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Structural and Functional Neuroimaging of Visual Hallucinations in Lewy Body Disease: A Systematic Literature Review


Structural and Functional Neuroimaging of Visual Hallucinations in Lewy Body Disease: A Systematic Literature Review

Stefania Pezzoli et al. Brain Sci.


Patients with Lewy body disease (LBD) frequently experience visual hallucinations (VH), well-formed images perceived without the presence of real stimuli. The structural and functional brain mechanisms underlying VH in LBD are still unclear. The present review summarises the current literature on the neural correlates of VH in LBD, namely Parkinson's disease (PD), and dementia with Lewy bodies (DLB). Following a systematic literature search, 56 neuroimaging studies of VH in PD and DLB were critically reviewed and evaluated for quality assessment. The main structural neuroimaging results on VH in LBD revealed grey matter loss in frontal areas in patients with dementia, and parietal and occipito-temporal regions in PD without dementia. Parietal and temporal hypometabolism was also reported in hallucinating PD patients. Disrupted functional connectivity was detected especially in the default mode network and fronto-parietal regions. However, evidence on structural and functional connectivity is still limited and requires further investigation. The current literature is in line with integrative models of VH suggesting a role of attention and perception deficits in the development of VH. However, despite the close relationship between VH and cognitive impairment, its associations with brain structure and function have been explored only by a limited number of studies.

Keywords: DTI; Lewy body; MRI; PET; Parkinson’s disease; Parkinson’s disease dementia; SPECT; dementia with Lewy bodies; fMRI; visual hallucinations.

Conflict of interest statement

The authors declare no conflict of interest.


Figure 1
Figure 1
Flow chart describing the selection process of the studies included (adapted from Moher et al. [14]). 1 Exclusion criteria: (1) pathologies other than dementia with Lewy bodies (DLB), Parkinson’s disease (PD), or Parkinson’s disease dementia (PDD); (2) neuroimaging analysis not related to visual hallucinations (VH); (3) patients with medication-induced VH; (4) studies not using magnetic resonance imaging (MRI), functional MRI (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and single photon emission computed tomography (SPECT); (5) PET and SPECT studies not investigating glucose metabolism and regional cerebral blood flow; (6) MRI studies using visual rating; (7) magnetic resonance spectroscopic imaging; (8) pharmacological studies; (9) case studies (except for fMRI during VH); (10) review and theoretical articles; (11) non-English articles; and (12) non-peer reviewed articles.

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    1. Dickson D.W., Braak H., Duda J.E., Duyckaerts C., Gasser T., Halliday G.M., Hardy J., Leverenz J.B., Del Tredici K., Wszolek Z.K., et al. Neuropathological assessment of parkinson’s disease: Refining the diagnostic criteria. Lancet Neurol. 2009;8:1150–1157. doi: 10.1016/S1474-4422(09)70238-8. - DOI - PubMed
    1. Lippa C.F., Duda J.E., Grossman M., Hurtig H.I., Aarsland D., Boeve B.F., Brooks D.J., Dickson D.W., Dubois B., Emre M., et al. Dlb and pdd boundary issues: Diagnosis, treatment, molecular pathology, and biomarkers. Neurology. 2007;68:812–819. doi: 10.1212/01.wnl.0000256715.13907.d3. - DOI - PubMed
    1. Aarsland D. Cognitive impairment in parkinson’s disease and dementia with lewy bodies. Parkinsonism Relat. Disord. 2016;22(Suppl. 1):S144–S148. doi: 10.1016/j.parkreldis.2015.09.034. - DOI - PubMed
    1. McKeith I.G., Dickson D.W., Lowe J., Emre M., O’Brien J.T., Feldman H., Cummings J., Duda J.E., Lippa C., Perry E.K., et al. Diagnosis and management of dementia with lewy bodies: Third report of the dlb consortium. Neurology. 2005;65:1863–1872. doi: 10.1212/01.wnl.0000187889.17253.b1. - DOI - PubMed
    1. Collerton D., Perry E., McKeith I. Why people see things that are not there: A novel perception and attention deficit model for recurrent complex visual hallucinations. Behav. Brain Sci. 2005;28:737–757; discussion 757–794. doi: 10.1017/S0140525X05000130. - DOI - PubMed