC5656278 DOI: 10.1038/nrneurol.2016.200] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In 2007, the clinical and research profile of illusions, hallucinations, delusions and related symptoms in Parkinson disease (PD) was raised with the publication of a consensus definition of PD psychosis. Symptoms that were previously deemed benign and clinically insignificant were incorporated into a continuum of severity, leading to the rapid expansion of literature focusing on clinical aspects, mechanisms and treatment. Here, we review this literature and the evolving view of PD psychosis. Key topics include the prospective risk of dementia in individuals with PD psychosis, and the causal and modifying effects of PD medication. We discuss recent developments, including recognition of an increase in the prevalence of psychosis with disease duration, addition of new visual symptoms to the psychosis continuum, and identification of frontal executive, visual perceptual and memory dysfunction at different disease stages. In addition, we highlight novel risk factors - for example, autonomic dysfunction - that have emerged from prospective studies, structural MRI evidence of frontal, parietal, occipital and hippocampal involvement, and approval of pimavanserin for the treatment of PD psychosis. The accumulating evidence raises novel questions and directions for future research to explore the clinical management and biomarker potential of PD psychosis.
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Affiliation(s)
- Dominic H Ffytche
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology &Neuroscience, King's College London, UK. De Crespigny Park, London SE5 8AF, UK
| | - Byron Creese
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- University of Exeter Medical School, University of Exeter, EX1 2LU, UK
| | - Marios Politis
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Neurodegeneration Imaging Group, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology &Neuroscience, King's College London, 125 Coldharbour Lane, London SE5 9NU, UK
| | - K Ray Chaudhuri
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, National Parkinson Foundation Centre of Excellence, King's College London/Kings College Hospital, 5 Cutcombe Road, London SE5 9RT, UK
| | - Daniel Weintraub
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania 3615 Chestnut Street, #330, Philadelphia, Pennsylvania 19104, USA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centres (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Centre 3900 Woodland Avenue, Philadelphia, Pennsylvania 19104, USA
| | - Clive Ballard
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- University of Exeter Medical School, University of Exeter, EX1 2LU, UK
| | - Dag Aarsland
- KCL-PARCOG group, Institute of Psychiatry, Psychology &Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology &Neuroscience, King's College London, UK. De Crespigny Park, London SE5 8AF, UK
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19
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ffytche DH, Aarsland D. Psychosis in Parkinson's Disease. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2017; 133:585-622. [DOI: 10.1016/bs.irn.2017.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Beaulieu-Boire I, Lang AE. Behavioral effects of levodopa. Mov Disord 2014; 30:90-102. [PMID: 25491470 DOI: 10.1002/mds.26121] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 11/08/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022] Open
Abstract
In recent years, levodopa-induced behavioral changes have received increased attention in the medical literature and in clinical practice. The spectrum of these symptoms includes non-motor fluctuations with neuropsychiatric symptoms, compulsive behaviors such as punding, dopamine dysregulation syndrome, and impulse control disorders, psychosis and hallucinations, as well as hypomania and mania. Despite knowledge of the clinical features associated with these behaviors, many of them are probably underdiagnosed. Although the mechanisms underlying behavioral symptoms are still incompletely understood, recent data from imaging and pathological studies have increased our understanding and guided new treatment strategies. Appropriate management remains challenging, because reduction of levodopa (l-dopa) and dopaminergic treatment is often recommended; however, doses required for control of motor symptoms may still induce behavioral changes. Newer modes of delivery of dopaminergic treatment, deep brain stimulation, and nondopaminergic agents may either provide alternatives for treatment of these behavioral problems or permit treatment of parkinsonism with less risk of these behavioral disorders.
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Affiliation(s)
- Isabelle Beaulieu-Boire
- Morton & Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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21
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Yao N, Pang S, Cheung C, Chang RSK, Lau KK, Suckling J, Yu K, Mak HKF, McAlonan G, Ho SL, Chua SE. Resting activity in visual and corticostriatal pathways in Parkinson's disease with hallucinations. Parkinsonism Relat Disord 2014; 21:131-7. [PMID: 25511330 DOI: 10.1016/j.parkreldis.2014.11.020] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/20/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Visual hallucinations are an important non-motor complication of Parkinson's disease (PD) and carry a negative prognosis. Their biological basis is uncertain, but may relate to the activity of resting state networks in brain. We therefore aimed to investigate functional activity of brain in patients with visual hallucinations (PDVH) in resting state compared to patients without hallucinations (PDnonVH) and a healthy control group (HC). METHODS Resting state functional MRI was acquired and the primary analysis compared the amplitude of low-frequency fluctuations (ALFF) across groups. This informed a secondary analysis, in the PD groups only, comparing functional connectivity between a 'seed' region in the occipital lobe and the rest of the brain. RESULTS Individuals with PDVH showed lower ALFF in bilateral lingual gyrus and cuneus and greater ALFF in temporo-parietal regions, medial temporal gyrus and cerebellum than PDnonVH and HC. PDnonVH also had lower ALFF in occipitoparietal region and greater ALFF in medial temporal gyrus, temporo-parietal and cerebellum regions than HC. Functional connectivity analysis revealed that, although both PD groups had lower occipital functional connectivity relative to the HC group, occipital - corticostriatal connectivity was significantly higher in those with PDVH compared with PDnonVH. CONCLUSION Our study reveals widespread hemodynamic alterations in PD. However, within a functionally abnormal occipital lobe, those with PDVH have even lower ALFF than non-hallucinators, but have higher occipital functional connectivity with cortical-striatal regions. These findings suggest disruption of pathways underpinning both primary visual perceptual and intrinsic visual integration may contribute to visual hallucinations in PD.
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Affiliation(s)
- Nailin Yao
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Shirley Pang
- Division of Neurology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Charlton Cheung
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
| | - Richard Shek-Kwan Chang
- Division of Neurology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Kui Kai Lau
- Division of Neurology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - John Suckling
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom & Cambridge and Peterborough Foundation NHS Trust, UK
| | - Kevin Yu
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong
| | - Henry Ka-Fung Mak
- Department of Diagnostic Radiology, The University of Hong Kong, Pokfulam, Hong Kong
| | - Grainne McAlonan
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong; Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King's College London, London SE5 8AZ, UK.
| | - Shu-Leong Ho
- Division of Neurology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
| | - Siew-Eng Chua
- Department of Psychiatry, Queen Mary Hospital, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory for Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong
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22
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23
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Abstract
Patients with Parkinson disease (PD) can experience hallucinations (spontaneous aberrant perceptions) and illusions (misinterpretations of real perceptual stimuli). Of such phenomena, visual hallucinations (VHs) and illusions are the most frequently encountered, although auditory, olfactory and tactile hallucinations can also occur. In cross-sectional studies, VHs occur in approximately one-third of patients, but up to three-quarters of patients might develop VHs during a 20-year period. Hallucinations can have substantial psychosocial effects and, historically, were the main reason for placing patients in nursing homes. Concomitant or overlapping mechanisms are probably active during VHs, and these include the following: central dopaminergic overactivity and an imbalance with cholinergic neurotransmission; dysfunction of the visual pathways, including specific PD-associated retinopathy and functional alterations of the extrastriate visual pathways; alterations of brainstem sleep-wake and dream regulation; and impaired attentional focus. Possible treatments include patient-initiated coping strategies, a reduction of antiparkinson medications, atypical neuroleptics and, potentially, cholinesterase inhibitors. Evidence-based studies, however, only support the use of one atypical neuroleptic, clozapine, and only in patients without dementia. Better phenomenological discrimination, combined with neuroimaging tools, should refine therapeutic options and improve prognosis. The aim of this Review is to present epidemiological, phenomenological, pathophysiological and therapeutic aspects of hallucinations in PD.
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Affiliation(s)
- Nico J Diederich
- Department of Neurology, Center Hospitalier de Luxembourg, 4 rue Barblé, Luxembourg City, Luxembourg.
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24
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Onofrj M, Thomas A, Bonanni L. New approaches to understanding hallucinations in Parkinson's disease: phenomenology and possible origins. Expert Rev Neurother 2008; 7:1731-50. [PMID: 18052766 DOI: 10.1586/14737175.7.12.1731] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors review current literature on hallucinations in Parkinson's disease (PD). Recent neuropathological studies showed that hallucinations occur in synucleinopathies and are a significant predictor of Lewy Body depositions. Therefore, hallucinations are a hallmark of PD and of dementia with Lewy Bodies. Visual hallucinations are mostly complex and kinematic; preserved or disturbed insight on the nature of hallucinations is a major prognostic factor, although eventually all hallucinators will present with reduced insight. Current theories on the origin of hallucinations point to visual dysfunction, dream overflow and cognitive impairment, yet objection can be raised on each one of the putative models of hallucinations. Understanding of the origin of hallucinations is required in order to develop treatments: all treatment evaluations were focused in general on psychosis, and only clozapine obtained positive evidence-based ratings on efficacy. However, it is likely that cholinesterase inhibitors, antipsychotics and anti-5-hydroxytryptamine(3) agents and drugs acting on sleep regulation will have different and perhaps opposite effects on different types of hallucinations, whether they are accompanied by disturbed insight, sleep disorders or other psychotic features. Further studies will try to separate phenomenology and responses to treatment and will investigate the relevance of concomitant sleep disorders and abnormality of frontoparietal networks involved in the attention process.
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Affiliation(s)
- Marco Onofrj
- University G. D'Annunzio, Department of Neurophysiopathology, Chieti-Pescara, 65124, Pescara, Italy.
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