Visual hallucinations in the Parkinsonian syndromes

Richard Armstrong

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)

Abstract

Differential clinical diagnosis of the parkinsonian syndromes,viz., Parkinson's disease (PD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and corticobasal degeneration (CBD) can be difficult. Visual hallucinations, however, are a chronic complication of some parkinsonian disorders and their presence may be a useful aid to diagnosis. The visual hallucinations in parkinsonism are often recurrent, well-formed, and detailed and occur in a significant proportion of cases of DLB and PD but are less common in PSP, MSA, and CBD. Hallucinations in PD often occur later in the disease and are complex, with flickering lights, and illusionary misconceptions often preceding the most common manifestation, viz., stereotypical colourful images. Hallucinations in DLB, however, are often present earlier in the disease and are similar to those in the 'misidentification syndromes', 'visual agnosias', and in 'delerium' but differ from those produced by hallucinogenic drugs such as LSD. Most typically in DLB, the hallucinations involve people or animals invading the patient's home but may also include inanimate objects and the appearance of writing on walls or ceilings. Visual hallucinations may involve a number of brain mechanisms including a change in the balance of neurotransmitter activity between the cholinergic and monoaminergic systems and may be a specific consequence of Lewy body (LB) pathology in brain stem nuclei. Ocular and retinal pathology may also contribute to hallucinations by reducing occipital stimulation. Hence, in patients with unclassifiable or with indeterminate parkinsonian symptoms, the presence of visual hallucinations should be regarded as a 'red flag' symptom indicating underlying Lewy body pathology and therefore, supporting a diagnosis of PD or DLB rather than PSP, MSA, or CBD. The presence of early visual hallucinations would support a diagnosis of DLB rather than PD.

LanguageEnglish
Title of host publicationHallucinations
Subtitle of host publicationcauses, management and prognosis
EditorsSofia Alvarez
Place of PublicationHauppage, NY (US)
PublisherNova science
Pages27-48
Number of pages22
ISBN (Electronic)978-1-62808-045-2
ISBN (Print)978-1-62808-044-5
Publication statusPublished - Jun 2013

Publication series

NamePsychiatry - Theory, Applications and Treatments
PublisherNova Publishers

Fingerprint

Hallucinations
Parkinsonian Disorders
Lewy Body Disease
Parkinson Disease
Progressive Supranuclear Palsy
Multiple System Atrophy
Lewy Bodies
Pathology
Dementia
Agnosia
Hallucinogens
Lysergic Acid Diethylamide
Cholinergic Agents
Brain Stem
Neurotransmitter Agents
Differential Diagnosis
Light
Brain

Keywords

  • visual hallucinations
  • Parkinsonian disorders
  • Lewy bodies
  • Parkinson’s disease
  • differential diagnosis

Cite this

Armstrong, R. (2013). Visual hallucinations in the Parkinsonian syndromes. In S. Alvarez (Ed.), Hallucinations: causes, management and prognosis (pp. 27-48). (Psychiatry - Theory, Applications and Treatments). Hauppage, NY (US): Nova science.
Armstrong, Richard. / Visual hallucinations in the Parkinsonian syndromes. Hallucinations: causes, management and prognosis. editor / Sofia Alvarez. Hauppage, NY (US) : Nova science, 2013. pp. 27-48 (Psychiatry - Theory, Applications and Treatments).
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Armstrong, R 2013, Visual hallucinations in the Parkinsonian syndromes. in S Alvarez (ed.), Hallucinations: causes, management and prognosis. Psychiatry - Theory, Applications and Treatments, Nova science, Hauppage, NY (US), pp. 27-48.

Visual hallucinations in the Parkinsonian syndromes. / Armstrong, Richard.

Hallucinations: causes, management and prognosis. ed. / Sofia Alvarez. Hauppage, NY (US) : Nova science, 2013. p. 27-48 (Psychiatry - Theory, Applications and Treatments).

Research output: Chapter in Book/Report/Conference proceedingChapter (peer-reviewed)

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Armstrong R. Visual hallucinations in the Parkinsonian syndromes. In Alvarez S, editor, Hallucinations: causes, management and prognosis. Hauppage, NY (US): Nova science. 2013. p. 27-48. (Psychiatry - Theory, Applications and Treatments).