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. 2015 Feb 17;7(1):6.
doi: 10.1186/s13195-014-0091-0. eCollection 2015.

Neural correlates of visual hallucinations in dementia with Lewy bodies

Camille Heitz  1 , Vincent Noblet  2 , Benjamin Cretin  3 , Nathalie Philippi  3 , Laurent Kremer  4 , Mélanie Stackfleth  1 , Fabrice Hubele  5 , Jean Paul Armspach  2 , Izzie Namer  5 , Frédéric Blanc  3
Affiliations

Neural correlates of visual hallucinations in dementia with Lewy bodies

Camille Heitz et al. Alzheimers Res Ther. .

Abstract

Introduction: 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.

Methods: We 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.

Results: We 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.

Conclusions: Visual 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.

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Figures

Figure 1
Figure 1
Comparison of patients with dementia with Lewy bodies with versus without hallucinations. A comparison of patients with dementia with Lewy bodies (DLB) with versus without hallucinations (P < 0.001, including age and type of radiotracer as nuisance covariates and a minimum cluster size of 25 voxels) revealed significant hypoperfusion in the left anterior cingulate gyrus (Brodmann area (BA) 32), the left orbitofrontal cortex (BA 11/47) and the left cuneus (BA 19).
Figure 2
Figure 2
Correlation analyses between cerebral hypoperfusion and severity of hallucinations in patients with dementia with Lewy bodies. Correlation analyses between cerebral hypoperfusion and the severity of the hallucinations in the patients with dementia with Lewy bodies revealed the involvement of the bilateral anterior cingulate cortex (Brodmann area (BA) 32), the left orbitofrontal cortex (BA 11/47), the right parahippocampal gyrus (BA 20) and the left cuneus (BA 18) (P < 0.001, including age and type of radiotracer as nuisance covariates and a minimum cluster size of 25 voxels).
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