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 Visual hallucinations in dementia- more likely in LBD 
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Post Visual hallucinations in dementia- more likely in LBD
This article on visual hallucinations in dementia was published recently. The goal of the study was to learn if certain types of pathology are associated with hallucinations in those who had dementia. The brain tissue of 148 deceased patients with clinical diagnoses of dementia was analyzed.

"Subjects with visual hallucinations were also more likely than subjects without visual hallucinations to have Lewy-related pathology (LRP) (78% versus 45%). In addition, a higher frequency of visual hallucinations was observed in subjects with neocortical LRP than subjects with limbic-, amygdala-, or brainstem-predominant LRP. Although Alzheimer disease with concomitant LRP was the most common neuropathologic subtype in the visual hallucinations-positive group (59%), the frequency of subjects with Alzheimer disease pathology did not differ significantly between those with and without visual hallucinations (74% versus 62%)."

The authors concluded: "Subjects with visual hallucinations were more likely to have concomitant postural and gait disturbance, additional neuropsychiatric symptoms, and neocortical LRP than subjects without visual hallucinations. Visual hallucinations accompanying dementia have distinct clinical and neuropathologic characteristics that are
important for prognosis and clinical management."

After reading over the full paper, here are a few more items I found interesting:

-- "Behaviorally, VH-positive subjects were more likely than VH-negative subjects to have exhibited delusions, agitation and aggression, and apathy."

-- "Subjects who experienced VHs were younger at intake... We speculate that VHs are associated with a more aggressive clinical course and an earlier age of onset. However, some studies have reported no differences in age at onset between DLB subjects with and without VHs. Thus, because of the highly selective nature of the previous studies, the association between age and VH status in neurodegenerative dementia remains inconclusive and requires further investigation..."

-- "There was little difference in APOE*4 allele frequencies between VH-positive and VH-negative groups (36% versus 31%)."

-- "In our study, 18% of dementia subjects were VH-positive."

The abstract follows.

Robin



American Journal of Geriatric Psychiatry. 2009 Apr;17(4):317-23.

Visual hallucinations in dementia: a prospective community-based study with autopsy.

Tsuang D, Larson EB, Bolen E, Thompson ML, Peskind E, Bowen J, McCormick W, Teri L, Kukull W, Vavrek D, Montine T, Leverenz JB.
Veterans Affairs Northwest Network Mental Illness Research, Education, and Clinical Center, USA.

OBJECTIVE: Several studies have demonstrated that specific neuropathologic features may be associated with the presence of visual hallucinations in dementia patients, but the clinical usefulness of these studies has been limited because their subjects were selected on the basis of neuropathologic findings rather than clinical presentations. This study seeks to investigate the demographic, clinical, and neuropathologic features of community-based dementia subjects with and without visual hallucinations.

DESIGN: A prospective examination of the clinical and neuropathologic correlates of visual hallucinations in community-based dementia subjects.

PARTICIPANTS: One hundred forty-eight subjects with sufficient clinical and neuropathologic data from a community-based incident dementia autopsy case series.

RESULTS: Subjects were classified according to the presence or absence of visual hallucinations and subjects with visual hallucinations (N = 27) were younger at intake and more likely to exhibit agitation, delusions, and apathy than subjects without visual hallucinations (N = 121). Subjects with visual hallucinations were also more likely than
subjects without visual hallucinations to have Lewy-related pathology (LRP) (78% versus 45%). In addition, a higher frequency of visual hallucinations was observed in subjects with neocortical LRP than subjects with limbic-, amygdala-, or brainstem-predominant LRP. Although Alzheimer disease with concomitant LRP was the most common neuropathologic subtype in the visual hallucinations-positive group (59%), the frequency of subjects with Alzheimer disease pathology did not differ significantly between those with and without visual hallucinations (74% versus 62%).

CONCLUSIONS: Subjects with visual hallucinations were more likely to have concomitant postural and gait disturbance, additional neuropsychiatric symptoms, and neocortical LRP than subjects without visual hallucinations. Visual hallucinations accompanying dementia have distinct clinical and neuropathologic characteristics that are
important for prognosis and clinical management.

PubMed ID#: 19307860 (see pubmed.gov for this abstract only; the abstract is available there for free)


Mon Jun 08, 2009 10:14 pm
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