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El Haj M, Larøi F, Chapelet G. Limited awareness of hallucinations in patients with Alzheimer's disease. Cogn Neuropsychiatry 2024; 29:173-185. [PMID: 38787633 DOI: 10.1080/13546805.2024.2357065] [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: 12/19/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION We investigated the degree of cognitive insight in patients with Alzheimer's Disease (AD) regarding their hallucinations, aiming to elucidate the subjective experiences and perceptions associated with this phenomenon. METHODS Using a cross-sectional design, we invited both AD patients (n = 31) and their informants to evaluate the occurrence of hallucinations. Degree of cognitive insight was based upon the discrepancy between the patients' and informants' evaluations. RESULTS Analysis demonstrated that AD patients rated the occurrence of hallucinations lower than their informants, indicating that patients tended to underestimate the frequency of their hallucinations. The discrepancy between the ratings of patients and informants was negatively correlated with cognitive functioning, suggesting that a greater discrepancy (indicating poorer insight) was associated with lower cognitive functioning in patients. DISCUSSION Our findings highlight the deficits in insight into hallucinations among AD patients, specifically indicating that AD patients have limited awareness of their own hallucinations. Furthermore, our findings support the idea that deficits in insight into hallucinations are associated with the progression of AD.
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Affiliation(s)
- Mohamad El Haj
- Institut Universitaire de France, Paris, France
- Clinical Gerontology Department, CHU Nantes, Nantes, France
- Faculté de Psychologie, LPPL - Laboratoire de Psychologie des Pays de la Loire, Université de Nantes, Nantes, France
| | - Frank Larøi
- Department of Psychology, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Guillaume Chapelet
- Clinical Gerontology Department, CHU Nantes, Nantes, France
- Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France
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Ronat L, Hanganu A. Neuropsychiatric and cognitive features of major depressive disorder in aging, based on the data from the US National Alzheimer's Coordinating Center (NACC). L'ENCEPHALE 2024; 50:130-136. [PMID: 37088582 DOI: 10.1016/j.encep.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 01/03/2023] [Accepted: 01/12/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE The diagnosis of Major Depressive Disorder (MDD) is based on the DSM-V criteria and is established by a clinician. This allows quantifying depression based on clinical criteria. As such, MDD differs from other types of depressions that are measured by subjective scales. Here, we evaluated the MDD risk factor on other neuropsychiatric symptoms (NPS) as well as MDD association with cognitive performance in Alzheimer's disease (AD), Mild Cognitive Impairment (MCI) and Healthy Controls (HC). METHODS Data of 208 patients with AD, 291 patients with MCI and 647 HC were extracted from the National Alzheimer's Coordinating Center database. All participants included in this study were assessed by a physician for the MDD criteria, underwent an NPS evaluation using the NeuroPsychiatric Inventory, and a comprehensive cognitive assessment. Participants were classified as being with and without MDD. We performed logistic regression and MANCOVA models respectively with NPS and cognitive performance as variables of interest and MDD as fixed factors within each group. The MANCOVA was controlled for the effects of age, sex, and education. RESULTS MDD increased the risk for psychotic, affective and behavioral NPS in MCI, as well as affective and behavioral NPS in HC and AD. Also, MCI with MDD had lower performance on selective attention and mental flexibility. CONCLUSIONS MDD seems to increase the probability of a prevalence of NPS in all groups (HC, MCI and AD). Longitudinal data processing would help to understand the neuropsychiatric evolution of elderly subjects with MDD.
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Affiliation(s)
- L Ronat
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, M7819, 4545 ch. Queen-Mary, H3W 1W6, Montréal, QC, Canada; Faculté de médecine, département de médecine, université de Montréal, Québec, Canada
| | - A Hanganu
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, M7819, 4545 ch. Queen-Mary, H3W 1W6, Montréal, QC, Canada; Faculté des arts et des sciences, département de psychologie, université de Montréal, Québec, Canada.
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Ercoli T, Bagella CF, Frau C, Ruiu E, Othmani S, Gusinu G, Masala C, Sechi LA, Solla P, Defazio G. Phantosmia in Parkinson's Disease: A Systematic Review of the Phenomenology of Olfactory Hallucinations. Neurol Int 2023; 16:20-32. [PMID: 38251050 PMCID: PMC10801480 DOI: 10.3390/neurolint16010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Olfactory dysfunction is a prevalent non-motor symptom in Parkinson's disease (PD), affecting approximately 65-90% of subjects. PD patients may also report odor perception in the absence of any external source, often referred to as olfactory hallucinations (OHs) or phantosmia. This study aims to explore the current understanding of OHs in PD and offer a comprehensive overview of their prevalence and characteristics. We conducted a systematic search of the literature published on PubMed from inception to July 2023 regarding OHs in PD, following PRISMA guidelines. From the 2875 studies identified through database searching, 29 studies fulfilled the necessary criteria and underwent data extraction. The frequency of OHs in PD patients varies widely, ranging from 0.5% to 18.2%, with female prevalence ranging from 36% to 75% of the patients. Olfactory experiences may vary widely, ranging from pleasant scents to unpleasant odors. Several studies have indicated the concurrent presence of other types of hallucinations alongside phantosmia, especially visual and auditory hallucinations. OHs in PD are a type of hallucination that has been largely overlooked. To gain a deeper understanding of OHs in PD patients, the next crucial step should involve the development and validation of a dedicated questionnaire.
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Affiliation(s)
- Tommaso Ercoli
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Caterina Francesca Bagella
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Claudia Frau
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Elisa Ruiu
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Sabrine Othmani
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Giansalvo Gusinu
- Department of Biomedical Sciences, Sassari University, 07100 Sassari, Italy; (G.G.); (L.A.S.)
| | - Carla Masala
- Department of Biomedical Sciences, University of Cagliari, SP 8 Cittadella Universitaria, 09042 Monserrato, Italy
| | - Leonardo Antonio Sechi
- Department of Biomedical Sciences, Sassari University, 07100 Sassari, Italy; (G.G.); (L.A.S.)
| | - Paolo Solla
- Department of Neurology, University of Sassari, Viale S. Pietro 10, 07100 Sassari, Italy; (T.E.); (C.F.B.); (C.F.); (E.R.); (S.O.)
| | - Giovanni Defazio
- Department of Translational Biomedicine and Neuroscience, University of Bari, 70121 Bari, Italy;
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Jiang X, Yuan Y, Li Z, Ou Y, Li Z. First-episode olfactory hallucination in a patient with anxiety disorder: A case report. Front Psychiatry 2022; 13:990341. [PMID: 36203838 PMCID: PMC9530368 DOI: 10.3389/fpsyt.2022.990341] [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] [Received: 07/09/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Olfactory hallucination refers to olfactory perception in the absence of chemical stimuli. Although it has been associated with many neurological and psychotic disorders, it has rarely been reported as the first and only symptom in patients with anxiety disorder, and its treatment remains inadequate. CASE SUMMARY A 66-year-old woman who had been experiencing gradually worsening olfactory hallucinations for almost 4 years was diagnosed with generalized anxiety disorder. Olfactory hallucination disappeared after treatment with anti-anxiety drugs. CONCLUSION Olfactory hallucination can be the first and only symptom in patients with anxiety disorder and may be effectively treated with anti-anxiety medication. In fact, it can precede the diagnosis of anxiety disorder by several years.
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Affiliation(s)
- Xingmei Jiang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yiwen Yuan
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Zhixiong Li
- The Third Department of Clinical Psychology, Karamay Municipal People's Hospital, Karamay, China
| | - Ying Ou
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Zhe Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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Parker JK, Kelly CE, Smith BC, Kirkwood AF, Hopkins C, Gane S. Patients' Perspectives on Qualitative Olfactory Dysfunction: Thematic Analysis of Social Media Posts. JMIR Form Res 2021; 5:e29086. [PMID: 34904953 PMCID: PMC8673716 DOI: 10.2196/29086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/26/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background The impact of qualitative olfactory disorders is underestimated. Parosmia, the distorted perception of familiar odors, and phantosmia, the experience of odors in the absence of a stimulus, can arise following postinfectious anosmia, and the incidences of both have increased substantially since the outbreak of COVID-19. Objective The aims of this study are to explore the symptoms and sequalae of postinfectious olfactory dysfunction syndrome using unstructured and unsolicited threads from social media, and to articulate the perspectives and concerns of patients affected by these debilitating olfactory disorders. Methods A thematic analysis and content analysis of posts in the AbScent Parosmia and Phantosmia Support group on Facebook was conducted between June and December 2020. Results In this paper, we identify a novel symptom, olfactory perseveration, which is a triggered, identifiable, and usually unpleasant olfactory percept that persists in the absence of an ongoing stimulus. We also observe fluctuations in the intensity and duration of symptoms of parosmia, phantosmia, and olfactory perseveration. In addition, we identify a group of the most common items (coffee, meat, onion, and toothpaste) that trigger distortions; however, people have difficulty describing these distortions, using words associated with disgust and revulsion. The emotional aspect of living with qualitative olfactory dysfunction was evident and highlighted the detrimental impact on mental health. Conclusions Qualitative and unsolicited data acquired from social media has provided useful insights into the patient experience of parosmia and phantosmia, which can inform rehabilitation strategies and ongoing research into understanding the molecular triggers associated with parosmic distortions and research into patient benefit.
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Affiliation(s)
- Jane K Parker
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, United Kingdom
| | - Christine E Kelly
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, United Kingdom.,AbScent, Andover, United Kingdom
| | - Barry C Smith
- Centre for the Study of the Senses, Institute of Philosophy, School of Advanced Study, University of London, London, United Kingdom
| | - Aidan F Kirkwood
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, United Kingdom
| | - Claire Hopkins
- Ear, Nose and Throat Department, Guy's and St Thomas' Hospitals, London, United Kingdom
| | - Simon Gane
- Royal National Ear, Nose and Throat and Eastman Dental Hospitals, London, United Kingdom
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El Haj M, Larøi F, Gallouj K. Hallucinations and Covid-19: Increased Occurrence of Hallucinations in Patients with Alzheimer's Disease During Lockdown. Psychiatr Q 2021; 92:1531-1539. [PMID: 34089149 PMCID: PMC8178053 DOI: 10.1007/s11126-021-09927-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 01/21/2023]
Abstract
We investigated the effects of lockdown, as implemented by retirement homes to cope with the spread of Covid-19, on hallucinatory experiences in patients with Alzheimer's disease (AD). The study included 47 patients with AD living in retirement homes and who were already experiencing hallucinations prior to the lockdown. We invited caregivers to rate hallucinatory experiences in these patients during the lockdown, and compared this rating with that provided by the same caregivers prior to the lockdown. Results demonstrated increased hallucinatory experiences in patients with AD during the lockdown, compared with before the lockdown. The decrease in social and physical activities during the lockdown, and especially, the physical separation of residents from family members, might have led to decreased sensory stimulation and increased loneliness, and consequently, to the hallucinatory experiences in patients with AD living in retirement homes during the lockdown. While the restrictive measures were necessary to cope with the spread of Covid-19, these measures have increased hallucinations in patients with AD living in retirement homes, at least in those who were already experiencing hallucinations prior to the lockdown.
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Affiliation(s)
- Mohamad El Haj
- Nantes Université, Univ Angers, Laboratoire de Psychologie Des Pays de La Loire (LPPL - EA 4638), 44000, Nantes, France. .,Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France. .,Institut Universitaire de France, Paris, France.
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Karim Gallouj
- Unité de Gériatrie, Centre Hospitalier de Tourcoing, Tourcoing, France
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Morosanu CO, Clamp PJ, Teo MK. Phantosmia as the first presentation of a cavernous sinus - clinoidal meningioma. Br J Neurosurg 2020; 37:1-7. [PMID: 33050720 DOI: 10.1080/02688697.2020.1834510] [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: 06/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
Cavernous sinus meningiomas (CSM) are complex skull base lesions that, due to their particular anatomical location, render surgical management difficult. Their symptomatology is versatile, and the clinical outcome is difficult to predict. We present the case of a 57-year old female patient who experienced phantosmia - an abnormal, persistent, olfactory sensation of cigarette smell for 18 months. MRI was performed and revealed a left cavernous sinus meningioma, extending into the left temporal fossa, with olfactory and optic nerve distortion. To our knowledge, this is the first reported case of phantosmia as the initial presentation of a lesion in the cavernous sinus.
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Affiliation(s)
| | - Philip J Clamp
- Department of Otolaryngology and Head & Neck Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Mario K Teo
- Department of Neurosurgery, Southmead Hospital, Bristol, UK
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