4.5 Article

A Multimodal Neuroimaging and Neuropsychological Study of Visual Hallucinations in Alzheimer's Disease

Journal

JOURNAL OF ALZHEIMERS DISEASE
Volume 89, Issue 1, Pages 133-149

Publisher

IOS PRESS
DOI: 10.3233/JAD-215107

Keywords

Alzheimer's disease; attention; FDG-PET; MRI; neuropsychology; visual hallucinations; visuoconstruction

Categories

Funding

  1. Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health) [U01AG024904]
  2. DODADNI (Department of Defense) [W81XWH-12-2-0012]
  3. National Institute on Aging
  4. National Institute of Biomedical Imaging and Bioengineering
  5. AbbVie
  6. Alzheimer's Association
  7. Alzheimer's Drug Discovery Foundation
  8. Araclon Biotech
  9. BioClinica, Inc.
  10. Biogen
  11. BristolMyers Squibb Company
  12. CereSpir, Inc.
  13. Cogstate
  14. Eisai Inc.
  15. Elan Pharmaceuticals, Inc.
  16. Eli Lilly and Company
  17. EuroImmun
  18. F. Hoffmann-La Roche Ltd.
  19. Genentech, Inc.
  20. Fujirebio
  21. GE Healthcare
  22. IXICO Ltd.
  23. Janssen Alzheimer Immunotherapy Research & Development, LLC
  24. Johnson & Johnson Pharmaceutical Research & Development LLC
  25. Lumosity
  26. Lundbeck
  27. Merck Co., Inc.
  28. Meso Scale Diagnostics, LLC
  29. NeuroRx Research
  30. Neurotrack Technologies
  31. Novartis Pharmaceuticals Corporation
  32. Pfizer Inc.
  33. Piramal Imaging
  34. Servier
  35. Takeda Pharmaceutical Company
  36. Transition Therapeutics
  37. Canadian Institutes of Health Research
  38. Department of excellence 2018-2022 initiative of the Italian Ministry of education (MIUR)

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In Alzheimer's disease (AD), visual hallucinations (VH) are associated with more severe cognitive and brain structural changes. Compared to patients without VH (NVH), VH patients show more severe visuoconstructive and attentional deficits. VH patients have gray matter atrophy and hypometabolism in the occipital and temporal areas of the brain. These findings contribute to our understanding of the emergence and development of VH in AD.
Background: Hallucinations in Alzheimer's disease (AD) have been linked to more severe cognitive and functional decline. However, research on visual hallucinations (VH), the most common type of hallucinations in AD, is limited. Objective: To investigate the cognitive and cerebral macrostructural and metabolic features associated with VH in AD. Methods: Twenty-four AD patients with VH, 24 with no VH (NVH), and 24 cognitively normal (CN) matched controls were selected from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Differences in regional gray matter (GM) volumes and cognitive performance were investigated with whole brain voxel-based morphometry analyses of MRI structural brain scans, and analyses of neuropsychological tests. Glucose metabolic changes were explored in a sub-sample of patients who had FDG-PET scans available. Results: More severe visuoconstructive and attentional deficits were found in AD VH compared with NVH. GM atrophy and hypometabolism were detected in occipital and temporal areas in VH patients in comparison with CN. On the other hand, NVH patients had atrophy and hypometabolism mainly in temporal areas. No differences in GM volume and glucose metabolism were found in the direct comparison between AD VH and NVH. Conclusion: In addition to the pattern of brain abnormalities typical of AD, occipital alterations were observed in patients with VH compared with CN. More severe visuoconstructive and attentional deficits were found in AD VH when directly compared with NVH, and might contribute to the emergence of VH in AD.

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