Visual symptoms in Parkinson's disease and Parkinson's disease dementia

Abstract

Visual symptoms are common in PD and PD dementia and include difficulty reading, double vision, illusions, feelings of presence and passage, and complex visual hallucinations. Despite the established prognostic implications of complex visual hallucinations, the interaction between cognitive decline, visual impairment, and other visual symptoms remains poorly understood. Our aim was to characterize the spectrum of visual symptomatology in PD and examine clinical predictors for their occurrence. Sixty-four subjects with PD, 26 with PD dementia, and 32 age-matched controls were assessed for visual symptoms, cognitive impairment, and ocular pathology. Complex visual hallucinations were common in PD (17%) and PD dementia (89%). Dementia subjects reported illusions (65%) and presence (62%) more frequently than PD or control subjects, but the frequency of passage hallucinations in PD and PD dementia groups was equivalent (48% versus 69%, respectively; P = 0.102). Visual acuity and contrast sensitivity was impaired in parkinsonian subjects, with disease severity and age emerging as the key predictors. Regression analysis identified a variety of factors independently predictive of complex visual hallucinations (e.g., dementia, visual acuity, and depression), illusions (e.g., excessive daytime somnolence and disease severity), and presence (e.g., rapid eye movement sleep behavior disorder and excessive daytime somnolence). Our results demonstrate that different "hallucinatory" experiences in PD do not necessarily share common disease predictors and may, therefore, be driven by different pathophysiological mechanisms. If confirmed, such a finding will have important implications for future studies of visual symptoms and cognitive decline in PD and PD dementia.

Visual Hallucinations in Eye Disease and Lewy Body Disease

“…The control groups which included friends/relatives (2,8) or spouses of patients, (2,3,5,8) volunteers recruited via advertisement in the Newcastle Elders magazine(4) and in a local church (3,4) and healthy controls from the research database held at the Institute for Ageing, Newcastle University (3,5) comprise the comparison group in this study. Diagnostic criteria were met using the revised International Consensus Guidelines from the third report of the DLB consortium for DLB, the Movement Disorder Committee, United Kingdom.…”

Oculo‐visual changes and clinical considerations affecting older patients with dementia

“…158 Hence, in a study of PDD (n = 26), hallucinations were very common. 159 Hallucinations are also common in DLB 160 but are less frequent in AD. [161][162][163][164] VH have also been reported in some genetic subtypes of FTD, especially those caused by chromosome nine open reading frame 72 (C9ORF72) gene mutations.…”

Parkinson’s Disease Psychosis: Therapy Tips and the Importance of Communication Between Neurologists and Psychiatrists

“…Illusions can present in up to 60% of PD patients with patients having reported a variety of objects such as a dark stain on the floor instead of areal insect or seeing animals or persons instead of trees or a coat rack [17,24].…”