Understanding hallucinations in probable Alzheimer's disease: Very low prevalence rates in a tertiary memory clinic

Linszen, Mascha M J; Lemstra, Afina W.; Dauwan, Meenakshi; Brouwer, Rachel M.; Scheltens, Philip; Sommer, Iris

doi:10.1016/j.dadm.2018.03.005

Cited by 22 publications

(16 citation statements)

References 19 publications

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“…Atrophy of the right anterior insula in patients with Alzheimer's disease is related to their experience of hallucinations, which is a major symptom of dementia [68,69]. Patients who experience hallucination achieve lower scores on the MMSE [69]. The previous observations agree with the present findings that high-frequency oscillatory intensity in the right anterior insula correlates with scores on the MMSE.…”

Section: Discussionsupporting

confidence: 90%

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Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment

et al. 2020

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Introduction: Pain has been identified as a risk factor for cognitive dysfunction, which in turn affects pain perception. Although pain, cognitive dysfunction, and their interaction are clinically important, the neural mechanism connecting the two phenomena remains unclear. Methods: The resting-state brain activity of 38 participants was measured using magnetoencephalography before and after the patients underwent selective nerve root block (SNRB) for the treatment of their pain. We then assessed the extent to which these data correlated with the subjective levels of pain experienced by the patients across SNRB based on the visual analogue scale and the cognitive status of the patients measured after SNRB using the Japanese versions of the Mini-Mental State Examination (MMSE-J). Results: Slow oscillations (delta) in the right precentral gyrus, right middle temporal gyrus, and left superior frontal gyrus were negatively correlated with the subjective level of pain, and fast oscillations (gamma) in the right insular cortex and right middle temporal gyrus before SNRB were negatively correlated with the MMSE-J score afterwards. These correlations disappeared after SNRB. Conclusion: The presently observed changes in neural activity, as indicated by oscillation changes, might represent the transient bridge between pain and cognitive dysfunction in patients with severe pain. Our findings underscore the importance of treating pain before a transient diminishment of cognitive function becomes persistent.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment

et al. 2020

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“…Visual hallucinations are rare in MCI but become more common in all-cause early dementia [55]. One large study based in a specialist early AD clinic found very low rates of VH, and the authors commented that VH seemed to be more prevalent in the later stages of the illness [56], perhaps reflecting cholinergic denervation in areas of the cortex affected later on than the temporal lobe. EEG slowing in AD and visual hallucinations was interpreted as a potential neurophysiological indicator of cholinergic deficiency [57].…”

Section: Discussionmentioning

confidence: 99%

Visual hallucinations in Alzheimer's disease do not seem to be associated with chronic hypoperfusion of to visual processing areas V2 and V3 but may be associated with reduced cholinergic input to these areas

Sinclair

Kumar²,

Darreh‐Shori³

et al. 2019

Alz Res Therapy

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Background Up to 20% of patients with AD experience hallucinations. The pathological substrate is not known. Visual hallucinations (VH) are more common in dementia with Lewy bodies (DLB). In autopsy studies, up to 60% of patients with AD have concomitant Lewy body pathology. Decreased perfusion of the occipital lobe has been implicated in DLB patients with VH, and post-mortem studies point to both decreased cholinergic activity and reduced oxygenation of the occipital cortex in DLB. Methods We used biochemical methods to assess microvessel density (level of von Willebrand factor, a marker of endothelial cell content), ante-mortem oxygenation (vascular endothelial growth factor, a marker of tissue hypoxia; myelin-associated glycoprotein to proteolipid protein-1 ratio, a measure of tissue oxygenation relative to metabolic demand), cholinergic innervation (acetylcholinesterase and choline acetyltransferase), butyrylcholinesterase and insoluble α-synuclein content in the BA18 and BA19 occipital cortex obtained post-mortem from 23 AD patients who had experienced visual hallucinations, 19 AD patients without hallucinations, 19 DLB patients, and 36 controls. The cohorts were matched for age, gender and post-mortem interval. Results There was no evidence of reduced microvessel density, hypoperfusion or reduction in ChAT activity in AD with visual hallucinations. Acetylcholinesterase activity was reduced in both BA18 and BA19, in all 3 dementia groups, and the concentration was also reduced in BA19 in the DLB and AD without visual hallucinations groups. Insoluble α-synuclein was raised in the DLB group in both areas but not in AD either with or without visual hallucinations. Conclusions Our results suggest that visual hallucinations in AD are associated with cholinergic denervation rather than chronic hypoperfusion or α-synuclein accumulation in visual processing areas of the occipital cortex.

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“…Older people with psychotic symptoms or late‐onset psychotic disorders are at 2.5 to 8 times higher risk to develop dementia compared with those without these symptoms depending on observation time and age . Delusions and hallucinations may also be part of the prodromal stage of dementia, although it is debated how often it occurs in early Alzheimer's disease (AD) .…”

Section: Introductionmentioning

confidence: 99%

Is the prevalence of psychosis in the very old decreasing? A comparison of 85‐year‐olds born 22 years apart

Östling

Bäckman

Sigström

et al. 2019

Int J Geriat Psychiatry

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Objective To elucidate whether there is a decrease of psychotic symptoms in 85‐years‐olds without dementia and if factors associated with psychotic symptoms have changed, we studied two birth cohorts of 85‐year‐olds born 22 years apart. Methods Every second, 85‐year‐olds in Gothenburg, Sweden was invited to neuropsychiatric examinations in 1986 to 1987 (participation 63.1%, N = 494) and in 2008 to 2010 (60.5%, N = 571). A close informant was interviewed by a psychiatrist or a research psychologist. Results The prevalence of psychotic symptoms in 85‐years‐olds without dementia decreased from 10.1% in 1986 to 1987 to 3.2% in 2008 to 2010 (P < .001). Disability in daily life (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.1‐4.5), depressed mood (OR, 3.9; 95% CI, 2.1‐7.1), irritability (OR, 3.6; 95% CI, 1.2‐10.5), and suicidal ideation (OR, 4.1; 95% CI, 2.1‐8.0) were associated with psychotic symptoms in both cohorts. Mean mini‐mental state examination (MMSE) score was lower in those with psychotic symptom compared with those with no psychotic symptoms (Cohort 1986‐1987, 26.4 vs 27.8, Cohort 2008‐2009, 26.1 vs 27.7, t value −4.24, Pr > t < 0.001). Conclusion The prevalence of psychotic symptoms decreased between 1986 to 1987 and 2008 to 2010 among 85‐years‐olds without dementia. These symptoms were associated with broad psychopathology, worse performance in cognitive testing, and with disability of daily life in both cohorts.

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Understanding hallucinations in probable Alzheimer's disease: Very low prevalence rates in a tertiary memory clinic

Cited by 22 publications

References 19 publications

Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment

Resting-State Magnetoencephalography Reveals Neurobiological Bridges Between Pain and Cognitive Impairment

Visual hallucinations in Alzheimer's disease do not seem to be associated with chronic hypoperfusion of to visual processing areas V2 and V3 but may be associated with reduced cholinergic input to these areas

Is the prevalence of psychosis in the very old decreasing? A comparison of 85‐year‐olds born 22 years apart

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