Visuoperceptual Impairment in Dementia With Lewy Bodies

Mori, Etsuro; Shimomura, Tatsuo; Fujimori, Misato; Hirono, Nobutsugu; Imamura, Toru; Hashimoto, Mamoru; Tanimukai, Satoshi; Kazui, Hiroaki; Hanihara, Tokiji

doi:10.1001/archneur.57.4.489

Cited by 191 publications

(120 citation statements)

References 33 publications

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“…In the present study, hallucinating DLB/ PDD patients were more impaired in all visual scores compared to patients without hallucinations. The interpretation of this finding needs caution, because as in previous studies, 39,40 the number of demented patients without hallucinations in this study was small (n ϭ 8).…”

Section: Figure (A Through C) Mean and 95% CI Of The Discrimination contrasting

confidence: 49%

“…Visual impairments in DLB patients with visual hallucination exceed those without hallucination, especially in the overlapping figure task 39 and in the line orientation task. 40 Barnes and David 41 compared visual imagery, visual perception, and recognition memory in nondemented PD patients with and without hallucinations and found that PD patients with visual hallucinations were more impaired in object perception.…”

Section: Figure (A Through C) Mean and 95% CI Of The Discrimination mentioning

confidence: 87%

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Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Mosimann

Mather²,

Wesnes³

et al. 2004

Neurology

259

176

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Abstract-Objective:To quantify visual discrimination, space-motion, and object-form perception in patients with Parkinson disease dementia (PDD), dementia with Lewy bodies (DLB), and Alzheimer disease (AD). Methods: The authors used a cross-sectional study to compare three demented groups matched for overall dementia severity (PDD: n ϭ 24; DLB: n ϭ 20; AD: n ϭ 23) and two age-, sex-, and education-matched control groups (PD: n ϭ 24, normal controls [NC]: n ϭ 25). Results: Visual perception was globally more impaired in PDD than in nondemented controls (NC, PD), but was not different from DLB. Compared to AD, PDD patients tended to perform worse in all perceptual scores. Visual perception of patients with PDD/DLB and visual hallucinations was significantly worse than in patients without hallucinations. Conclusions: Parkinson disease dementia (PDD) is associated with profound visuoperceptual impairments similar to dementia with Lewy bodies (DLB) but different from Alzheimer disease. These findings are consistent with previous neuroimaging studies reporting hypoactivity in cortical areas involved in visual processing in PDD and DLB. NEUROLOGY 2004;63:2091-2096 Parkinson disease (PD) is associated with a higher risk of developing dementia compared to healthy elderly controls; longitudinal studies suggest that up to 78% of PD patients will develop dementia after nearly two decades of motor symptoms.1 Once dementia is established, clinical symptoms of PD dementia (PDD) may show, apart from a longer duration of motor features, considerable overlap with dementia with Lewy bodies (DLB). The postural instability-gait type of parkinsonism is overrepresented in PDD and DLB 2 and both disorders show similar fluctuation of attention 3 and response to cholinergic therapy. 4,5 Studies comparing visual perception and visual construction of PDD with Alzheimer disease (AD) have revealed contradictory results. Some studies report PDD to be more impaired, 6,7 whereas other studies found no differences. 8,9 Similar inconsistencies have been found when perception of PD patients was compared with healthy controls.10 Since operationalized criteria to define the clinical boundaries between PD and PDD or PDD and DLB require refinement, these inconsistencies may be partly due to diagnostic heterogeneity. When DLB was compared with AD, studies consistently reported greater visual impairment in DLB 11 and a recent study found similar impairments in pentagon copying in DLB and PDD.12 Some of these studies used construction tasks as evidence, but this may not be legitimate given the motor impairments in these patients. Studies quantifying visual perception of DLB and PDD using tasks without motor requirements are lacking.Peripheral structures such as the retina, the optic nerve and tract, and primary visual cortex are multimodal in their function, whereas the visual association cortex is more specialized.13 Low-level visual discrimination is mainly processed in visual area V1/ V2, whereas high-level visual functions require additional activati...

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Section: Figure (A Through C) Mean and 95% CI Of The Discrimination contrasting

confidence: 49%

Section: Figure (A Through C) Mean and 95% CI Of The Discrimination mentioning

confidence: 87%

Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Mosimann

Mather²,

Wesnes³

et al. 2004

Neurology

259

176

View full text Add to dashboard Cite

show abstract

“…A much more severe impairment in copying tasks is observed in early-onset AD patients and in PCA variant, in which severe constructive defects are usually associated with progressive visual-spatial disorders, including Balint syndrome and unilateral spatial neglect [100,101]. A very similar pattern of drawing impairment is found in LBD, in which visuospatial difficulties are often early and prominent and contribute to the disproportionate impairment in constructional tasks observed in these patients [151][152][153].…”

Section: Discussionmentioning

confidence: 91%

“…Visuospatial tasks, such as object size discrimination, form discrimination, overlapping figure identification, and visual counting tasks, may reveal more impaired performances in LBD than in AD, and these defects likely contribute to the disproportionate impairment in constructional tasks in LBD patients [151][152][153].…”

Section: Drawing Disorders In Lewy Body Dementiamentioning

confidence: 99%

Drawing Disorders in Alzheimer’s Disease and Other Forms of Dementia

Trojano

Gainotti

2016

JAD

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Abstract. Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.

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“…150 Individuals with DLB (n = 24) had a poorer performance than those with AD (n = 48) on object size discrimination, form discrimination, overlapping figure identification, and on visual counting tasks. 151 This was concluded to play a role in the perceptual deficits observed in DLB, such as visual hallucinations. Other complex visual tasks such as colour integration and rotated object comparison are also impaired in DLB, which corresponds with the cortical areas affected by the disease.…”

Section: Complex Visual Functionsmentioning

confidence: 99%

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

Armstrong

Kergoat

2015

Ophthalmic Physiologic Optic

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Purpose Dementia is associated with various alterations of the eye and visual function. Over 60% of cases are attributable to Alzheimer's disease, a significant proportion of the remainder to vascular dementia or dementia with Lewy bodies, while frontotemporal dementia, and Parkinson's disease dementia are less common. This review describes the oculo‐visual problems of these five dementias and the pathological changes which may explain these symptoms. It further discusses clinical considerations to help the clinician care for older patients affected by dementia. Recent findings Visual problems in dementia include loss of visual acuity, defects in colour vision and visual masking tests, changes in pupillary response to mydriatics, defects in fixation and smooth and saccadic eye movements, changes in contrast sensitivity function and visual evoked potentials, and disturbance of complex visual functions such as in reading ability, visuospatial function, and the naming and identification of objects. Pathological changes have also been reported affecting the crystalline lens, retina, optic nerve, and visual cortex. Clinically, issues such as cataract surgery, correcting the refractive error, quality of life, falls, visual impairment and eye care for dementia have been addressed. Summary Many visual changes occur across dementias, are controversial, often based on limited patient numbers, and no single feature can be regarded as diagnostic of any specific dementia. Nevertheless, visual hallucinations may be more characteristic of dementia with Lewy bodies and Parkinson's disease dementia than Alzheimer's disease or frontotemporal dementia. Differences in saccadic eye movement dysfunction may also help to distinguish Alzheimer's disease from frontotemporal dementia and Parkinson's disease dementia from dementia with Lewy bodies. Eye care professionals need to keep informed of the growing literature in vision/dementia, be attentive to signs and symptoms suggestive of cognitive impairment, and be able to adapt their practice and clinical interventions to best serve patients with dementia.

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Visuoperceptual Impairment in Dementia With Lewy Bodies

Abstract: Visual perception is defective in probable DLB. The defective visual perception plays a role in development of visual hallucinations, delusional misidentifications, visual agnosias, and visuoconstructive disability charcteristic of DLB.

Cited by 191 publications

References 33 publications

Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Visual perception in Parkinson disease dementia and dementia with Lewy bodies

Drawing Disorders in Alzheimer’s Disease and Other Forms of Dementia

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

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