Visual hallucinations in neurological and ophthalmological disease: pathophysiology and management
Top Cited Papers
Open Access
- 25 March 2020
- journal article
- review article
- Published by BMJ in Journal of Neurology, Neurosurgery & Psychiatry
- Vol. 91 (5), 512-519
- https://doi.org/10.1136/jnnp-2019-322702
Abstract
Visual hallucinations are common in older people and are especially associated with ophthalmological and neurological disorders, including dementia and Parkinson’s disease. Uncertainties remain whether there is a single underlying mechanism for visual hallucinations or they have different disease-dependent causes. However, irrespective of mechanism, visual hallucinations are difficult to treat. The National Institute for Health Research (NIHR) funded a research programme to investigate visual hallucinations in the key and high burden areas of eye disease, dementia and Parkinson’s disease, culminating in a workshop to develop a unified framework for their clinical management. Here we summarise the evidence base, current practice and consensus guidelines that emerged from the workshop. Irrespective of clinical condition, case ascertainment strategies are required to overcome reporting stigma. Once hallucinations are identified, physical, cognitive and ophthalmological health should be reviewed, with education and self-help techniques provided. Not all hallucinations require intervention but for those that are clinically significant, current evidence supports pharmacological modification of cholinergic, GABAergic, serotonergic or dopaminergic systems, or reduction of cortical excitability. A broad treatment perspective is needed, including carer support. Despite their frequency and clinical significance, there is a paucity of randomised, placebo-controlled clinical trial evidence where the primary outcome is an improvement in visual hallucinations. Key areas for future research include the development of valid and reliable assessment tools for use in mechanistic studies and clinical trials, transdiagnostic studies of shared and distinct mechanisms and when and how to treat visual hallucinations.Keywords
Funding Information
- Programme Grants for Applied Research (RP‐PG‐0610‐10100)
This publication has 94 references indexed in Scilit:
- Advances In the Treatment of Visual Hallucinations In Neurodegenerative DiseasesFuture Neurology, 2013
- Dopamine transporter imaging is associated with long‐term outcomes in Parkinson's diseaseMovement Disorders, 2012
- Frequency, prevalence, incidence and risk factors associated with visual hallucinations in a sample of patients with Parkinson's disease: a longitudinal 4‐year studyInternational Journal of Geriatric Psychiatry, 2012
- Pareidolias: complex visual illusions in dementia with Lewy bodiesBrain, 2012
- Improved Visual Hallucination by Donepezil and Occipital Glucose Metabolism in Dementia with Lewy Bodies: The Osaki-Tajiri ProjectEuropean Neurology, 2010
- Pimavanserin, a Serotonin2A Receptor Inverse Agonist, for the Treatment of Parkinson's Disease PsychosisNeuropsychopharmacology, 2009
- Successful Treatment of Hallucinations Associated With Sensory Impairment Using GabapentinThe Journal of Neuropsychiatry and Clinical Neurosciences, 2008
- Cholinesterase inhibitors in advanced Dementia with Lewy bodies: increase or stop?International Journal of Geriatric Psychiatry, 2006
- What best differentiates Lewy body from Alzheimer's disease in early-stage dementia?Brain, 2006
- Natural history of behavioural changes and psychiatric symptoms in Alzheimer's diseaseThe British Journal of Psychiatry, 1999