Brain, Vol. 125, No. 2, 391-403,
February 1, 2002
© 2002 Oxford University Press
Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe
Prince of Wales Medical Research Institute and University of New South Wales, Barker Street, Sydney, NSW 2031, Australia
Correspondence to: Associate Professor G. M. Halliday, Prince of Wales Medical Research Institute, Barker Street, Randwick, NSW 2031, Australia. E-mail: G.Halliday{at}unsw.edu.au
Consensus opinion characterizes dementia with Lewy bodies (DLB) as a progressive dementing illness, with significant fluctuations in cognition, visual hallucinations and/or parkinsonism. When parkinsonism is an early dominant feature, consensus opinion recommends that dementia within the first year is necessary for a diagnosis of DLB. If dementia occurs later, a diagnosis of Parkinson’s disease with dementia (PDD) is recommended. While many previous studies have correlated the neuropathology in DLB with dementia and parkinsonism, few have analysed the relationship between fluctuating cognition and/or well-formed visual hallucin ations and the underlying neuropathology in DLB and PDD. The aim of the present study was to determine any relationship between these less-studied core clinical features of DLB, and the distribution and density of cortical Lewy bodies (LB). The brains of 63 cases with LB were obtained over 6 years following population-based studies of dementia and parkinsonian syndromes. Annual, internationally standardized, clinical assessment batteries were reviewed to determine the presence and onset of the core clinical features of DLB. The maximal density of LB, plaques and tangles in the amygdala, parahippocampal, anterior cingulate, superior frontal, inferior temporal, inferior parietal and visual cortices were determined. Current clinicopathological diagnostic criteria were used to classify cases into DLB (n = 29), PDD (n = 18) or parkinsonism without dementia (n = 16) groups. Predictive statistics were used to ascertain whether fluctuating cognition or visual hallucinations predicted the clinicopathological group. Analysis of variance and regressions were used to identify any significant relationship(s) between the presence and severity of neuropathological and clinical features. Cognitive fluctuations and/or visual hallucinations were not good predictors of DLB in pathologically proven patients, although the absence of these features early in the disease course was highly predictive of PDD. Cases with DLB had higher LB densities in the inferior temporal cortex than cases with PDD. There was no association across groups between any neuropathological variable and the presence or absence of fluctuating cognition. However, there was a striking association between the distribution of temporal lobe LB and well-formed visual hallucinations. Cases with well-formed visual hallucinations had high densities of LB in the amygdala and parahippocampus, with early hallucinations relating to higher densities in parahippocampal and inferior temporal cortices. These temporal regions have previously been associated with visual hallucinations in other disorders. Thus, our results suggest that the distribution of temporal lobe LB is more related to the presence and duration of visual hallucinations in cases with LB than to the presence, severity or duration of dementia.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. M. Meppelink, B. M. de Jong, R. Renken, K. L. Leenders, F. W. Cornelissen, and T. van Laar Impaired visual processing preceding image recognition in Parkinson's disease patients with visual hallucinations Brain, November 1, 2009; 132(11): 2980 - 2993. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Neumann, J. Bras, E. Deas, S. S. O'Sullivan, L. Parkkinen, R. H. Lachmann, A. Li, J. Holton, R. Guerreiro, R. Paudel, et al. Glucocerebrosidase mutations in clinical and pathologically proven Parkinson's disease Brain, July 1, 2009; 132(7): 1783 - 1794. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y Compta, M J Marti, M J Rey, and M Ezquerra Parkinsonism, dysautonomia, REM behaviour disorder and visual hallucinations mimicking synucleinopathy in a patient with progressive supranuclear palsy J. Neurol. Neurosurg. Psychiatry, May 1, 2009; 80(5): 578 - 579. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Prakash, A. Pathak, S. Munda, and D. Bagati Quetiapine Effective in Treatment of Inappropriate Sexual Behavior of Lewy Body Disease With Predominant Frontal Lobe Signs American Journal of Alzheimer's Disease and Other Dementias, April 1, 2009; 24(2): 136 - 140. [Abstract] [PDF]
|
|
|
|
 |
|
 A. J. Lees The Parkinson chimera Neurology, February 17, 2009; 72(7_Supplement_2): S2 - S11. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-Y. Lim, S. H. Fox, and A. E. Lang Overview of the Extranigral Aspects of Parkinson Disease Arch Neurol, February 1, 2009; 66(2): 167 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Devinsky Delusional misidentifications and duplications: Right brain lesions, left brain delusions Neurology, January 6, 2009; 72(1): 80 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Nervi, C. Reitz, M.-X. Tang, V. Santana, A. Piriz, D. Reyes-Dumeyer, R. Lantigua, M. Medrano, I. Z. Jimenez-Velazquez, J. H. Lee, et al. Comparison of Clinical Manifestations in Alzheimer Disease and Dementia With Lewy Bodies Arch Neurol, December 1, 2008; 65(12): 1634 - 1639. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D R Williams, J D Warren, and A J Lees Using the presence of visual hallucinations to differentiate Parkinson's disease from atypical parkinsonism J. Neurol. Neurosurg. Psychiatry, June 1, 2008; 79(6): 652 - 655. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Carota, N. Mishra, M. Allaoua, and J. Ghika A Squint of Brain: A Capgras Syndrome Variant J Neuropsychiatry Clin Neurosci, February 1, 2008; 20(1): 109 - 110. [Full Text] [PDF]
|
|
|
|
 |
|
 W D Knight, N C Fox, M N Rossor, and J D Warren The cultural context of visual hallucinations Postgrad. Med. J., February 1, 2008; 84(988): 103 - 105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Weintraub and H. I. Hurtig Presentation and Management of Psychosis in Parkinson's Disease and Dementia With Lewy Bodies Am J Psychiatry, October 1, 2007; 164(10): 1491 - 1498. [Full Text] [PDF]
|
|
|
|
|
|
P. J. Nestor The Lewy body, the hallucination, the atrophy and the physiology Brain, October 1, 2007; 130(10): e81 - e81. [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Fodero-Tavoletti, D. P. Smith, C. A. McLean, P. A. Adlard, K. J. Barnham, L. E. Foster, L. Leone, K. Perez, M. Cortes, J. G. Culvenor, et al. In Vitro Characterization of Pittsburgh Compound-B Binding to Lewy Bodies J. Neurosci., September 26, 2007; 27(39): 10365 - 10371. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Beyer, J. P. Larsen, and D. Aarsland Gray matter atrophy in Parkinson disease with dementia and dementia with Lewy bodies Neurology, August 21, 2007; 69(8): 747 - 754. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Oka, M. Yoshioka, K. Onouchi, M. Morita, S. Mochio, M. Suzuki, T. Hirai, Y. Ito, and K. Inoue Characteristics of orthostatic hypotension in Parkinson's disease Brain, August 2, 2007; (2007) awm174v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Weisman, M. Cho, C. Taylor, A. Adame, L. J. Thal, and L. A. Hansen In dementia with Lewy bodies, Braak stage determines phenotype, not Lewy body distribution Neurology, July 24, 2007; 69(4): 356 - 359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Boecker, A. O. Ceballos-Baumann, D. Volk, B. Conrad, H. Forstl, and P. Haussermann Metabolic Alterations in Patients With Parkinson Disease and Visual Hallucinations Arch Neurol, July 1, 2007; 64(7): 984 - 988. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. C. Rowe, S. Ng, U. Ackermann, S. J. Gong, K. Pike, G. Savage, T. F. Cowie, K. L. Dickinson, P. Maruff, D. Darby, et al. Imaging {beta}-amyloid burden in aging and dementia Neurology, May 15, 2007; 68(20): 1718 - 1725. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. F. Lippa, J. E. Duda, M. Grossman, H. I. Hurtig, D. Aarsland, B. F. Boeve, D. J. Brooks, D. W. Dickson, B. Dubois, M. Emre, et al. DLB and PDD boundary issues: Diagnosis, treatment, molecular pathology, and biomarkers Neurology, March 13, 2007; 68(11): 812 - 819. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Whitwell, S. D. Weigand, M. M. Shiung, B. F. Boeve, T. J. Ferman, G. E. Smith, D. S. Knopman, R. C. Petersen, E. E. Benarroch, K. A. Josephs, et al. Focal atrophy in dementia with Lewy bodies on MRI: a distinct pattern from Alzheimer's disease Brain, March 1, 2007; 130(3): 708 - 719. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D Aarsland, K Bronnick, U Ehrt, P P De Deyn, S Tekin, M Emre, and J L Cummings Neuropsychiatric symptoms in patients with Parkinson's disease and dementia: frequency, profile and associated care giver stress J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 36 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Ballard, I. Ziabreva, R. Perry, J. P. Larsen, J. O'Brien, I. McKeith, E. Perry, and D. Aarsland Differences in neuropathologic characteristics across the Lewy body dementia spectrum Neurology, December 12, 2006; 67(11): 1931 - 1934. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Papapetropoulos Regional Alpha-Synuclein Aggregation, Dopaminergic Dysregulation, and the Development of Drug-Related Visual Hallucinations in Parkinson's Disease J Neuropsychiatry Clin Neurosci, May 1, 2006; 18(2): 149 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Matsui, F. Udaka, A. Tamura, M. Oda, T. Kubori, K. Nishinaka, and M. Kameyama Impaired Visual Acuity as a Risk Factor for Visual Hallucinations in Parkinson's Disease J Geriatr Psychiatry Neurol, March 1, 2006; 19(1): 36 - 40. [Abstract] [PDF]
|
|
|
|
|
|
I. G. McKeith, D. W. Dickson, J. Lowe, M. Emre, J. T. O'Brien, H. Feldman, J. Cummings, J. E. Duda, C. Lippa, E. K. Perry, et al. Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium Neurology, December 27, 2005; 65(12): 1863 - 1872. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Oishi, F. Udaka, M. Kameyama, N. Sawamoto, K. Hashikawa, and H. Fukuyama Regional cerebral blood flow in Parkinson disease with nonpsychotic visual hallucinations Neurology, December 13, 2005; 65(11): 1708 - 1715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Devos, M. Tir, C. A. Maurage, N. Waucquier, L. Defebvre, S. Defoort-Dhellemmes, and A. Destee ERG and anatomical abnormalities suggesting retinopathy in dementia with Lewy bodies Neurology, October 11, 2005; 65(7): 1107 - 1110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bozzali, A. Falini, M. Cercignani, F. Baglio, E. Farina, M. Alberoni, P. Vezzulli, F. Olivotto, F. Mantovani, T. Shallice, et al. Brain tissue damage in dementia with Lewy bodies: an in vivo diffusion tensor MRI study Brain, July 1, 2005; 128(7): 1595 - 1604. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Summerfield, C. Junque, E. Tolosa, P. Salgado-Pineda, B. Gomez-Anson, M. J. Marti, P. Pastor, B. Ramirez-Ruiz, and J. Mercader Structural Brain Changes in Parkinson Disease With Dementia: A Voxel-Based Morphometry Study Arch Neurol, February 1, 2005; 62(2): 281 - 285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. P. Mosimann, G. Mather, K. A. Wesnes, J. T. O'Brien, D. J. Burn, and I. G. McKeith Visual perception in Parkinson disease dementia and dementia with Lewy bodies Neurology, December 14, 2004; 63(11): 2091 - 2096. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Moretti, P. Torre, R. M. Antonello, T. Cattaruzza, and G. Cazzato Cholinesterase inhibition as a possible therapy for delirium in vascular dementia: A controlled, open 24-month study of 246 patients American Journal of Alzheimer's Disease and Other Dementias, November 1, 2004; 19(6): 333 - 339. [Abstract] [PDF]
|
|
|
|
|
|
C. F. Lippa Synaptophysin immunoreactivity in Pick's disease: Comparison with Alzheimer's disease and dementia with Lewy bodies American Journal of Alzheimer's Disease and Other Dementias, November 1, 2004; 19(6): 341 - 344. [Abstract] [PDF]
|
|
|
|
|
|
G. T. Stebbins, C. G. Goetz, M. C. Carrillo, K. J. Bangen, D. A. Turner, G. H. Glover, and J. D.E. Gabrieli Altered cortical visual processing in PD with hallucinations: An fMRI study Neurology, October 26, 2004; 63(8): 1409 - 1416. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Aarsland, C. G. Ballard, and G. Halliday Are Parkinson's Disease with dementia and Dementia with lewy Bodies the Same Entity? J Geriatr Psychiatry Neurol, September 1, 2004; 17(3): 137 - 145. [Abstract] [PDF]
|
|
|
|
|
|
C. G. Ballard, R. Jacoby, T. Del Ser, M. N. Khan, D. G. Munoz, C. Holmes, Z. Nagy, E. K. Perry, C. Joachim, E. Jaros, et al. Neuropathological Substrates of Psychiatric Symptoms in Prospectively Studied Patients With Autopsy-Confirmed Dementia With Lewy Bodies Am J Psychiatry, May 1, 2004; 161(5): 843 - 849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D J Burn Cortical Lewy body disease J. Neurol. Neurosurg. Psychiatry, February 1, 2004; 75(2): 175 - 178. [Full Text] [PDF]
|
|
|
|
|
|
D Aarsland, I Litvan, D Salmon, D Galasko, T Wentzel-Larsen, and J P Larsen Performance on the dementia rating scale in Parkinson's disease with dementia and dementia with Lewy bodies: comparison with progressive supranuclear palsy and Alzheimer's disease J. Neurol. Neurosurg. Psychiatry, September 1, 2003; 74(9): 1215 - 1220. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Moretti, P. Torre, R. M. Antonello, G. Cazzato, and A. Bava Rivastigmine in subcortical vascular dementia: A randomized, controlled, open 12-month study in 208 patients American Journal of Alzheimer's Disease and Other Dementias, September 1, 2003; 18(5): 265 - 272. [Abstract] [PDF]
|
|
|
|
|
|
A. J. Harding, E. Stimson, J. M. Henderson, and G. M. Halliday Clinical correlates of selective pathology in the amygdala of patients with Parkinson's disease Brain, November 1, 2002; 125(11): 2431 - 2445. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Minoshima, N. L. Foster, E. C. Petrie, R. L. Albin, K. A. Frey, and D. E. Kuhl Neuroimaging in Dementia with Lewy Bodies: Metabolism, Neurochemistry, and Morphology J Geriatr Psychiatry Neurol, January 1, 2002; 15(4): 200 - 209. [Abstract] [PDF]
|
|