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Frontal and subcortical contribution to visual hallucinations in dementia with Lewy bodies and Parkinson's disease.
Postgrad Med 2019; 131(7):509-522PM

Abstract

Objectives:

Visual hallucinations (VH) are common in Lewy body disease (LBD), and have been associated with cognitive and structural brain alterations. Evidence so far concerns mainly Parkinson's disease (PD), but little is known about symptom-specific pathophysiological mechanisms across the LBD spectrum, especially related to the presence of dementia. The aim of the present pilot study was to investigate the neuroanatomical, and neuropsychological characteristics related to VH in two forms of LBD, namely dementia with Lewy bodies (DLB) and PD without dementia.

Methods:

Whole brain voxel-based morphometry (VBM) analyses on 3D MRI acquired structural brain scans, and neuropsychological testing were performed on 28 clinically diagnosed DLB (11 with VH, 17 NVH), and 24 PD (9 with VH, and 15 NVH) patients. In order to assess differences in gray matter (GM) regional volumes, and cognitive performance, hallucinating patients for each group were compared with corresponding non-hallucinating ones.

Results:

DLB patients with VH presented significantly worse visual attention deficits compared to those without, which persisted even when controlling for visual perception. Whole brain VBM analysis revealed decreased GM volume in DLB with VH in the right superior and medial frontal gyri, putamen, caudate nucleus and insula. Subcortical regional volumes were also significantly associated with visual attention performance. Hallucinating PD patients, instead, presented more severe executive dysfunction, but VBM showed no volumetric differences between the two PD subgroups. Post hoc region of interest analyses revealed striatal GM loss in PD with VH.

Conclusion:

Frontal and striatal GM atrophy may contribute to the emergence of VH in DLB, which may be fostered by the more severe attention deficits. Striatal GM loss and executive dysfunction, instead, appeared to underlie VH in PD without dementia.

Authors+Show Affiliations

Department of Neuroscience, Medical School, University of Sheffield , Sheffield , UK.Department of Neurosciences, University of Padua , Padua , Italy.Department of Neurosciences, University of Padua , Padua , Italy.Department of Neuroscience, Medical School, University of Sheffield , Sheffield , UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31422718

Citation

Pezzoli, Stefania, et al. "Frontal and Subcortical Contribution to Visual Hallucinations in Dementia With Lewy Bodies and Parkinson's Disease." Postgraduate Medicine, vol. 131, no. 7, 2019, pp. 509-522.
Pezzoli S, Cagnin A, Antonini A, et al. Frontal and subcortical contribution to visual hallucinations in dementia with Lewy bodies and Parkinson's disease. Postgrad Med. 2019;131(7):509-522.
Pezzoli, S., Cagnin, A., Antonini, A., & Venneri, A. (2019). Frontal and subcortical contribution to visual hallucinations in dementia with Lewy bodies and Parkinson's disease. Postgraduate Medicine, 131(7), pp. 509-522. doi:10.1080/00325481.2019.1656515.
Pezzoli S, et al. Frontal and Subcortical Contribution to Visual Hallucinations in Dementia With Lewy Bodies and Parkinson's Disease. Postgrad Med. 2019;131(7):509-522. PubMed PMID: 31422718.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Frontal and subcortical contribution to visual hallucinations in dementia with Lewy bodies and Parkinson's disease. AU - Pezzoli,Stefania, AU - Cagnin,Annachiara, AU - Antonini,Angelo, AU - Venneri,Annalena, Y1 - 2019/08/28/ PY - 2019/8/20/pubmed PY - 2019/10/24/medline PY - 2019/8/20/entrez KW - Lewy body KW - MRI KW - Parkinson’s disease KW - VBM KW - Visual hallucinations KW - attention KW - dementia with Lewy bodies KW - executive dysfunction KW - frontal KW - gray matter KW - striatum SP - 509 EP - 522 JF - Postgraduate medicine JO - Postgrad Med VL - 131 IS - 7 N2 - Objectives: Visual hallucinations (VH) are common in Lewy body disease (LBD), and have been associated with cognitive and structural brain alterations. Evidence so far concerns mainly Parkinson's disease (PD), but little is known about symptom-specific pathophysiological mechanisms across the LBD spectrum, especially related to the presence of dementia. The aim of the present pilot study was to investigate the neuroanatomical, and neuropsychological characteristics related to VH in two forms of LBD, namely dementia with Lewy bodies (DLB) and PD without dementia. Methods: Whole brain voxel-based morphometry (VBM) analyses on 3D MRI acquired structural brain scans, and neuropsychological testing were performed on 28 clinically diagnosed DLB (11 with VH, 17 NVH), and 24 PD (9 with VH, and 15 NVH) patients. In order to assess differences in gray matter (GM) regional volumes, and cognitive performance, hallucinating patients for each group were compared with corresponding non-hallucinating ones. Results: DLB patients with VH presented significantly worse visual attention deficits compared to those without, which persisted even when controlling for visual perception. Whole brain VBM analysis revealed decreased GM volume in DLB with VH in the right superior and medial frontal gyri, putamen, caudate nucleus and insula. Subcortical regional volumes were also significantly associated with visual attention performance. Hallucinating PD patients, instead, presented more severe executive dysfunction, but VBM showed no volumetric differences between the two PD subgroups. Post hoc region of interest analyses revealed striatal GM loss in PD with VH. Conclusion: Frontal and striatal GM atrophy may contribute to the emergence of VH in DLB, which may be fostered by the more severe attention deficits. Striatal GM loss and executive dysfunction, instead, appeared to underlie VH in PD without dementia. SN - 1941-9260 UR - https://www.unboundmedicine.com/medline/citation/31422718/Frontal_and_subcortical_contribution_to_visual_hallucinations_in_dementia_with_Lewy_bodies_and_Parkinson's_disease_ L2 - http://www.tandfonline.com/doi/full/10.1080/00325481.2019.1656515 DB - PRIME DP - Unbound Medicine ER -