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Phan TX, Baratono S, Drew W, Tetreault AM, Fox MD, Darby RR. Increased Cortical Thickness in Alzheimer's Disease. Ann Neurol 2024; 95:929-940. [PMID: 38400760 PMCID: PMC11060923 DOI: 10.1002/ana.26894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVE Patients with Alzheimer's disease (AD) have diffuse brain atrophy, but some regions, such as the anterior cingulate cortex (ACC), are spared and may even show increase in size compared to controls. The extent, clinical significance, and mechanisms associated with increased cortical thickness in AD remain unknown. Recent work suggested neural facilitation of regions anticorrelated to atrophied regions in frontotemporal dementia. Here, we aim to determine whether increased thickness occurs in sporadic AD, whether it relates to clinical symptoms, and whether it occur in brain regions functionally connected to-but anticorrelated with-locations of atrophy. METHODS Cross-sectional clinical, neuropsychological, and neuroimaging data from the Alzheimer's Disease Neuroimaging Initiative were analyzed to investigate cortical thickness in AD subjects versus controls. Atrophy network mapping was used to identify brain regions functionally connected to locations of increased thickness and atrophy. RESULTS AD patients showed increased thickness in the ACC in a region-of-interest analysis and the visual cortex in an exploratory analysis. Increased thickness in the left ACC was associated with preserved cognitive function, while increased thickness in the left visual cortex was associated with hallucinations. Finally, we found that locations of increased thickness were functionally connected to, but anticorrelated with, locations of brain atrophy (r = -0.81, p < 0.05). INTERPRETATION Our results suggest that increased cortical thickness in Alzheimer's disease is relevant to AD symptoms and preferentially occur in brain regions functionally connected to, but anticorrelated with, areas of brain atrophy. Implications for models of compensatory neuroplasticity in response to neurodegeneration are discussed. ANN NEUROL 2024;95:929-940.
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Affiliation(s)
- Tony X. Phan
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Sheena Baratono
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - William Drew
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Aaron M. Tetreault
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - R. Ryan Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
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2
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Sy AJ, Gochioco DC. Charles Bonnet Syndrome as Sequelae of Occipital Lobe Infarct With Hemorrhagic Conversion: A Case Report. Cureus 2023; 15:e50472. [PMID: 38222233 PMCID: PMC10786581 DOI: 10.7759/cureus.50472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/16/2024] Open
Abstract
Charles Bonnet syndrome occurs in the setting of visual impairment with subsequent complex and repetitive visual hallucinations confined in the area of visual loss, with intact cognition and insight. It has been described as a sequelae of ischemic stroke affecting the visual pathway. We report a case of a male presenting with right homonymous hemianopsia secondary to acute left occipital lobe infarct of cardioembolic etiology. He then developed visual hallucinations on the side of the visual loss. MRI showed hemorrhagic conversion of the occipital lobe infarct. Electroencephalogram showed focal and intermittent slowing of the anterior temporal and frontal region. Charles Bonnet syndrome may signify the worsening or progression of a structural lesion affecting the visual pathway, such as hemorrhagic conversion, and warrants prompt and thorough evaluation. Understanding these conditions is crucial for healthcare professionals and caregivers to provide effective support and interventions for those affected.
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Affiliation(s)
- Alfeo Julius Sy
- Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, PHL
| | - Diane Charleen Gochioco
- Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, PHL
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3
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Guan M, Xie Y, Li C, Zhang T, Ma C, Wang Z, Ma Z, Wang H, Fang P. Rich-club reorganization of white matter structural network in schizophrenia patients with auditory verbal hallucinations following 1 Hz rTMS treatment. Neuroimage Clin 2023; 40:103546. [PMID: 37988997 PMCID: PMC10701084 DOI: 10.1016/j.nicl.2023.103546] [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: 11/12/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
The human brain comprises a large-scale structural network of regions and interregional pathways, including a selectively defined set of highly central and interconnected hub regions, often referred to as the "rich club", which may play a pivotal role in the integrative processes of the brain. A quintessential symptom of schizophrenia, auditory verbal hallucinations (AVH) have shown a decrease in severity following low-frequency repetitive transcranial magnetic stimulation (rTMS). However, the underlying mechanism of rTMS in treating AVH remains elusive. This study investigated the effect of low-frequency rTMS on the rich-club organization within the brain in patients diagnosed with schizophrenia who experience AVH using diffusion tensor imaging data. Through by constructing structural connectivity networks, we identified several critical rich hub nodes, which constituted a rich-club subnetwork, predominantly located in the prefrontal cortices. Notably, our findings revealed enhanced connection strength and density within the rich-club subnetwork following rTMS treatment. Furthermore, we found that the decreased connectivity within the subnetwork components, including the rich-club subnetwork, was notably enhanced in patients following rTMS treatment. In particular, the increased connectivity strength of the right median superior frontal gyrus, which functions as a critical local bridge, with the right postcentral gyrus exhibited a significant correlation with improvements in both positive symptoms and AVH. These findings provide valuable insights into the role of rTMS in inducing reorganizational changes within the rich-club structural network in schizophrenia and shed light on potential mechanisms through which rTMS may alleviate AVH.
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Affiliation(s)
- Muzhen Guan
- Department of Mental Health, Xi'an Medical College, Xi'an, China.
| | - Yuanjun Xie
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China; Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Chenxi Li
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Tian Zhang
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Chaozong Ma
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China
| | - Zhongheng Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhujing Ma
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Huaning Wang
- Department of Psychiatry, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
| | - Peng Fang
- Military Medical Psychology School, Fourth Military Medical University, Xi'an, China.
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Blackman G, Dadwal AK, Teixeira-Dias M, Ffytche D. The association between visual hallucinations and secondary psychosis: a systematic review and meta-analysis. Cogn Neuropsychiatry 2023; 28:391-405. [PMID: 37922514 DOI: 10.1080/13546805.2023.2266872] [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] [Received: 10/26/2022] [Accepted: 09/28/2023] [Indexed: 11/05/2023]
Abstract
INTRODUCTION Visual hallucinations are often considered to be suggestive of a secondary cause of psychosis, however, this association has never been assessed meta-analytically. We aimed to compare the presence of visual hallucinations in patients with psychosis due to a primary or secondary cause. METHOD We conducted a meta-analysis of case-control studies directly comparing primary and secondary psychosis. A random-effects model, following the DerSimonian and Laird method, was used to pool studies and generate overall odds ratios (OR), 95% confidence intervals (CI) and prediction intervals (PI). RESULTS Fourteen studies (904 primary and 804 secondary psychosis patients) were included. Visual hallucinations were significantly associated with secondary psychosis (OR = 3.0, 95% CI = 1.7-5.1, p < 0.001) with moderate between-study heterogeneity (I2 = 70%). Subgroup analysis by type of secondary psychosis (organic, drug-induced, mixed) was non-significant. Analysis of the content of visual hallucinations (51 primary and 142 secondary psychosis patients) found hallucinations of inanimate objects were significantly more likely to be associated with secondary psychosis (OR = 0.1, 95% CI = 0.01-0.8, p = 0.03). CONCLUSIONS Visual hallucinations were strongly associated with a secondary cause of psychosis. The presence of visual hallucinations in a patient presenting with psychosis may serve as a potential "red flag" for a secondary cause and warrant further investigation.
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Affiliation(s)
- Graham Blackman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amber Kaur Dadwal
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Maria Teixeira-Dias
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Ffytche
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Visual Perceptual Disorder Clinic, South London and Maudsley NHS Foundation Trust, London, UK
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Merino D, Gérard AO, Van Obberghen EK, Destere A, Lanteri-Minet M, Drici MD. The Neuropsychiatric Safety Profile of Lasmiditan: A Comparative Disproportionality Analysis with Triptans. Neurotherapeutics 2023; 20:1305-1315. [PMID: 37436579 PMCID: PMC10480366 DOI: 10.1007/s13311-023-01404-1] [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] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Migraine constitutes the world's second-leading cause of disability. Triptans, as serotonin 5-HT1B/1D receptor agonists, remain the first-line treatment, despite discouraged use in individuals at high cardiovascular risk. Lasmiditan, a selective lipophilic 5-HT1F agonist without vasoconstrictive effects, is an emerging option. We aimed to investigate the safety profile of lasmiditan in the WHO pharmacovigilance database (VigiBase®) using a comparative disproportionality analysis with triptans. VigiBase® was queried for all reports involving lasmiditan and triptans. Disproportionality analyses relied on the calculation of the information component (IC), for which 95% confidence interval (CI) lower bound positivity was required for signal detection. We obtained 826 reports involving lasmiditan. Overall, 10 adverse drug reaction classes were disproportionately reported with triptans, while only neurological (IC 1.6; 95% CI 1.5-1.7) and psychiatric (IC 1.5; 95% CI 1.3-1.7) disorders were disproportionately reported with lasmiditan. Sedation, serotonin syndrome, euphoric mood, and autoscopy had the strongest signals. When compared with triptans, 19 out of 22 neuropsychiatric signals persisted. The results of our analysis provide a more precise semiology of the neuropsychiatric effects of lasmiditan, with symptoms such as autoscopy and panic attacks. The cardiovascular adverse drug reaction risk with triptans was confirmed. In contrast, caution is warranted with lasmiditan use in patients with neurological or psychiatric comorbidities or serotonin syndrome risk. Our study was hindered by pharmacovigilance flaws, and further studies should help in validating these results. Our findings suggest that lasmiditan is a safe alternative for migraine treatment, especially when the neuropsychiatric risk is outweighed by the cardiovascular burden.
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Affiliation(s)
- Diane Merino
- Department of Psychiatry, Université Côte d'Azur, University Hospital of Nice, Nice, France
- Department of Pharmacology and Pharmacovigilance Center of Nice, Université Côte d'Azur, University Hospital of Nice, Nice, France
| | - Alexandre O Gérard
- Department of Pharmacology and Pharmacovigilance Center of Nice, Université Côte d'Azur, University Hospital of Nice, Nice, France
- Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, Université Côte d'Azur, CNRS, Nice, France
| | - Elise K Van Obberghen
- Department and FHU InovPain, Université Côte d'Azur, University Hospital of Nice, Nice, France
| | - Alexandre Destere
- Department of Pharmacology and Pharmacovigilance Center of Nice, Université Côte d'Azur, University Hospital of Nice, Nice, France
- Laboratoire J.A. Dieudonné, Université Côte d'Azur, Inria, CNRS, Maasai Team, Nice, France
| | - Michel Lanteri-Minet
- Department and FHU InovPain, Université Côte d'Azur, University Hospital of Nice, Nice, France
- UMR 1107, Migraine and Trigeminal Pain, INSERM, Auvergne University, Clermont-Ferrand, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance Center of Nice, Université Côte d'Azur, University Hospital of Nice, Nice, France.
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Muacevic A, Adler JR, Varghese V, Michael P. Can a Cerebral Congenital Anomaly Present in Adulthood? Cureus 2022; 14:e31985. [PMID: 36589192 PMCID: PMC9797250 DOI: 10.7759/cureus.31985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
Colpocephaly, a congenital anomaly in the ventricles, is usually discovered early in infancy and rarely during adulthood. Partial or complete agenesis of the corpus callosum or Chiari malformations (developmental arrest of white matter formation in early fetal development) can lead to abnormal asymmetrical ventricular enlargement. Minimal literature about colpocephaly is available for clinicians, making diagnosis and treatment very challenging. Colpocephaly in adults is an infrequent condition, mostly found as an incidental finding with no neurological or cognitive impairment. Symptoms usually represent the affected lobe in the brain as our patient's visual hallucination may be attributed to the lesioned occipital horn. Differentiating from normal pressure hydrocephalus, representing new-onset dementia, can help avoid unnecessary procedures. Neurological and psychiatric consultation should be practiced to exclude other causes of neurological and cognitive impairment. While there is no definitive treatment for this condition, seizure prophylaxis has been helpful. Cognitive behavioral therapy, psychotherapy, and social skills training are recommended in some literature. Typical and atypical antipsychotics can control symptoms with uncertain efficacy.
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Rossi S, Romoli M, Urbinati G, Benini M, Russo M, D’Anna L, Abu-Rumeileh S, Sacco S, Querzani P, Foschi M. Acute stroke-like deficits associated with nonketotic hyperglycemic hyperosmolar state: an illustrative case and systematic review of literature. Neurol Sci 2022; 43:4671-4683. [PMID: 35482160 PMCID: PMC9349111 DOI: 10.1007/s10072-022-06088-7] [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: 01/30/2022] [Accepted: 04/18/2022] [Indexed: 12/05/2022]
Abstract
Introduction Nonketotic hyperglycemic hyperosmolar state (NKHHS) is associated with a wide spectrum of neurological syndromes including acute stroke-like deficits. Clinical features and etiology have not been established yet. Methods Here we provide a case illustration and systematic review on non-epileptic acute neurological deficits in NKHSS. The systematic literature search followed PRISMA guidelines and a predefined protocol, including cases of NKHSS with acute stroke-like presentation. Results The database search yielded 18 cases. Hemianopia was the most common clinical presentation (73%), followed by partial or total anterior circulation syndrome (26%). Patients with symptoms of acute anterior circulation infarct were significantly older (69.5 ± 5.1 vs. 52.2 ± 13.9 years; p = 0.03) and showed higher mean glucose levels at the admission vs. those with hemianopia (674.8 ± 197.2 vs. 529.4 ± 190.8 mg/dL; p = 0.16). Brain MRI was performed in 89% of patients, resulting abnormal in 71% of them, especially hemianopic (91%). Subcortical hypointensities in T2-FLAIR MR sequences were present in all the analyzed cases. Cortical DWI hyperintensities were also common (64%). EEG showed diffuse or focal slow wave activity in 68% of patients, especially with visual hallucinations (85%). Neurological symptoms completely resolved in 78% of patients within 6 (IQR 3–10) days, following aggressive treatment and glucose normalization. Conclusions Our results suggest neuronal dysfunction on a metabolic basis as the leading cause of acute neurological deficits in NKHHS. Despite the generally favorable prognosis, prompt identification and aggressive treatment are crucial to avoid irreversible damage. Larger cohort studies are needed to confirm our findings.
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Wearne D, Ayalde J, Curtis G, Gopisetty A, Banerjee A, Melvill-Smith P, Orr K, Rajanthiran L, Waters F. Visual phenomenology in schizophrenia and post-traumatic stress disorder: an exploratory study. BJPsych Open 2022; 8:e143. [PMID: 35876067 PMCID: PMC9345685 DOI: 10.1192/bjo.2022.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Visual experiences such as hallucinations are commonly reported by people with psychosis, psychological trauma and dissociative states, although questions remain about their similarities and differences. For diagnostic and therapeutic purposes, clinical research must better delineate and compare the characteristics of these experiences in post-traumatic stress disorder (PTSD) and in schizophrenia. AIMS To compare visual phenomena and dissociation in participants with a primary psychotic illness and those with a trauma diagnosis. METHOD A quantitative group design study comparing visual phenomena in three participant groups who also have a history of hearing voices: schizophrenia and no trauma history (n = 19), PTSD with dissociation (n = 17) and comorbid schizophrenia and PTSD (n = 20). Validated clinical measures included the North-East Visual Hallucination Interview, PTSD Symptoms Scale Interview, Clinician Administered Dissociative States Scale, Psychotic Symptoms Rating Scales and Positive and Negative Syndrome Scale. RESULTS There was a remarkable similarity in visual experiences, including rates of complex visual hallucinations, between the three diagnostic groups. There were no significant differences in the severity or components of distress surrounding the visual experiences. Dissociation predicted visual hallucination severity for the comorbid schizophrenia and PTSD group, but not for PTSD or schizophrenia alone. CONCLUSIONS Visual experiences in PTSD can include visual hallucinations that are indistinguishable from those experienced in schizophrenia. Multimodal hallucinations are frequently observed in both schizophrenia and PTSD. A model for visual hallucinations in PTSD is suggested, following two separate neurobiological pathways based on distinct responses to trauma.
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Affiliation(s)
- Deborah Wearne
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Jeremiah Ayalde
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Guy Curtis
- Department of Psychology, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Aarethi Gopisetty
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Amit Banerjee
- Early Psychosis Program Perth, headspace National Youth Mental Health Foundation, Melbourne, Victoria, Australia
| | - Peter Melvill-Smith
- Department of Psychiatry, Western Australia Department of Health, Perth, Western Australia, Australia
| | - Kenneth Orr
- Department of Psychiatry, St John of God Health Care, Perth, Western Australia, Australia
| | - Leon Rajanthiran
- Department of Psychiatry, St John of God Health Care, Perth, Western Australia, Australia
| | - Flavie Waters
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
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Li Y, Tan Z, Wang J, Wang M, Wang L. Neural Substrates of External and Internal Visual Sensations Induced by Human Intracranial Electrical Stimulation. Front Neurosci 2022; 16:918767. [PMID: 35937874 PMCID: PMC9355733 DOI: 10.3389/fnins.2022.918767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Offline perceptions are self-generated sensations that do not involve physical stimulus. These perceptions can be induced by external hallucinated objects or internal imagined objects. However, how the brain dissociates these visual sensations remains unclear. We aimed to map the brain areas involved in internal and external visual sensations induced by intracranial electrical stimulation and further investigate their neural differences. In this study, we collected subjective reports of internal and external visual sensations elicited by electrical stimulation in 40 drug-refractory epilepsy during presurgical evaluation. The response rate was calculated and compared to quantify the dissociated distribution of visual responses. We found that internal and external visual sensations could be elicited when different brain areas were stimulated, although there were more overlapping brain areas. Specifically, stimulation of the hippocampus and inferior temporal cortex primarily induces internal visual sensations. In contrast, stimulation of the occipital visual cortex mainly triggers external visual sensations. Furthermore, compared to that of the dorsal visual areas, the ventral visual areas show more overlap between the two visual sensations. Our findings show that internal and external visual sensations may rely on distinct neural representations of the visual pathway. This study indicated that implantation of electrodes in ventral visual areas should be considered during the evaluation of visual sensation aura epileptic seizures.
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Affiliation(s)
- Yanyan Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zheng Tan
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jing Wang
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Mengyang Wang
- Sanbo Brain Hospital, Capital Medical University, Beijing, China
- Mengyang Wang,
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Liang Wang,
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Lawn T, Dipasquale O, Vamvakas A, Tsougos I, Mehta MA, Howard MA. Differential contributions of serotonergic and dopaminergic functional connectivity to the phenomenology of LSD. Psychopharmacology (Berl) 2022; 239:1797-1808. [PMID: 35322297 PMCID: PMC9166846 DOI: 10.1007/s00213-022-06117-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 03/11/2022] [Indexed: 02/25/2023]
Abstract
RATIONALE LSD is the prototypical psychedelic. Despite a clear central role of the 5HT2a receptor in its mechanism of action, the contributions of additional receptors for which it shows affinity and agonist activity remain unclear. OBJECTIVES We employed receptor-enriched analysis of functional connectivity by targets (REACT) to explore differences in functional connectivity (FC) associated with the distributions of the primary targets of LSD-the 5HT1a, 5HT1b, 5HT2a, D1 and D2 receptors. METHODS We performed secondary analyses of an openly available dataset (N = 15) to estimate the LSD-induced alterations in receptor-enriched FC maps associated with these systems. Principal component analysis (PCA) was employed as a dimension reduction strategy for subjective experiences associated with LSD captured by the Altered States of Consciousness (ASC) questionnaire. Correlations between these principal components as well as VAS ratings of subjective effects with receptor-enriched FC were explored. RESULTS Compared to placebo, LSD produced differences in FC when the analysis was enriched with each of the primary serotonergic and dopaminergic receptors. Altered receptor-enriched FC showed relationships with the subjective effects of LSD on conscious experience, with serotonergic and dopaminergic systems being predominantly associated with perceptual effects and perceived selfhood as well as cognition respectively. These relationships were dissociable, with different receptors showing the same relationships within, but not between, the serotonergic and dopaminergic systems. CONCLUSIONS These exploratory findings provide new insights into the pharmacology of LSD and highlight the need for additional investigation of non-5HT2a-mediated mechanisms.
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Affiliation(s)
- Timothy Lawn
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ottavia Dipasquale
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandros Vamvakas
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Medical Physics Department, School of Medicine, University of Thessaly, Larissa, Greece
| | - Ioannis Tsougos
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Medical Physics Department, School of Medicine, University of Thessaly, Larissa, Greece
| | - Mitul A. Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matthew A. Howard
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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11
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Fénelon G. From Dreams to Hallucinations: Jean Lhermitte's Contribution to the Study of Peduncular Hallucinosis and the Dissociation of States. J Neuropsychiatry Clin Neurosci 2022; 34:16-29. [PMID: 34711070 DOI: 10.1176/appi.neuropsych.20120314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Jean Lhermitte (1877-1959) was one of the pioneers of behavioral neurology, including the field of hallucinations. This article focuses on his work concerning the relationship between hallucinations, sleep, and dreams. From 1910, Lhermitte became interested in sleep and its disorders, particularly narcolepsy and its accompanying symptoms. He also reported on sleep disorders and hallucinations occurring in people with lesions of the diencephalic region ("infundibular syndrome"), and later encephalitis lethargica. In 1922, he described a syndrome of complex, predominantly visual hallucinations in patients with vascular damage to the midbrain, known as peduncular hallucinosis. Twelve historical cases of peduncular hallucinosis, including 10 from Lhermitte, are reviewed. He gave a precise phenomenological description of peduncular hallucinosis, and put forward the hypothesis that the lesion disrupted the anatomy and connections of a center regulating wakefulness and sleep, thus enabling a dissociation of the mechanisms of dream and waking states. Although the pathophysiology of peduncular hallucinosis remains to this day partly obscure, the model of a limited subcortical lesion acting through complex mechanisms and ultimately involving the cortex remains valid. Lhermitte was also a pioneer in characterizing what contemporary sleep specialists call dissociation of states.
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Affiliation(s)
- Gilles Fénelon
- Service de Neurologie, Centre Expert Parkinson, Hôpital Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France; Département d'Etudes Cognitives, École Normale Supérieure, Paris Sciences et Lettres University, Paris; and Equipe NeuroPsychologie Interventionnelle, Institut Mondor de Recherche Biomédicale, Paris-Est Créteil Val-de-Marne University, Créteil, France
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12
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Yang W, Xu X, Wang C, Cheng Y, Li Y, Xu S, Li J. Alterations of dynamic functional connectivity between visual and executive-control networks in schizophrenia. Brain Imaging Behav 2022; 16:1294-1302. [PMID: 34997915 DOI: 10.1007/s11682-021-00592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/20/2021] [Indexed: 01/28/2023]
Abstract
Schizophrenia is a chronic mental disorder characterized by continuous or relapsing episodes of psychosis. While previous studies have detected functional network connectivity alterations in patients with schizophrenia, and most have focused on static functional connectivity. However, brain activity is believed to change dynamically over time. Therefore, we computed dynamic functional network connectivity using the sliding window method in 38 patients with schizophrenia and 31 healthy controls. We found that patients with schizophrenia exhibited higher occurrences in the weakly and sparsely connected state (state 3) than healthy controls, positively correlated with negative symptoms. In addition, patients exhibited fewer occurrences in a strongly connected state (state 4) than healthy controls. Lastly, the dynamic functional network connectivity between the right executive-control network and the medial visual network was decreased in schizophrenia patients compared to healthy controls. Our results further prove that brain activity is dynamic, and that alterations of dynamic functional network connectivity features might be a fundamental neural mechanism in schizophrenia.
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Affiliation(s)
- Weiliang Yang
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Xuexin Xu
- Department of Radiology, MRI Center, Tianjin Children Hospital, Tianjin Medical University Affiliated Tianjin Children Hospital, Tianjin, China
| | - Chunxiang Wang
- Department of Radiology, MRI Center, Tianjin Children Hospital, Tianjin Medical University Affiliated Tianjin Children Hospital, Tianjin, China
| | - Yongying Cheng
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Yan Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Shuli Xu
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China
| | - Jie Li
- Laboratory of Biological Psychiatry, Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, Tianjin, 300222, China.
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13
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An Integrated Neuroimaging Approach to Inform Transcranial Electrical Stimulation Targeting in Visual Hallucinations. Harv Rev Psychiatry 2022; 30:181-190. [PMID: 35576449 PMCID: PMC9179829 DOI: 10.1097/hrp.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
For decades, noninvasive brain stimulation (NIBS), such as transcranial electrical stimulation (tES), has been used to directly modulate human brain mechanisms of visual perception, setting the groundwork for the development of novel circuit-based therapies. While the field of NIBS has grown considerably over recent years, few studies have used these technologies to treat visual hallucinations (VH). Here, we review the NIBS-VH literature and find mixed results due to shortcomings that may potentially be addressed with a unique multimodal neuroimaging-NIBS approach. We highlight methodological advances in NIBS research that have provided researchers with more precise anatomical measurements that may improve our ability to influence brain activity. Specifically, we propose a methodology that combines neuroimaging advances, clinical neuroscience developments such as the identification of brain regions causally involved in VH, and personalized NIBS approaches that improve anatomical targeting. This methodology may enable us to reconcile existing discrepancies in tES-VH research and pave the way for more effective, VH-specific protocols for treating a number of neuropsychiatric disorders with VH as a core symptom.
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14
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Abrevaya S, Fittipaldi S, García AM, Dottori M, Santamaria-Garcia H, Birba A, Yoris A, Hildebrandt MK, Salamone P, De la Fuente A, Alarco-Martí S, García-Cordero I, Matorrel-Caro M, Pautassi RM, Serrano C, Sedeño L, Ibáñez A. At the Heart of Neurological Dimensionality: Cross-Nosological and Multimodal Cardiac Interoceptive Deficits. Psychosom Med 2021; 82:850-861. [PMID: 33003072 PMCID: PMC7647435 DOI: 10.1097/psy.0000000000000868] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/10/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Neurological nosology, based on categorical systems, has largely ignored dimensional aspects of neurocognitive impairments. Transdiagnostic dimensional approaches of interoception (the sensing of visceral signals) may improve the descriptions of cross-pathological symptoms at behavioral, electrophysiological, and anatomical levels. Alterations of cardiac interoception (encompassing multidimensional variables such as accuracy, learning, sensibility, and awareness) and its neural correlates (electrophysiological markers, imaging-based anatomical and functional connectivity) have been proposed as critical across disparate neurological disorders. However, no study has examined the specific impact of neural (relative to autonomic) disturbances of cardiac interoception or their differential manifestations across neurological conditions. METHODS Here, we used a computational approach to classify and evaluate which markers of cardiac interoception (behavioral, metacognitive, electrophysiological, volumetric, or functional) offer the best discrimination between neurological conditions and cardiac (hypertensive) disease (model 1), and among neurological conditions (Alzheimer's disease, frontotemporal dementia, multiple sclerosis, and brain stroke; model 2). In total, the study comprised 52 neurological patients (mean [standard deviation] age = 55.1 [17.3] years; 37 women), 25 cardiac patients (age = 66.2 [9.1] years; 13 women), and 72 healthy controls (age = 52.65 [17.1] years; 50 women). RESULTS Cardiac interoceptive outcomes successfully classified between neurological and cardiac conditions (model 1: >80% accuracy) but not among neurological conditions (model 2: 53% accuracy). Behavioral cardiac interoceptive alterations, although present in all conditions, were powerful in differentiating between neurological and cardiac diseases. However, among neurological conditions, cardiac interoceptive deficits presented more undifferentiated and unspecific disturbances across dimensions. CONCLUSIONS Our result suggests a diffuse pattern of interoceptive alterations across neurological conditions, highlighting their potential role as dimensional, transdiagnostic markers.
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15
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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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16
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Visual Release Hallucinations After Facial Allotransplantation. Harv Rev Psychiatry 2021; 29:327-334. [PMID: 34033593 DOI: 10.1097/hrp.0000000000000296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Abstract
Visual hallucinations have intrigued neurologists and physicians for generations due to patients' vivid and fascinating descriptions. They are most commonly associated with Parkinson's disease and dementia with Lewy bodies, but also occur in people with visual loss, where they are known as Charles Bonnet syndrome. More rarely, they can develop in other neurological conditions, such as thalamic or midbrain lesions, when they are known as peduncular hallucinosis. This review considers the mechanisms underlying visual hallucinations across diagnoses, including visual loss, network dysfunction across the brain and changes in neurotransmitters. We propose a framework to explain why visual hallucinations occur most commonly in Parkinson's disease and dementia with Lewy bodies, and discuss treatment approaches to visual hallucinations in these conditions.
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, University College London, London, UK
| | - A J Lees
- Reta Lila Weston Institute of Neurological Studies, University College London, London, UK
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18
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Zhuo C, Chen M, Xu Y, Jiang D, Chen C, Ma X, Li R, Sun Y, Li Q, Zhou C, Lin X. Reciprocal deterioration of visual and auditory hallucinations in schizophrenia presents V-shaped cognition impairment and widespread reduction in brain gray matter-A pilot study. J Clin Neurosci 2020; 79:154-159. [PMID: 33070887 DOI: 10.1016/j.jocn.2020.07.054] [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: 01/26/2020] [Revised: 05/07/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
Schizophrenic patients often experience visual hallucinations (VHs) and auditory hallucinations (AHs); however, brain aberrations associated with combined VH and AH in schizophrenic patients remains poorly documented. Changes to the brain and cognition during the first episode of untreated schizophrenic patients (FUSCH) with both VHs and AHs (FUSCHVA) were evaluated. One-hundred and fifty-seven patients were enrolled that had FUSCH (1) with VHs but not AHs (FUSCHV), and (2) with AHs but not VHs (FUSCHA), plus FUSCHVA and healthy controls (n = 30). Gray matter volume (GMV) and MATRICS Consensus Cognitive Battery (MCCB) was measured to reflect impairments to the brain and cognition, respectively. FUSCHVA patients had the severest cognitive impairment for all components of the MCCB, followed by FUSCHV and FUSCHA patients. Compared to healthy patients, FUSCHVA patients had reduced GMV in the occipital, parietal, frontal, and temporal cortex, and increased GMV in the hippocampus and striatum. Compared to FUSCHV patients, FUSCHVA patients had reduced GMV in the occipital cortex and postcentral gyrus, and increased GMV in the posterio-parietal lobe. Compared to patients with FUSCHA, the GMV in patients with FUSCHVV was reduced in the occipital cortex and posterio parietal lobe. In conclusion, visual and auditory hallucinations appear to deteriorate reciprocally in FUSCHVA patients, accompanied with sever cognitive impairments. Compared to AHs, VHs might be accompanied with severe GMV impairment in the brain, especially in the primary visual cortex and higher perception integration cortex (posterio parietal lobe) in patients with FUSCH.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Neuroimage-Genetics Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, Jining 272119, Shandong Province, China; Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan 030001, China; Department of Psychiatric-Neuroimage-Genetics, Wenzhou Seventh People's Hospital, Wenzhou 325000, China; Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Heath Teaching Hospital, 300222 Tianjin, China; Key labaratory of Real Time of Brain Circuits Tracing For Neurology and Psychiatry, Tianjin Medical University Affiliated Tianjin Forth Centre Hospital, Tianjin Fourth Centre Hospital, Tianjin 300024, China.
| | - Min Chen
- Department of Neuroimage-Genetics Laboratory of Schizophrenia, School of Mental Health, Jining Medical University, Jining 272119, Shandong Province, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; MDT Center for Cognitive Impairment and Sleep Disorders, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Deguo Jiang
- Department of Psychiatric-Neuroimage-Genetics, Wenzhou Seventh People's Hospital, Wenzhou 325000, China
| | - Ce Chen
- Department of Psychiatric-Neuroimage-Genetics, Wenzhou Seventh People's Hospital, Wenzhou 325000, China
| | - Xiaoyan Ma
- Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Heath Teaching Hospital, 300222 Tianjin, China
| | - Ranli Li
- Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Heath Teaching Hospital, 300222 Tianjin, China
| | - Yun Sun
- Psychiatric-Neuroimaging-Genetics and Co-morbidity Laboratory (PNGC_Lab), Tianjin Anding Hospital, Tianjin Mental Health Center, Tianjin Medical University Mental Heath Teaching Hospital, 300222 Tianjin, China
| | - Qianchen Li
- Department of Pharmacoloy, The First Hospital of Hebei Medical University, Shijiazhuang 05000, Hebei Province, China
| | - Chunhua Zhou
- Department of Pharmacoloy, The First Hospital of Hebei Medical University, Shijiazhuang 05000, Hebei Province, China.
| | - Xiaodong Lin
- Department of Pharmacoloy, The First Hospital of Hebei Medical University, Shijiazhuang 05000, Hebei Province, China
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19
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Knolle F, Garofalo S, Viviani R, Justicia A, Ermakova AO, Blank H, Williams GB, Arrondo G, Ramachandra P, Tudor-Sfetea C, Bunzeck N, Duezel E, Robbins TW, Barker RA, Murray GK. Altered subcortical emotional salience processing differentiates Parkinson's patients with and without psychotic symptoms. NEUROIMAGE-CLINICAL 2020; 27:102277. [PMID: 32540629 PMCID: PMC7298672 DOI: 10.1016/j.nicl.2020.102277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 03/30/2020] [Accepted: 05/05/2020] [Indexed: 01/03/2023]
Abstract
Emotional salience processing differentiates PD patients with and without psychosis. Enhanced striatal, hippocampal and midbrain responses in PD patients with psychosis. Indication for ‘jumping to conclusions’ bias in the same PD patients with psychosis. Aberrant top-down and salience processing associated with PD psychosis. Similar deficits as proposed in ‘aberrant salience hypothesis’ of schizophrenia.
Objective Current research does not provide a clear explanation for why some patients with Parkinson’s Disease (PD) develop psychotic symptoms. The ‘aberrant salience hypothesis’ of psychosis has been influential and proposes that dopaminergic dysregulation leads to inappropriate attribution of salience to irrelevant/non-informative stimuli, facilitating the formation of hallucinations and delusions. The aim of this study is to investigate whether non-motivational salience is altered in PD patients and possibly linked to the development of psychotic symptoms. Methods We investigated salience processing in 14 PD patients with psychotic symptoms, 23 PD patients without psychotic symptoms and 19 healthy controls. All patients were on dopaminergic medication for their PD. We examined emotional salience using a visual oddball fMRI paradigm that has been used to investigate early stages of schizophrenia spectrum psychosis, controlling for resting cerebral blood flow as assessed with arterial spin labelling fMRI. Results We found significant differences between patient groups in brain responses to emotional salience. PD patients with psychotic symptoms had enhanced brain responses in the striatum, dopaminergic midbrain, hippocampus and amygdala compared to patients without psychotic symptoms. PD patients with psychotic symptoms showed significant correlations between the levels of dopaminergic drugs they were taking and BOLD signalling, as well as psychotic symptom scores. Conclusion Our study suggests that enhanced signalling in the striatum, dopaminergic midbrain, the hippocampus and amygdala is associated with the development of psychotic symptoms in PD, in line with that proposed in the ‘aberrant salience hypothesis’ of psychosis in schizophrenia.
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Affiliation(s)
- F Knolle
- Department of Psychiatry, University of Cambridge, Cambridge, UK; Department of Neuroradiology, Technical University Munich, Munich, Germany.
| | - S Garofalo
- University of Bologna, Department of Psychology, Bologna, Italy
| | - R Viviani
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria; Psychiatry and Psychotherapy Clinic III, University of Ulm, Ulm, Germany
| | - A Justicia
- Department of Psychiatry, University of Cambridge, Cambridge, UK; IMIM (Hospital del Mar Medical Research Institute), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - A O Ermakova
- Faculty of Natural Sciences, Imperial College London, UK
| | - H Blank
- Institute of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G B Williams
- Department of Clinical Neuroscience and WT-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - G Arrondo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P Ramachandra
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - C Tudor-Sfetea
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - N Bunzeck
- Institute of Psychology I, University of Lübeck, Lübeck, Germany
| | - E Duezel
- Otto-von-Guericke University Magdeburg, Institute of Cognitive Neurology and Dementia Research, Magdeburg, Germany; German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - T W Robbins
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - R A Barker
- Department of Clinical Neuroscience and WT-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge, UK
| | - G K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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20
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O'Brien J, Taylor JP, Ballard C, Barker RA, Bradley C, Burns A, Collerton D, Dave S, Dudley R, Francis P, Gibbons A, Harris K, Lawrence V, Leroi I, McKeith I, Michaelides M, Naik C, O'Callaghan C, Olsen K, Onofrj M, Pinto R, Russell G, Swann P, Thomas A, Urwyler P, Weil RS, Ffytche D. Visual hallucinations in neurological and ophthalmological disease: pathophysiology and management. J Neurol Neurosurg Psychiatry 2020; 91:512-519. [PMID: 32213570 PMCID: PMC7231441 DOI: 10.1136/jnnp-2019-322702] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022]
Abstract
Visual hallucinations are common in older people and are especially associated with ophthalmological and neurological disorders, including dementia and Parkinson's disease. Uncertainties remain whether there is a single underlying mechanism for visual hallucinations or they have different disease-dependent causes. However, irrespective of mechanism, visual hallucinations are difficult to treat. The National Institute for Health Research (NIHR) funded a research programme to investigate visual hallucinations in the key and high burden areas of eye disease, dementia and Parkinson's disease, culminating in a workshop to develop a unified framework for their clinical management. Here we summarise the evidence base, current practice and consensus guidelines that emerged from the workshop.Irrespective of clinical condition, case ascertainment strategies are required to overcome reporting stigma. Once hallucinations are identified, physical, cognitive and ophthalmological health should be reviewed, with education and self-help techniques provided. Not all hallucinations require intervention but for those that are clinically significant, current evidence supports pharmacological modification of cholinergic, GABAergic, serotonergic or dopaminergic systems, or reduction of cortical excitability. A broad treatment perspective is needed, including carer support. Despite their frequency and clinical significance, there is a paucity of randomised, placebo-controlled clinical trial evidence where the primary outcome is an improvement in visual hallucinations. Key areas for future research include the development of valid and reliable assessment tools for use in mechanistic studies and clinical trials, transdiagnostic studies of shared and distinct mechanisms and when and how to treat visual hallucinations.
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Affiliation(s)
- John O'Brien
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - John Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clive Ballard
- University of Exeter Medical School, Medical School Building, St Luke's Campus, Exeter, UK
| | - Roger A Barker
- Department of Clinical Neurosciences, WT-MRC Cambridge Stem Cell Institute, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Clare Bradley
- Health Psychology Research Ltd, Egham, Surrey, UK.,Health Psychology Research Unit, Royal Holloway University of London, Egham, Surrey, UK
| | - Alistair Burns
- Faculty of Medical and Human Sciences, The University of Manchester, Manchester, United Kingdom
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sonali Dave
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Rob Dudley
- Gateshead Early Intervention in Psychosis Service, Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust, Gateshead, UK
| | - Paul Francis
- University of Exeter Medical School, Medical School Building, St Luke's Campus, Exeter, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway University of London, Egham, Surrey, UK
| | - Kate Harris
- Department of Clinical Neurosciences, WT-MRC Cambridge Stem Cell Institute, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Vanessa Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Iracema Leroi
- Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ian McKeith
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michel Michaelides
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Chaitali Naik
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Claire O'Callaghan
- Brain and Mind Centre and Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marco Onofrj
- Clinical Neurologica, Dipartimento di Neuroscienze, Imaging e Scienze Cliniche, Università G.D'Annunzio, Chieti-Pescara, Italy
| | - Rebecca Pinto
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Lynfield Mount Hospital, Bradford, UK
| | - Peter Swann
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
| | - Alan Thomas
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.,University Neurorehabilitation Unit, Department of Neurology, University Hospital Inselspital, Bern, Switzerland
| | | | - Dominic Ffytche
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, London, UK
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21
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Weil RS, Hsu JK, Darby RR, Soussand L, Fox MD. Neuroimaging in Parkinson's disease dementia: connecting the dots. Brain Commun 2019; 1:fcz006. [PMID: 31608325 PMCID: PMC6777517 DOI: 10.1093/braincomms/fcz006] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 12/11/2022] Open
Abstract
Dementia is a common and devastating symptom of Parkinson's disease but the anatomical substrate remains unclear. Some evidence points towards hippocampal involvement but neuroimaging abnormalities have been reported throughout the brain and are largely inconsistent across studies. Here, we test whether these disparate neuroimaging findings for Parkinson's disease dementia localize to a common brain network. We used a literature search to identify studies reporting neuroimaging correlates of Parkinson's dementia (11 studies, 385 patients). We restricted our search to studies of brain atrophy and hypometabolism that compared Parkinson's patients with dementia to those without cognitive involvement. We used a standard coordinate-based activation likelihood estimation meta-analysis to assess for consistency in the neuroimaging findings. We then used a new approach, coordinate-based network mapping, to test whether neuroimaging findings localized to a common brain network. This approach uses resting-state functional connectivity from a large cohort of normative subjects (n = 1000) to identify the network of regions connected to a reported neuroimaging coordinate. Activation likelihood estimation meta-analysis failed to identify any brain regions consistently associated with Parkinson's dementia, showing major heterogeneity across studies. In contrast, coordinate-based network mapping found that these heterogeneous neuroimaging findings localized to a specific brain network centred on the hippocampus. Next, we tested whether this network showed symptom specificity and stage specificity by performing two further analyses. We tested symptom specificity by examining studies of Parkinson's hallucinations (9 studies, 402 patients) that are frequently co-morbid with Parkinson's dementia. We tested for stage specificity by using studies of mild cognitive impairment in Parkinson's disease (15 studies, 844 patients). Coordinate-based network mapping revealed that correlates of visual hallucinations fell within a network centred on bilateral lateral geniculate nucleus and correlates of mild cognitive impairment in Parkinson's disease fell within a network centred on posterior default mode network. In both cases, the identified networks were distinct from the hippocampal network of Parkinson's dementia. Our results link heterogeneous neuroimaging findings in Parkinson's dementia to a common network centred on the hippocampus. This finding was symptom and stage-specific, with implications for understanding Parkinson's dementia and heterogeneity of neuroimaging findings in general.
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Affiliation(s)
- Rimona S Weil
- Dementia Research Centre, UCL, London,Wellcome Centre for Human Neuroimaging, UCL, London,Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA,Correspondence to: Rimona S. Weil UCL Dementia Research Centre, 8-11 Queen Square, London WC1N 3BG UK E-mail:
| | - Joey K Hsu
- Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA
| | - Ryan R Darby
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Louis Soussand
- Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA
| | - Michael D Fox
- Berenson-Allen Center, Beth Israel Deaconess Medical Center, Harvard Medical Center, Boston, MA, USA,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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22
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Dauwan M, Hoff JI, Vriens EM, Hillebrand A, Stam CJ, Sommer IE. Aberrant resting-state oscillatory brain activity in Parkinson's disease patients with visual hallucinations: An MEG source-space study. Neuroimage Clin 2019; 22:101752. [PMID: 30897434 PMCID: PMC6425119 DOI: 10.1016/j.nicl.2019.101752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/18/2019] [Accepted: 03/09/2019] [Indexed: 12/31/2022]
Abstract
To gain insight into possible underlying mechanism(s) of visual hallucinations (VH) in Parkinson's disease (PD), we explored changes in local oscillatory activity in different frequency bands with source-space magnetoencephalography (MEG). Eyes-closed resting-state MEG recordings were obtained from 20 PD patients with hallucinations (Hall+) and 20 PD patients without hallucinations (Hall-), matched for age, gender and disease severity. The Hall+ group was subdivided into 10 patients with VH only (unimodal Hall+) and 10 patients with multimodal hallucinations (multimodal Hall+). Subsequently, neuronal activity at source-level was reconstructed using an atlas-based beamforming approach resulting in source-space time series for 78 cortical and 12 subcortical regions of interest in the automated anatomical labeling (AAL) atlas. Peak frequency (PF) and relative power in six frequency bands (delta, theta, alpha1, alpha2, beta and gamma) were compared between Hall+ and Hall-, unimodal Hall+ and Hall-, multimodal Hall+ and Hall-, and unimodal Hall+ and multimodal Hall+ patients. PF and relative power per frequency band did not differ between Hall+ and Hall-, and multimodal Hall+ and Hall- patients. Compared to the Hall- group, unimodal Hall+ patients showed significantly higher relative power in the theta band (p = 0.005), and significantly lower relative power in the beta (p = 0.029) and gamma (p = 0.007) band, and lower PF (p = 0.011). Compared to the unimodal Hall+, multimodal Hall+ showed significantly higher PF (p = 0.007). In conclusion, a subset of PD patients with only VH showed slowing of MEG-based resting-state brain activity with an increase in theta activity, and a concomitant decrease in beta and gamma activity, which could indicate central cholinergic dysfunction as underlying mechanism of VH in PD. This signature was absent in PD patients with multimodal hallucinations.
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Affiliation(s)
- M Dauwan
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Neuroimaging Center 3111, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands; Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Neuroscience Campus Amsterdam, Postbus 7057, 1007 MB Amsterdam, the Netherlands; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Postbus 85500, 3508 GA Utrecht, the Netherlands.
| | - J I Hoff
- Department of Neurology, St. Antonius Ziekenhuis, Nieuwegein, Utrecht, the Netherlands
| | - E M Vriens
- Department of Neurology, Diakonessenhuis Utrecht, the Netherlands
| | - A Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Neuroscience Campus Amsterdam, Postbus 7057, 1007 MB Amsterdam, the Netherlands
| | - C J Stam
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Neuroscience Campus Amsterdam, Postbus 7057, 1007 MB Amsterdam, the Netherlands
| | - I E Sommer
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Neuroimaging Center 3111, Antonius Deusinglaan 2, 9713 AW Groningen, the Netherlands; Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Norway
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Rollins CP, Garrison JR, Simons JS, Rowe JB, O'Callaghan C, Murray GK, Suckling J. Meta-analytic Evidence for the Plurality of Mechanisms in Transdiagnostic Structural MRI Studies of Hallucination Status. EClinicalMedicine 2019; 8:57-71. [PMID: 31193632 PMCID: PMC6537703 DOI: 10.1016/j.eclinm.2019.01.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/15/2019] [Accepted: 01/27/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Hallucinations are transmodal and transdiagnostic phenomena, occurring across sensory modalities and presenting in psychiatric, neurodegenerative, neurological, and non-clinical populations. Despite their cross-category occurrence, little empirical work has directly compared between-group neural correlates of hallucinations. METHODS We performed whole-brain voxelwise meta-analyses of hallucination status across diagnoses using anisotropic effect-size seed-based d mapping (AES-SDM), and conducted a comprehensive systematic review in PubMed and Web of Science until May 2018 on other structural correlates of hallucinations, including cortical thickness and gyrification. FINDINGS 3214 abstracts were identified. Patients with psychiatric disorders and hallucinations (eight studies) exhibited reduced gray matter (GM) in the left insula, right inferior frontal gyrus, left anterior cingulate/paracingulate gyrus, left middle temporal gyrus, and increased in the bilateral fusiform gyrus, while patients with neurodegenerative disorders with hallucinations (eight studies) showed GM decreases in the left lingual gyrus, right supramarginal gyrus/parietal operculum, left parahippocampal gyrus, left fusiform gyrus, right thalamus, and right lateral occipital gyrus. Group differences between psychiatric and neurodegenerative hallucination meta-analyses were formally confirmed using Monte Carlo randomizations to determine statistical significance, and a jackknife sensitivity analysis established the reproducibility of results across nearly all study combinations. For other structural measures (28 studies), the most consistent findings associated with hallucination status were reduced cortical thickness in temporal gyri in schizophrenia and altered hippocampal volume in Parkinson's disease and dementia. Additionally, increased severity of hallucinations in schizophrenia correlated with GM reductions within the left superior temporal gyrus, right middle temporal gyrus, bilateral supramarginal and angular gyri. INTERPRETATION Distinct patterns of neuroanatomical alteration characterize hallucination status in patients with psychiatric and neurodegenerative diseases, suggesting a plurality of anatomical signatures. This approach has implications for treatment, theoretical frameworks, and generates refutable predictions for hallucinations in other diseases and their occurrence within the general population. FUNDING None.
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Affiliation(s)
- Colleen P.E. Rollins
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Corresponding author at: Department of Psychiatry, University of Cambridge, Cambridge CB2 0SP, UK
| | - Jane R. Garrison
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology and Behavioural & Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Jon S. Simons
- Department of Psychology and Behavioural & Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - James B. Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Graham K. Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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24
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Yu K, Yu T, Qiao L, Liu C, Wang X, Zhou X, Ni D, Zhang G, Li Y. Electrical stimulation of the insulo-opercular region: visual phenomena and altered body-ownership symptoms. Epilepsy Res 2018; 148:96-106. [DOI: 10.1016/j.eplepsyres.2018.09.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/16/2018] [Accepted: 09/26/2018] [Indexed: 01/08/2023]
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25
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Dudley R, Aynsworth C, Cheetham R, McCarthy-Jones S, Collerton D. Prevalence and characteristics of multi-modal hallucinations in people with psychosis who experience visual hallucinations. Psychiatry Res 2018; 269:25-30. [PMID: 30145297 DOI: 10.1016/j.psychres.2018.08.032] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 06/25/2018] [Accepted: 08/12/2018] [Indexed: 12/12/2022]
Abstract
Hallucinations can occur in single or multiple sensory modalities. Historically, greater attention has been paid to single sensory modality experiences with a comparative neglect of hallucinations that occur across two or more sensory modalities (multi-modal hallucinations). With growing evidence suggesting that visual hallucinations may be experienced along with other hallucinations, this study aimed to explore multi-modal hallucinations in a sample of people with psychotic disorders who reported visual hallucinations (n = 22). No participants reported just visual hallucinations i.e. all reported related or unrelated auditory hallucinations. Twenty-one participants reported multi-modal hallucinations that were serial in nature, whereby they saw visual hallucinations and heard unrelated auditory hallucinations at other times. Nineteen people out of the twenty two also reported simultaneous multi-modal hallucinations, with the most common being an image that talked to and touched them. Multi-modal related and simultaneous hallucinations appeared to be associated with greater conviction that the experiences were real, and greater distress. Theoretical and clinical implications of multi-modal hallucinations are discussed.
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Affiliation(s)
- Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Gateshead, United Kingdom.
| | - Charlotte Aynsworth
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Gateshead, United Kingdom
| | - Rea Cheetham
- Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland, United Kingdom
| | | | - Daniel Collerton
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom; Older People's Psychology Service, Northumberland, Tyne and Wear NHS Foundation Trust, Bensham Hospital, Gateshead, United Kingdom
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26
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Creese B, Da Silva MV, Johar I, Ballard C. The modern role of antipsychotics for the treatment of agitation and psychosis in Alzheimer's disease. Expert Rev Neurother 2018; 18:461-467. [PMID: 29764230 DOI: 10.1080/14737175.2018.1476140] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Antipsychotics have long been the mainstay of treatment for agitation and psychosis in Alzheimer's disease. Despite their current use successive studies have shown that they only confer a modest benefit which must be balanced against their well-established serious side effects (extrapyramidal symptoms, stroke, accelerated cognitive decline and mortality). Areas covered: This review outlines the current guidance on antipsychotic usage and the evidence of their continued usage against a backdrop of emerging pharmacological treatments and an increasing emphasis on the importance of non-pharmacological interventions. Expert commentary: The current justification for antipsychotic use in the context of the changing landscape of prescribing and provide a view on the most promising alternative candidates to this class of drug are appraised.
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Affiliation(s)
- Byron Creese
- a University of Exeter Medical School , University of Exeter , UK
| | | | - Iskandar Johar
- b Department of Old Age Psychiatry , Institute of Psychiatry, Psychology and Neuroscience, King's College London , UK
| | - Clive Ballard
- a University of Exeter Medical School , University of Exeter , UK
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27
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El Haj M, Roche J, Jardri R, Kapogiannis D, Gallouj K, Antoine P. Clinical and neurocognitive aspects of hallucinations in Alzheimer's disease. Neurosci Biobehav Rev 2017; 83:713-720. [PMID: 28235545 PMCID: PMC5565710 DOI: 10.1016/j.neubiorev.2017.02.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/17/2017] [Accepted: 02/20/2017] [Indexed: 01/14/2023]
Abstract
Due to their prevalence, hallucinations are considered as one of the most frequent psychotic symptoms in Alzheimer's disease (AD). These psychotic manifestations reduce patients' well-being, increase the burden of caregivers, contribute to early institutionalization, and are related with the course of cognitive decline in AD. Considering their consequences, we provide a comprehensive account of the current state of knowledge about the prevalence and characteristics of hallucinations in AD. We propose a comprehensive and testable theoretical model about hallucinations in AD: the ALZHA (ALZheimer and HAllucinations) model. In this model, neurological, genetic, cognitive, affective, and iatrogenic factors associated with hallucinations in AD are highlighted. According to the ALZHA model, hallucinations in AD first involve trait markers (i.e., cognitive deficits, neurological deficits, genetic predisposition and/or sensory deficits) to which state markers that may trigger these experiences are added (e.g., psychological distress and/or iatrogenic factors). Finally, we provide recommendations for assessment and management of these psychotic manifestations in AD, with the aim to benefit patients, caregivers, and health professionals.
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Affiliation(s)
- Mohamad El Haj
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France.
| | - Jean Roche
- CHU de Lille, Unité de Psychogériatrie, Pôle de gérontologie, 59037 Lille, France
| | - Renaud Jardri
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | | | - Karim Gallouj
- Department of Geriatrics, Tourcoing Hospital, France
| | - Pascal Antoine
- Univ. Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
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28
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The role of the retina in visual hallucinations: A review of the literature and implications for psychosis. Neuropsychologia 2017; 99:128-138. [DOI: 10.1016/j.neuropsychologia.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/09/2017] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
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29
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Garofalo S, Justicia A, Arrondo G, Ermakova AO, Ramachandra P, Tudor-Sfetea C, Robbins TW, Barker RA, Fletcher PC, Murray GK. Cortical and Striatal Reward Processing in Parkinson's Disease Psychosis. Front Neurol 2017; 8:156. [PMID: 28484422 PMCID: PMC5402044 DOI: 10.3389/fneur.2017.00156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 04/03/2017] [Indexed: 01/29/2023] Open
Abstract
Psychotic symptoms frequently occur in Parkinson’s disease (PD), but their pathophysiology is poorly understood. According to the National Institute of Health RDoc programme, the pathophysiological basis of neuropsychiatric symptoms may be better understood in terms of dysfunction of underlying domains of neurocognition in a trans-diagnostic fashion. Abnormal cortico-striatal reward processing has been proposed as a key domain contributing to the pathogenesis of psychotic symptoms in schizophrenia. This theory has received empirical support in the study of schizophrenia spectrum disorders and preclinical models of psychosis, but has not been tested in the psychosis associated with PD. We, therefore, investigated brain responses associated with reward expectation and prediction error signaling during reinforcement learning in PD-associated psychosis. An instrumental learning task with monetary gains and losses was conducted during an fMRI study in PD patients with (n = 12), or without (n = 17), a history of psychotic symptoms, along with a sample of healthy controls (n = 24). We conducted region of interest analyses in the ventral striatum (VS), ventromedial prefrontal and posterior cingulate cortices, and whole-brain analyses. There was reduced activation in PD patients with a history of psychosis, compared to those without, in the posterior cingulate cortex and the VS during reward anticipation (p < 0.05 small volume corrected). The results suggest that cortical and striatal abnormalities in reward processing, a putative pathophysiological mechanism of psychosis in schizophrenia, may also contribute to the pathogenesis of psychotic symptoms in PD. The finding of posterior cingulate dysfunction is in keeping with prior results highlighting cortical dysfunction in the pathogenesis of PD psychosis.
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Affiliation(s)
- Sara Garofalo
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Azucena Justicia
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Gonzalo Arrondo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Anna O Ermakova
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | | | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Roger A Barker
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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30
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Ffytche DH, Pereira JB, Ballard C, Chaudhuri KR, Weintraub D, Aarsland D. Risk factors for early psychosis in PD: insights from the Parkinson's Progression Markers Initiative. J Neurol Neurosurg Psychiatry 2017; 88:325-331. [PMID: 28315846 PMCID: PMC5362125 DOI: 10.1136/jnnp-2016-314832] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) psychosis refers to the spectrum of illusions, formed hallucinations and delusions that occur in PD. Visual hallucinations and illusions are thought to be caused by specific cognitive and higher visual function deficits and patients who develop such symptoms early in the disease course have greater rates of cognitive decline and progression to dementia. To date, no studies have investigated whether such deficits are found prior to the onset of PD psychosis. METHOD Here we compare baseline cognitive, biomarker (structural imaging and cerebrospinal fluid) and other PD psychosis risk factor data in patients who go on to develop illusions or hallucinations within 3-4 years of follow-up in the Parkinson's Progression Markers Initiative cohort of newly diagnosed PD. RESULTS Of n=423 patients with PD, n=115 (27%) reported predominantly illusions with the median time of onset at 19.5 months follow-up. At study entry these patients had reduced CSF amyloid Aß1-42, lower olfaction scores, higher depression scores and increased REM sleep behaviour disorder symptoms compared to patients without early onset PD psychosis but no differences in cognitive, higher visual or structural imaging measures. A subset of patients with early onset formed hallucinations (n=21) had reduced higher visual function at baseline, cortical thinning in parietal, occipital and frontal cortex and reduced hippocampal volume. CONCLUSIONS The findings suggest early onset illusions and formed hallucinations are linked to amyloid pathology in PD and point to a difference in the underlying pathophysiological mechanism of illusions and formed hallucinations, with implications for their respective links to future cognitive decline.
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Affiliation(s)
- Dominic H Ffytche
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joana B Pereira
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Clive Ballard
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- University of Exeter Medical School, University of Exeter, Exeter, Devon, UK
| | - K Ray Chaudhuri
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Daniel Weintraub
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Parkinson's Disease and Mental Illness Research, Education and Clinical Centres (PADRECC and MIRECC), Philadelphia Veterans Affairs Medical Centre, Philadelphia, Pennsylvania, USA
| | - Dag Aarsland
- KCL-PARCOG Group, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre of Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
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31
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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: 205] [Impact Index Per Article: 29.3] [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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32
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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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Khundakar AA, Hanson PS, Erskine D, Lax NZ, Roscamp J, Karyka E, Tsefou E, Singh P, Cockell SJ, Gribben A, Ramsay L, Blain PG, Mosimann UP, Lett DJ, Elstner M, Turnbull DM, Xiang CC, Brownstein MJ, O'Brien JT, Taylor JP, Attems J, Thomas AJ, McKeith IG, Morris CM. Analysis of primary visual cortex in dementia with Lewy bodies indicates GABAergic involvement associated with recurrent complex visual hallucinations. Acta Neuropathol Commun 2016; 4:66. [PMID: 27357212 PMCID: PMC4928325 DOI: 10.1186/s40478-016-0334-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 01/12/2023] Open
Abstract
Dementia with Lewy bodies (DLB) patients frequently experience well formed recurrent complex visual hallucinations (RCVH). This is associated with reduced blood flow or hypometabolism on imaging of the primary visual cortex. To understand these associations in DLB we used pathological and biochemical analysis of the primary visual cortex to identify changes that could underpin RCVH. Alpha-synuclein or neurofibrillary tangle pathology in primary visual cortex was essentially absent. Neurone density or volume within the primary visual cortex in DLB was also unchanged using unbiased stereology. Microarray analysis, however, demonstrated changes in neuropeptide gene expression and other markers, indicating altered GABAergic neuronal function. Calcium binding protein and GAD65/67 immunohistochemistry showed preserved interneurone populations indicating possible interneurone dysfunction. This was demonstrated by loss of post synaptic GABA receptor markers including gephyrin, GABARAP, and Kif5A, indicating reduced GABAergic synaptic activity. Glutamatergic neuronal signalling was also altered with vesicular glutamate transporter protein and PSD-95 expression being reduced. Changes to the primary visual cortex in DLB indicate that reduced GABAergic transmission may contribute to RCVH in DLB and treatment using targeted GABAergic modulation or similar approaches using glutamatergic modification may be beneficial.
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Affiliation(s)
- Ahmad A Khundakar
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter S Hanson
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Daniel Erskine
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Nichola Z Lax
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Joseph Roscamp
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Evangelia Karyka
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Eliona Tsefou
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Preeti Singh
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Simon J Cockell
- Bioinformatics Support Unit, Newcastle University, Leech Building, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Andrew Gribben
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Lynne Ramsay
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Peter G Blain
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK
| | - Urs P Mosimann
- University Hospital of Old Age Psychiatry, University Bern, CH 3010, Bern, Switzerland
| | - Deborah J Lett
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Matthias Elstner
- Department of Neurology and Clinical Neurophysiology, Academic Hospital Bogenhausen, Technical University of Munich, Munich, Germany
| | - Douglass M Turnbull
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, The Medical School, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK
| | - Charles C Xiang
- Laboratory of Genetics at the National Institute of Mental Health/National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, MD20892, USA
| | - Michael J Brownstein
- Laboratory of Genetics at the National Institute of Mental Health/National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, MD20892, USA
| | - John T O'Brien
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Box 189, Level E4 Cambridge Biomedical Campus, Cambridge, CB2 0SP, UK
| | - John-Paul Taylor
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Johannes Attems
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Alan J Thomas
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Ian G McKeith
- Biomedical Research Building, Institute of Neuroscience, Newcastle University, Newcastle University, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK
| | - Christopher M Morris
- Edwardson Building, Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle upon Tyne, NE4 5PL, UK.
- Medical Toxicology Centre, Newcastle University, Wolfson Building, Claremont Place, Newcastle, NE2 4AA, UK.
- Laboratory of Genetics at the National Institute of Mental Health/National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, MD20892, USA.
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