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Watanabe H, Uchiyama M, Yokoi K, Mamiya Y, Narita W, Iizuka O, Baba T, Suzuki K, Mori E, Nishio Y. Behavioral and neural correlates of pareidolic illusions in dementia with Lewy bodies. Parkinsonism Relat Disord 2023; 113:105513. [PMID: 37441885 DOI: 10.1016/j.parkreldis.2023.105513] [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] [Received: 02/19/2023] [Revised: 05/25/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION Pareidolia, a form of visual illusions phenomenologically similar to complex visual hallucinations, is a phenomenon that is associated with visual hallucinations in dementia with Lewy bodies (DLB). This study aimed to identify commonalities and differences in behavioral and neural correlates between pareidolic illusions and visual hallucinations in DLB. METHODS Forty-three patients with DLB underwent the scene pareidolia test, which evokes and measures pareidolic illusions, and standardized neuropsychological and behavioral assessments. Regional cerebral blood flow (rCBF) was measured by single-photon emission computed tomography. Factor analysis was performed to assess the relationships among pareidolic illusions, cognitive functions, and behavioral symptoms. Partial least squares correlation analysis was used to investigate the relationship between these symptoms and rCBF. RESULTS Factor analysis yielded three behavior factors: the first factor (hallucinations/fluctuations) consisted of pareidolic illusions, visual hallucinations, and fluctuating cognition; the second factor (general cognitive function) consisted of general cognitive function and working memory; and the third factor (visual processing) consisted of visual processing and pareidolic illusions. Partial least squares correlation analysis identified two brain-behavior correlation patterns: (1) rCBF reduction in the frontal and perisylvian/periventricular regions was associated with lower general cognitive function and lower visual processing; and (2) rCBF reduction in the bilateral occipitotemporal cortex was associated with more severe hallucinations/fluctuations and lower visual processing. CONCLUSIONS At the behavioral level, pareidolic illusions are associated with visual hallucinations, fluctuating cognition, and visual processing in DLB. At the neural level, pareidolic illusions may arise from the synergistic effects of global neuropathological changes and occipitotemporal cortical dysfunctions.
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Affiliation(s)
- Hiroyuki Watanabe
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Uchiyama
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Speech, Language and Hearing Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Kayoko Yokoi
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuyuki Mamiya
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Wataru Narita
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Osamu Iizuka
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Baba
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Sendai-Nishitaga Hospital, Sendai, Japan
| | - Kyoko Suzuki
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Yoshiyuki Nishio
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan; Department of Psychiatry and Neurology, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
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Matar E, Brooks D, Lewis SJ, Halliday GM. Limbic thalamus atrophy is associated with visual hallucinations in Lewy body disorders. Neurobiol Aging 2022; 112:122-128. [DOI: 10.1016/j.neurobiolaging.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/04/2021] [Accepted: 01/03/2022] [Indexed: 01/22/2023]
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Murphy N, Killen A, Gupta RK, Graziadio S, Rochester L, Firbank M, Baker MR, Allan C, Collerton D, Taylor JP, Urwyler P. Exploring Bottom-Up Visual Processing and Visual Hallucinations in Parkinson's Disease With Dementia. Front Neurol 2021; 11:579113. [PMID: 33584490 PMCID: PMC7876258 DOI: 10.3389/fneur.2020.579113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/31/2020] [Indexed: 01/28/2023] Open
Abstract
Visual hallucinations (VH) are a common symptom of Parkinson's disease with dementia (PDD), affecting up to 65% of cases. Integrative models of their etiology posit that a decline in executive control of the visuo-perceptual system is a primary mechanism of VH generation. The role of bottom-up processing in the manifestation of VH in this condition is still not clear although visual evoked potential (VEP) differences have been associated with VH at an earlier stage of PD. Here we compared the amplitude and latency pattern reversal VEPs in healthy controls (n = 21) and PDD patients (n = 34) with a range of VH severities. PDD patients showed increased N2 latency relative to controls, but no significant differences in VEP measures were found for patients reporting complex VH (CVH) (n = 17) compared to those without VH. Our VEP findings support previous reports of declining visual system physiology in PDD and some evidence of visual system differences between patients with and without VH. However, we did not replicate previous findings of a major relationship s between the integrity of the visual pathway and VH.
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Affiliation(s)
- Nicholas Murphy
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Alison Killen
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rajnish Kumar Gupta
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Sara Graziadio
- National Institute for Health Research Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Firbank
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R. Baker
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Charlotte Allan
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Daniel Collerton
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John-Paul Taylor
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Prabitha Urwyler
- Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
- University Neurorehabilitation Unit, Department of Neurology, Inselspital, Bern University Hospital, Bern, Switzerland
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Renouf S, Ffytche D, Pinto R, Murray J, Lawrence V. Visual hallucinations in dementia and Parkinson's disease: A qualitative exploration of patient and caregiver experiences. Int J Geriatr Psychiatry 2018; 33:1327-1334. [PMID: 29953689 DOI: 10.1002/gps.4929] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 04/13/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Visual hallucinations (VHs) can occur in several clinical conditions, of which the dementias, broadly defined, and Parkinson's disease rank among the most common. There is limited research on the lived experience of hallucinations among affected individuals and therefore a lack of evidence-based management strategies. This study used qualitative methods to explore the VH experience of individuals with dementia or Parkinson's disease and their informal caregivers. METHODS In-depth interviews were conducted with 10 individuals with VHs and dementia and 11 informal caregivers, and 11 individuals with VHs and Parkinson's disease and 9 informal caregivers. Interviews were analysed using an inductive thematic approach. RESULTS Three themes emerged from the data: "Insight and distress," "Caregiver approach: challenging v reassurance," and "Normality and stigma." Insight appeared to affect whether hallucinations were perceived as threatening and whether acceptance occurred over time. Emotional reactions and management strategies varied as insight changed with disease progression. Concerns around stigmatisation negatively influenced help-seeking and acceptance of the hallucinations. CONCLUSIONS Degree of insight and cognitive ability appear fundamental to the lived experience of hallucinations. Irrespective of the clinical context, support in early stages should focus on raising awareness of VH, symptom disclosure, stigma reduction, and contact with others affected. In later stages, the focus shifts to informal caregiver needs and a flexible approach to reassuring those affected.
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Affiliation(s)
- Sarah Renouf
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rebecca Pinto
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joanna Murray
- Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Health Services and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Holiday KA, Pirogovsky‐Turk E, Malcarne VL, Filoteo JV, Litvan I, Lessig SL, Song D, Schiehser DM. Psychometric Properties and Characteristics of the North-East Visual Hallucinations Interview in Parkinson's Disease. Mov Disord Clin Pract 2017; 4:717-723. [PMID: 28435846 PMCID: PMC5396180 DOI: 10.1002/mdc3.12479] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/31/2016] [Accepted: 01/29/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Visual Hallucinations (VH) are a common symptom experienced by individuals with Parkinson's disease (PD); however, a validated measure of VH has yet to be established for this population. The North-East Visual Hallucinations Interview (NEVHI), a promising VH measure, has not been well validated in PD. The aim of this study was to evaluate the convergent and discriminant validity of the NEVHI as well as the proportional identification and characteristics of VH in PD. METHODS One hundred seventeen individuals with PD completed the NEVHI as well as evaluations of psychological, cognitive, motor, and visual functioning as measures of convergent and divergent validity. The hallucination items from the Neuropsychiatric Inventory (NPI) and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Scale (MDS-UPDRS) were used to assess convergent validity. RESULTS The NEVHI identified 20.5% of PD patients with VH, which consisted of all individuals detected by the MDS-UPDRS and NPI and nine additional individuals not detected by the other measures. The NEVHI was strongly correlated with the MDS-UPDRS hallucinations item, and weakly correlated with the NPI VH item. Weak to non-significant correlations were found between the NEVHI and measures of psychological, cognitive, motor, visual, and demographic characteristics. DISCUSSION The NEVHI identified a greater number of individuals with VH than either the MDS-UPDRS or NPI. Results demonstrated good convergent validity between the NEVHI and a clinician-administered-to-patient-report measure of VH and excellent divergent validity, supporting the NEVHI as a valid and preferable measure for assessing the presence of VH in PD.
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Affiliation(s)
- Kelsey A. Holiday
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Eva Pirogovsky‐Turk
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Vanessa L. Malcarne
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical PsychologySan DiegoCalifornia
- Universisty of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - J. Vincent Filoteo
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
| | - Irene Litvan
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCalifornia
| | - Stephanie L. Lessig
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCalifornia
- Neurology ServiceVA San Diego Healthcare SystemSan DiegoCalifornia
| | - David Song
- Department of NeuroscienceUniversity of CaliforniaRiversideCalifornia
| | - Dawn M. Schiehser
- Research ServiceVeterans Affairs (VA) San Diego Healthcare SystemSan DiegoCalifornia
- Department of PsychiatryUniversity of California San DiegoSan DiegoCalifornia
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Urwyler P, Nef T, Müri R, Archibald N, Makin SM, Collerton D, Taylor JP, Burn D, McKeith I, Mosimann UP. Visual Hallucinations in Eye Disease and Lewy Body Disease. Am J Geriatr Psychiatry 2016; 24:350-8. [PMID: 26796926 DOI: 10.1016/j.jagp.2015.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Visual hallucinations (VH) most commonly occur in eye disease (ED), Parkinson disease (PD), and Lewy body dementia (LBD). The phenomenology of VH is likely to carry important information about the brain areas within the visual system generating them. METHODS Data from five controlled cross-sectional VH studies (164 controls, 135 ED, 156 PD, 79 [PDD 48 + DLB 31] LBD) were combined and analyzed. The prevalence, phenomenology, frequency, duration, and contents of VH were compared across diseases and sex. RESULTS Simple VH were most common in ED patients (ED 65% versus LBD 22% versus PD 9%, χ(2) = 31.43, df = 2, p < 0.001), whereas complex VH were more common in LBD (LBD 76% versus ED 38%, versus PD 28%, χ(2) = 96.80, df = 2, p < 0.001). The phenomenology of complex VH was different across diseases and sex. ED patients reported more "flowers" (ED 21% versus LBD 6% versus PD 0%, χ(2) = 10.04, df = 2, p = 0.005) and "body parts" (ED 40% versus LBD 17% versus PD 13%, χ(2) = 11.14, df = 2, p = 0.004); in contrast, LBD patients reported "people" (LBD 85% versus ED 67% versus PD 63%, χ(2) = 6.20, df = 2, p = 0.045) and "animals/insects" (LBD 50% versus PD 42% versus ED 21%, χ(2) = 9.76, df = 2, p = 0.008). Men reported more "machines" (13% versus 2%, χ(2) = 6.94, df = 1, p = 0.008), whereas women reported more "family members/children" (48% versus 29%, χ(2) = 5.10, df = 1, p = 0.024). CONCLUSIONS The phenomenology of VH is likely related to disease-specific dysfunctions within the visual system and to past, personal experiences.
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Affiliation(s)
- Prabitha Urwyler
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René Müri
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; Perception and Eye Movement Laboratory, Departments of Neurology and Clinical Research, University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Neil Archibald
- James Cook University Hospital, Middlesbrough, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Selina Margaret Makin
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel Collerton
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumberland, Tyne & Wear NHS Foundation Trust, Bensham Hospital, Gateshead, UK
| | - John-Paul Taylor
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - David Burn
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Ian McKeith
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Urs Peter Mosimann
- Gerontechnology & Rehabilitation Group, University of Bern, Bern, Switzerland; University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
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