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Cerebral basis of visual hallucinations in Parkinson's disease: Structural and functional MRI studies

  • Naroa Ibarretxe-Bilbao
    Correspondence
    Corresponding author at: Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Avenida de las Universidades 24, 48007 Bilbao,Spain. Tel.: +34 94 413 90 00x2891.
    Affiliations
    Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Spain

    Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain

    Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain

    Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Spain
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  • Carme Junque
    Affiliations
    Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Spain

    Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Spain
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  • Maria J. Marti
    Affiliations
    Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Spain

    Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain
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  • Eduardo Tolosa
    Affiliations
    Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Spain

    Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Spain
    Search for articles by this author

      Abstract

      The presence of visual hallucinations (VH) is a significant predictor of dementia in Parkinson's disease (PD) and it is associated with a more rapid cognitive decline. Non-demented PD patients with VH present greater neuropsychological impairment than those without VH in domains such as verbal and visual memory, language comprehension, and visuospatial and visuoperceptive functions. Frontal dysfunction has also been described in PD with VH, including deficits in verbal fluency, sustained attention, and inhibition. In PD with VH, structural and functional abnormalities within the primary visual system and visual association areas, including ventral and dorsal pathways, have been reported. Structural MRI studies have shown that non-demented PD patients with VH present grey matter reduction in parieto-occipital areas and the hippocampal head. A follow-up study performed at a mean of 30 months revealed that unlike PD patients without VH, PD patients with VH frequently develop dementia associated with progressive atrophy in limbic, paralimbic and neocortical areas. Functional MRI (fMRI) studies have revealed altered activation in occipito-temporal and frontal areas in response to simple and complex visual stimuli in PD patients with VH, suggesting a marked impairment in bottom-up visual processing, as well as an attentional deficit in the pathophysiology of VH in PD.

      Keywords

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