1
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Devenyi RA, Hamedani AG. Visual dysfunction in dementia with Lewy bodies. Curr Neurol Neurosci Rep 2024; 24:273-284. [PMID: 38907811 PMCID: PMC11258179 DOI: 10.1007/s11910-024-01349-8] [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: 06/10/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE OF REVIEW To review the literature on visual dysfunction in dementia with Lewy bodies (DLB), including its mechanisms and clinical implications. RECENT FINDINGS Recent studies have explored novel aspects of visual dysfunction in DLB, including visual texture agnosia, mental rotation of 3-dimensional drawn objects, and reading fragmented letters. Recent studies have shown parietal and occipital hypoperfusion correlating with impaired visuoconstruction performance. While visual dysfunction in clinically manifest DLB is well recognized, recent work has focused on prodromal or mild cognitive impairment (MCI) due to Lewy body pathology with mixed results. Advances in retinal imaging have recently led to the identification of abnormalities such as parafoveal thinning in DLB. Patients with DLB experience impairment in color perception, form and object identification, space and motion perception, visuoconstruction tasks, and illusions in association with visual cortex and network dysfunction. These symptoms are associated with visual hallucinations, driving impairment, falls, and other negative outcomes.
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Affiliation(s)
- Ryan A Devenyi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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2
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Collerton D, Tsuda I, Nara S. Episodic Visual Hallucinations, Inference and Free Energy. ENTROPY (BASEL, SWITZERLAND) 2024; 26:557. [PMID: 39056919 PMCID: PMC11275595 DOI: 10.3390/e26070557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
Understandings of how visual hallucinations appear have been highly influenced by generative approaches, in particular Friston's Active Inference conceptualization. Their core proposition is that these phenomena occur when hallucinatory expectations outweigh actual sensory data. This imbalance occurs as the brain seeks to minimize informational free energy, a measure of the distance between predicted and actual sensory data in a stationary open system. We review this approach in the light of old and new information on the role of environmental factors in episodic hallucinations. In particular, we highlight the possible relationship of specific visual triggers to the onset and offset of some episodes. We use an analogy from phase transitions in physics to explore factors which might account for intermittent shifts between veridical and hallucinatory vision. In these triggered forms of hallucinations, we suggest that there is a transient disturbance in the normal one-to-one correspondence between a real object and the counterpart perception such that this correspondence becomes between the real object and a hallucination. Generative models propose that a lack of information transfer from the environment to the brain is one of the key features of hallucinations. In contrast, we submit that specific information transfer is required at onset and offset in these cases. We propose that this transient one-to-one correspondence between environment and hallucination is mediated more by aberrant discriminative than by generative inference. Discriminative inference can be conceptualized as a process for maximizing shared information between the environment and perception within a self-organizing nonstationary system. We suggest that generative inference plays the greater role in established hallucinations and in the persistence of individual hallucinatory episodes. We further explore whether thermodynamic free energy may be an additional factor in why hallucinations are temporary. Future empirical research could productively concentrate on three areas. Firstly, subjective perceptual changes and parallel variations in brain function during specific transitions between veridical and hallucinatory vision to inform models of how episodes occur. Secondly, systematic investigation of the links between environment and hallucination episodes to probe the role of information transfer in triggering transitions between veridical and hallucinatory vision. Finally, changes in hallucinatory episodes over time to elucidate the role of learning on phenomenology. These empirical data will allow the potential roles of different forms of inference in the stages of hallucinatory episodes to be elucidated.
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Affiliation(s)
- Daniel Collerton
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Ichiro Tsuda
- AIT Center, Sapporo City University, Sapporo 005-0864, Japan;
| | - Shigetoshi Nara
- Graduate School of Environmental, Life, Natural Science and Technology, Electrical and Electronic Engineering Department, Okayama University, Okayama 700-8530, Japan;
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3
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Camenzind M, Göbel N, Eberhard-Moscicka A, Knobel S, Hegi H, Single M, Kaufmann B, Schumacher R, Nyffeler T, Nef T, Müri R. The phenomenology of pareidolia in healthy subjects and patients with left- or right-hemispheric stroke. Heliyon 2024; 10:e27414. [PMID: 38468958 PMCID: PMC10926141 DOI: 10.1016/j.heliyon.2024.e27414] [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] [Received: 08/25/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
Pareidolia are perceptions of recognizable images or meaningful patterns where none exist. In recent years, this phenomenon has been increasingly studied in healthy subjects and patients with neurological or psychiatric diseases. The current study examined pareidolia production in a group of 53 stroke patients and 82 neurologically healthy controls who performed a natural images task. We found a significant reduction of absolute pareidolia production in left- and right-hemispheric stroke patients, with right-hemispheric patients producing overall fewest pareidolic output. Responses were categorized into 28 distinct categories, with 'Animal', 'Human', 'Face', and 'Body parts' being the most common, accounting for 72% of all pareidolia. Regarding the percentages of the different categories of pareidolia, we found a significant reduction for the percentage of "Body parts" pareidolia in the left-hemispheric patient group as compared to the control group, while the percentage of this pareidolia type was not significantly reduced in right-hemispheric patients compared to healthy controls. These results support the hypothesis that pareidolia production may be influenced by local-global visual processing with the left hemisphere being involved in local and detailed analytical visual processing to a greater extent. As such, a lesion to the right hemisphere, that is believed to be critical for global visual processing, might explain the overall fewest pareidolic output produced by the right-hemispheric patients.
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Affiliation(s)
- M. Camenzind
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
| | - N. Göbel
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Research and Analysis Services, University Hospital Basel and University of Basel, Basel, Switzerland
| | - A.K. Eberhard-Moscicka
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - S.E.J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - H. Hegi
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - M. Single
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - B.C. Kaufmann
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - R. Schumacher
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - T. Nyffeler
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - T. Nef
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - R.M. Müri
- Perception and Eye Movement Laboratory, Departments of Neurology and BioMedical Research, Inselspital, Bern University Hospital and University of Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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4
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Firbank MJ, Collerton D, Morgan KD, Schumacher J, Donaghy PC, O'Brien JT, Thomas A, Taylor J. Functional connectivity in Lewy body disease with visual hallucinations. Eur J Neurol 2024; 31:e16115. [PMID: 37909801 PMCID: PMC11235993 DOI: 10.1111/ene.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND AND PURPOSE Visual hallucinations are a common, potentially distressing experience of people with Lewy body disease (LBD). The underlying brain changes giving rise to visual hallucinations are not fully understood, although previous models have posited that alterations in the connectivity between brain regions involved in attention and visual processing are critical. METHODS Data from 41 people with LBD and visual hallucinations, 48 with LBD without visual hallucinations and 60 similarly aged healthy comparator participants were used. Connections were investigated between regions in the visual cortex and ventral attention, dorsal attention and default mode networks. RESULTS Participants with visual hallucinations had worse cognition and motor function than those without visual hallucinations. In those with visual hallucinations, reduced functional connectivity within the ventral attention network and from the visual to default mode network was found. Connectivity strength between the visual and default mode network correlated with the number of correct responses on a pareidolia task, and connectivity within the ventral attention network with visuospatial performance. CONCLUSIONS Our results add to evidence of dysfunctional connectivity in the visual and attentional networks in those with LBD and visual hallucinations.
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Affiliation(s)
- Michael J. Firbank
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Daniel Collerton
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | | | - Julia Schumacher
- Deutsches Zentrum für Neurodegenerative Erkrankungen Standort Rostock/GreifswaldRostockMecklenburg‐VorpommernGermany
- Department of NeurologyUniversity Medical Center RostockRostockGermany
| | - Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - John T. O'Brien
- Department of Psychiatry, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Alan Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - John‐Paul Taylor
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
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Bernardin F, Remy I, Giersch A, Schwan R, Schwitzer T, Laprevote V. Commentary: Visual Hallucinations in Psychosis: The Curious Absence of the Primary Visual Cortex. Schizophr Bull 2024; 50:1-4. [PMID: 37611909 PMCID: PMC10754165 DOI: 10.1093/schbul/sbad121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Florent Bernardin
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Irving Remy
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Anne Giersch
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Raymund Schwan
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- University of Lorraine, IADI, INSERM U1254, Nancy, France
| | - Thomas Schwitzer
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
- University of Lorraine, IADI, INSERM U1254, Nancy, France
| | - Vincent Laprevote
- Centre Psychothérapique de Nancy, Pôle Hospitalo-Universitaire de Psychiatrie d’Adultes du Grand Nancy, Laxou, France
- Institut National de la Santé et de la Recherche Médical, INSERM U1114, Pôle de Psychiatrie, Fédération de Médecine Translationnelle de Strasbourg, Centre Hospitalier Régional Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France
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6
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Hart de Ruyter FJ, Morrema THJ, den Haan J, Gase G, Twisk JWR, de Boer JF, Scheltens P, Bouwman FH, Verbraak FD, Rozemuller AJM, Hoozemans JJM. α-Synuclein pathology in post-mortem retina and optic nerve is specific for α-synucleinopathies. NPJ Parkinsons Dis 2023; 9:124. [PMID: 37640753 PMCID: PMC10462645 DOI: 10.1038/s41531-023-00570-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
There is increasing interest in studying retinal biomarkers for various neurodegenerative diseases. Specific protein aggregates associated with neurodegenerative diseases are present in the retina and could be visualised in a non-invasive way. This study aims to assess the specificity and sensitivity of retinal α-synuclein aggregates in neuropathologically characterised α-synucleinopathies, other neurodegenerative diseases and non-neurological controls. Post-mortem eyes (N = 99) were collected prospectively through the Netherlands Brain Bank from donors with Parkinson's disease (and dementia), dementia with Lewy bodies, multiple system atrophy, Alzheimer's disease, other neurodegenerative diseases and non-neurological controls. Multiple retinal and optic nerve cross-sections were immunostained with anti-α-synuclein antibodies (LB509, KM51, and anti-pSer129) and assessed for aggregates and inclusions. α-Synuclein was observed as Lewy neurites in the retina and oligodendroglial cytoplasmic inclusions in the optic nerve and was highly associated with Lewy body disease (P < 0.001) and multiple system atrophy (P = 0.001). In all multiple system atrophy cases, the optic nerve showed oligodendroglial cytoplasmic inclusions, while retinal Lewy neurites were absent, despite coincidental brain Lewy pathology. With high specificity (97%) and sensitivity (82%), retinal/optic nerve α-synuclein differentiates primary α-synucleinopathies from other cases and controls. α-Synuclein pathology occurs specifically in the retina and optic nerve of primary α-synucleinopathies as opposed to other neurodegenerative diseases-with and without α-synuclein co-pathology-and controls. The absence of retinal Lewy neurites in multiple system atrophy could contribute to the development of an in vivo retinal biomarker that discriminates between Lewy body disease and multiple system atrophy.
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Affiliation(s)
- Frederique J Hart de Ruyter
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Department of Neurology and Alzheimer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Tjado H J Morrema
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jurre den Haan
- Department of Neurology and Alzheimer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Gina Gase
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Johannes F de Boer
- Department of Physics and Astronomy and LaserLaB, Vrije Universiteit Amsterdam, De Boelelaan 1081, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology and Alzheimer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Department of Neurology and Alzheimer Center Amsterdam, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Frank D Verbraak
- Department of Ophthalmology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Annemieke J M Rozemuller
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Jeroen J M Hoozemans
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands.
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7
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Linszen MMJ, de Boer JN, Schutte MJL, Begemann MJH, de Vries J, Koops S, Blom RE, Bohlken MM, Heringa SM, Blom JD, Sommer IEC. Occurrence and phenomenology of hallucinations in the general population: A large online survey. SCHIZOPHRENIA 2022; 8:41. [PMID: 35853871 PMCID: PMC9261095 DOI: 10.1038/s41537-022-00229-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Although epidemiological studies report that hallucinations occur in 6–15% of the general population, little is known about their phenomenology. To overcome this paucity, this study investigates the phenomenological characteristics of hallucinations in the general population, by using a nationally promoted online survey to assess hallucination phenomenology in four sensory modalities, through a self-report version of the Questionnaire for Psychotic Experiences (QPE), in 10,448 participants (aged 14–88 years). The phenomenology of hallucinations was assessed if hallucinations reportedly occurred in the past month. In the past month, auditory hallucinations were reported most frequently (29.5%), followed by visual (21.5%), tactile (19.9%), and olfactory hallucinations (17.3%); hallucinations in two or more modalities were reported by 47.6%. Substantial numbers of participants rated their hallucinations as severe, due to negative content (16.0–31.6%), previous bothersome experiences (14.8–20.2%), ensuing distress (10.5–16.8%), and/or ensuing disfunctioning (12.7–17.3%). Decreased insight was found in 10.2–11.4%. Hypnagogia was reported by 9.0–10.6%, and bereavement hallucinations by 2.8%. Despite a low prevalence of delusions (7.0%), these phenomena were significantly associated with recent hallucinations, observed in up to 13.4% of the participants with hallucinations during the past week (p < 0.001). Our results indicate a wide variety of the phenomenology of hallucinations in the general population and support the existence of a phenomenological continuum.
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8
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Firbank MJ, daSilva Morgan K, Collerton D, Elder GJ, Parikh J, Olsen K, Schumacher J, Ffytche D, Taylor JP. Investigation of structural brain changes in Charles Bonnet Syndrome. Neuroimage Clin 2022; 35:103041. [PMID: 35576854 PMCID: PMC9118504 DOI: 10.1016/j.nicl.2022.103041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/14/2022]
Abstract
Reduced grey matter in the occipital cortex in eye disease groups. Widespread altered diffusivity in eye disease groups. No cortical or white matter changes associated with presence of visual hallucinations. Negative association between hippocampal volume and Hallucination severity.
Background and objectives In Charles Bonnet Syndrome (CBS), visual hallucinations (VH) are experienced by people with sight loss due to eye disease or lesional damage to early visual pathways. The aim of this cross-sectional study was to investigate structural brain changes using magnetic resonance imaging (MRI) in CBS. Methods Sixteen CBS patients, 17 with eye disease but no VH, and 19 normally sighted people took part. Participants were imaged on a 3T scanner, with 1 mm resolution T1 weighted structural imaging, and diffusion tensor imaging with 64 diffusion directions. Results The three groups were well matched for age, sex and cognitive scores (MMSE). The two eye disease groups were matched on visual acuity. Compared to the sighted controls, we found reduced grey matter in the occipital cortex in both eye disease groups. We also found reductions of fractional anisotropy and increased diffusivity in widespread areas, including occipital tracts, the corpus callosum, and the anterior thalamic radiation. We did not find any significant differences between the eye disease participants with VH versus without VH, but did observe a negative association between hippocampal volume and VH severity in the CBS group. Discussion Our findings suggest that although there are cortical and subcortical effects associated with sight loss, structural changes do not explain the occurrence of VHs. CBS may relate instead to connectivity or excitability changes in brain networks linked to vision.
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Affiliation(s)
- Michael J Firbank
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Katrina daSilva Morgan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Collerton
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Greg J Elder
- Northumbria Sleep Research, Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Jehill Parikh
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Olsen
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julia Schumacher
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, King's College London, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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9
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Montagnese M, Vignando M, Collerton D, Ffytche D, Mosimann UP, Taylor JP, daSilva Morgan K, Urwyler P. Cognition, hallucination severity and hallucination-specific insight in neurodegenerative disorders and eye disease. Cogn Neuropsychiatry 2022; 27:105-121. [PMID: 34338592 DOI: 10.1080/13546805.2021.1960812] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Hallucinations occur across neurodegenerative disorders, with increasing severity, poorer cognition and impaired hallucination-specific insight associated with worse outcomes and faster disease progression. It remains unclear how changes in cognition, temporal aspects of hallucinations, hallucination-specific insight and distress relate to each other.Methods: Extant samples of patients experiencing visual hallucinations were included in the analyses: Parkinson's Disease (n = 103), Parkinson's Disease Dementia (n = 41), Dementia with Lewy Bodies (n = 27) and Eye Disease (n = 113). We explored the relationship between factors of interest with Spearman's correlations and random-effect linear models.Results: Spearman's correlation analyses at the whole-group level showed that higher hallucination-specific insight was related to higher MMSE score (rs = 0.39, p < 0.001) and less severe hallucinations (rs = -0.28, p < .01). Linear mixed-models controlling for diagnostic group showed that insight was related to higher MMSE (p < .001), to hallucination severity (p = 0.003), and to VH duration (p = 0.04). Interestingly, insight was linked to the distress component but not the frequency component of severity. No significant relationship was found between MMSE and hallucination severity in these analyses.Conclusion: Our findings highlight the importance of hallucination-specific insight, distress and duration across groups. A better understanding of the role these factors play in VH may help with the development of future therapeutic interventions trans-diagnostically.
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Affiliation(s)
- Marcella Montagnese
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Miriam Vignando
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Daniel Collerton
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Urs Peter Mosimann
- Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Katrina daSilva Morgan
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland.,Department of Neurology, University Neurorehabilitation Unit, Inselspital, Bern, Switzerland
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10
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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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11
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Zorzi G, Thiebaut de Schotten M, Manara R, Bussè C, Corbetta M, Cagnin A. White matter abnormalities of right hemisphere attention networks contribute to visual hallucinations in dementia with Lewy bodies. Cortex 2021; 139:86-98. [PMID: 33848693 DOI: 10.1016/j.cortex.2021.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/16/2021] [Accepted: 03/04/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Functional alterations of the visual attention networks in a setting of impaired visual information processing have a role in the genesis of visual hallucinations (VH) in dementia with Lewy bodies (DLB). This multimodal MRI study aims at exploring structural and functional basis of VH. METHODS 23 DLB patients (10 with and 13 without VH) and 13 healthy controls were studied. They underwent MRI with T1-w sequences to measure cortical thickness, DTI for whole-brain and single tract microstructural properties and rs-fMRI of the default mode, dorsal and ventral attention, and visual networks. RESULTS In DLB with VH, whole-brain DTI revealed a lower fractional anisotropy and a greater mean diffusivity in the right frontal and temporo-parietal white matter tracts. Tracts dissection showed lower fractional anisotropy in the right inferior and superior (ventral part) longitudinal fasciculi (ILF and SLF) (p < .05, corrected), and greater mean diffusivity (p < .05). The extent of white matter microstructural alterations involving the right ILF and SLF correlated with the severity of VH (r = .55, p < .01; r = .42, p < .05, respectively), and with performance in the visual attention task (r = -.56 and r = -.61; p < .01, respectively). Cortical thickness in the projection areas of the right SLF was significantly reduced (p < .05). Patients with VH also showed an altered functional connectivity in the ventral attention network, connected by the ventral portion of the SLF (p < .05). CONCLUSIONS Our findings suggest that a combination of microstructural and functional alterations involving the attention networks in the right hemisphere may be important in the genesis of VH.
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Affiliation(s)
- Giovanni Zorzi
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
| | - Michel Thiebaut de Schotten
- Padova Neuroscience Center, University of Padova, Padova, Italy; Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France; Groupe d'Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Renzo Manara
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Cinzia Bussè
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Maurizio Corbetta
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy; Department of Neurology, Radiology, Neuroscience, Washington University School of Medicine, St.Louis, MO, USA
| | - Annachiara Cagnin
- Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy
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12
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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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13
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Teufel C, Fletcher PC. Forms of prediction in the nervous system. Nat Rev Neurosci 2020; 21:231-242. [DOI: 10.1038/s41583-020-0275-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2020] [Indexed: 12/18/2022]
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14
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Chin KS, Teodorczuk A, Watson R. Dementia with Lewy bodies: Challenges in the diagnosis and management. Aust N Z J Psychiatry 2019; 53:291-303. [PMID: 30848660 DOI: 10.1177/0004867419835029] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Dementia with Lewy bodies is the second most common form of neurodegenerative dementia in older age yet is often under-recognised and misdiagnosed. This review aims to provide an overview of the clinical features of dementia with Lewy bodies, discussing the frequent challenges clinicians experience in diagnosing dementia with Lewy bodies, and outlines a practical approach to the clinical management, particularly in the Australian setting. METHODS This paper is a narrative review and a semi-structured database (PubMed and MEDLINE) search strategy was implemented. Articles were screened and clinically relevant studies were selected for inclusion. RESULTS Dementia with Lewy bodies is clinically characterised by complex visual hallucinations, spontaneous motor parkinsonism, prominent cognitive fluctuations and rapid eye movement sleep behaviour disorder. Neuropsychiatric features and autonomic dysfunction are also common. The new diagnostic criteria and specific diagnostic biomarkers help to improve detection rates and diagnostic accuracy, as well as guide appropriate management. Clinical management of dementia with Lewy bodies is challenging and requires an individualised multidisciplinary approach with specialist input. CONCLUSION Dementia with Lewy bodies is a common form of dementia. It often presents as a diagnostic challenge to clinicians, particularly at early stages of disease, and in patients with mixed neuropathological changes, which occur in over 50% of people with dementia with Lewy bodies. Prompt diagnosis and comprehensive treatment strategies are important in improving patients' care.
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Affiliation(s)
- Kai Sin Chin
- 1 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Teodorczuk
- 3 School of Medicine, Griffith University, Gold Coast, QLD, Australia.,4 Metro North Mental Health, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Rosie Watson
- 1 The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia.,2 Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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15
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Firbank MJ, Parikh J, Murphy N, Killen A, Allan CL, Collerton D, Blamire AM, Taylor JP. Reduced occipital GABA in Parkinson disease with visual hallucinations. Neurology 2018; 91:e675-e685. [PMID: 30021920 PMCID: PMC6105043 DOI: 10.1212/wnl.0000000000006007] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/23/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To investigate the relationship between visual hallucinations in Parkinson disease (PD) and levels of γ-aminobutyric acid (GABA) in the primary visual cortex. Methods We utilized magnetic resonance spectroscopy to investigate occipital GABA levels in 36 participants with PD, 19 with and 17 without complex visual hallucinations, together with 20 healthy controls without hallucinations. In addition, we acquired T1-weighted MRI, whole-brain fMRI during a visual task, and diffusion tensor imaging. Results We found lower GABA+/creatine in PD with visual hallucinations (0.091 ± 0.010) vs those without (0.101 ± 0.010) and controls (0.099 ± 0.010) (F2,49 = 4.5; p = 0.016). Reduced gray matter in the hallucinations group was also observed in the anterior temporal lobe. Although there were widespread reductions in white matter integrity in the visual hallucinations group, this was no longer significant after controlling for cognitive function. Conclusions The data suggest that reduced levels of GABA are associated with visual hallucinations in PD and implicate changes to the ventral visual stream in the genesis of visual hallucinations. Modulation of visual cortical excitability through, for example, pharmacologic intervention, may be a promising treatment avenue to explore.
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Affiliation(s)
- Michael J Firbank
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX.
| | - Jehill Parikh
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
| | - Nicholas Murphy
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
| | - Alison Killen
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
| | - Charlotte L Allan
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
| | - Daniel Collerton
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
| | - Andrew M Blamire
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
| | - John-Paul Taylor
- From the Institute of Neuroscience (M.J.F., A.K., C.L.A., D.C., J.-P.T.), Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne; and Newcastle Magnetic Resonance Centre (J.P., A.M.B.), Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; and Baylor College of Medicine (N.M.), Houston, TX
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16
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Abstract
PURPOSE OF REVIEW This article discusses visual disorders in both Parkinson disease (PD) and other Parkinsonian disorders. It is organized largely by the anatomical site of pathology and emphasizes practical treatments. Targeted treatment options include medications, surgery, occupational, and physical therapies as well as optical aids. RECENT FINDINGS The causes of visual complaints in Parkinson disease and other similar disorders are being more clearly identified. A new medication approved specifically to treat hallucinations in PD now is available. There is increased understanding of the important role that an ophthalmologist can play in the care of these patients. Finally, research and therapeutic development are unmet needs in accessing and treating visual complaints in PD and Parkinsonian disorders. A better understanding of Parkinson-related visual complaints and of available treatment options is important to optimize patient safety and quality of life. Vision impairment leads to difficulties in many common activities including reading, ambulating, and driving. Falls and injuries, made more likely because of impaired vision, result in an early loss of independence. Awareness of the problem, patient education, ophthalmologic care, selected therapeutics, physical therapy, and occupational therapy are crucial to maximizing quality of life in these patients.
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Affiliation(s)
- Joseph Savitt
- Department of Neurology, University of Maryland School of Medicine, 110 South Paca Street 3rd Floor, Baltimore, MD, 21201, USA.
| | - Michaela Mathews
- Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, MD, USA
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17
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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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18
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Yaffe K. Moving Beyond Dualism to Advance Geriatric Neuropsychiatry. Am J Geriatr Psychiatry 2016; 24:339-41. [PMID: 27066734 DOI: 10.1016/j.jagp.2016.01.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Kristine Yaffe
- From the Departments of Psychiatry, Neurology, Epidemiology and Biostatistics, University of California, San Francisco, CA; San Francisco VA Medical Center, San Francisco, CA.
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