Abstract
IntroductionThe aim of this study was to investigate the association between visual hallucinations in dementia with Lewy bodies (DLB) and brain perfusion using single-photon emission computed tomography.MethodsWe retrospectively included 66 patients with DLB, 36 of whom were having visual hallucinations (DLB-hallu) and 30 of whom were not (DLB-c). We assessed visual hallucination severity on a 3-point scale of increasing severity: illusions, simple visual hallucinations and complex visual hallucinations. We performed voxel-level comparisons between the two groups and assessed correlations between perfusion and visual hallucinations severity.ResultsWe found a significant decrease in perfusion in the left anterior cingulate cortex, the left orbitofrontal cortex and the left cuneus in the DLB-hallu group compared with the DLB-c group. We also found a significant correlation between decreased bilateral anterior cingulate cortex, left orbitofrontal cortex, right parahippocampal gyrus, right inferior temporal cortex and left cuneus perfusion with the severity of hallucinations.ConclusionsVisual hallucinations seem to be associated with the impairment of anterior and posterior regions (secondary visual areas, orbitofrontal cortex and anterior cingulate cortex) involved in a top-down and bottom-up mechanism, respectively. Furthermore, involvement of the bilateral anterior cingulate cortex and right parahippocampal gyrus seems to lead to more complex hallucinations.
Highlights
The aim of this study was to investigate the association between visual hallucinations in dementia with Lewy bodies (DLB) and brain perfusion using single-photon emission computed tomography
The DLB-c group performed worse than the DLB-hallu group on the Free and Cued Selective Reminding Test (FCSRT), and the DLB-hallu group performed worse than the DLB-c group on the Trail Making Test (TMT) A, but without a significant difference
Severity of hallucinations In correlation analysis of cerebral perfusion regarding the severity of hallucinations in the patients with DLB, we found significant hypoperfusion in the bilateral anterior cingulate cortex (ACC) (BA 32), the right parahippocampal gyrus, the right inferior temporal gyrus (BA 20), the left orbitofrontal cortex (BA 11 and 47) and the left cuneus (BA 18) (Figure 2 and Table 3)
Summary
The aim of this study was to investigate the association between visual hallucinations in dementia with Lewy bodies (DLB) and brain perfusion using single-photon emission computed tomography. Visual hallucinations (VHs) are one of the commonest features of DLB, present in 54% to 70% of patients [3]. It most frequently consists of simple visual illusions wherein objects are distorted or deformed, even though more complex hallucinations may occur. One of the main hypotheses is that VHs could be consecutive to visuospatial, visuoperceptual or attention deficits, which are more frequent in DLB with VHs than in either DLB without VHs or AD [4]. These visual deficits of central origin are coherent
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