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Preclinical polymodal hallucinations for 13 years before dementia with Lewy bodies.

Abbate C, Trimarchi PD, Inglese S, Viti N, Cantatore A, De Agostini L, Pirri F, Marino L, Bagarolo R, Mari D - Behav Neurol (2014)

Bottom Line: The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS).The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB.It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker.

View Article: PubMed Central - PubMed

Affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Unità Operativa Complessa di Geriatria, Via Pace 9, 20122 Milan, Italy.

ABSTRACT

Objective: We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations.

Background: Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood.

Methods: The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage.

Results: The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB.

Conclusions: This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder.

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Related in: MedlinePlus

BG's copy of the Rey-Osterrieth complex figure.
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fig2: BG's copy of the Rey-Osterrieth complex figure.

Mentions: As shown in Table 3, global cognitive functioning and general intellectual functions were preserved. A slight impairment of prefrontal executive functions emerged. In particular, BG had some difficulty on the WCST [38] and her performance was impaired on the switching task (TMT, part B) [39], on the categorical thinking task (Weigl test) [40], and on the CET [41]. Her performance on the other prefrontal tests, the semantic and phonologic verbal fluency tasks and the working memory task, was normal. A slight psychomotor slowness was evident, as measured by the tracking task (TMT, part A). Short-term, anterograde, and semantic memory were all preserved. No impairments of selective visual attention, visual spatial attention (neglect), language, ideomotor, and orofacial praxis emerged. A significant impairment resulted on the object decision task from the BORB [53], suggesting an isolated mild disruption at the structural description stage of visual processing [60]. No other impairments of visual perception from the early (discrimination of scribbles test and minimal feature view task from BORB) to late (picture naming test and associative match task from BORB) stages of visual processing emerged. A significant deficit, suggesting simultanagnosia, appeared on Navon's letters task (BG's performance = 30/60; mean control performance = 52.5, SD = 6.5; t = −3.205, P = .024, two-tailed). A mild visuoconstructional impairment resulted from the copy of Rey-Osterrieth complex figure test [44] (see Figure 2). The copy of geometrical figures test was globally unimpaired; nevertheless, BG made two errors while drawing the two most complex figures included in this test. No impairments of other visuospatial abilities emerged (dot counting task). Finally, no signs of finger agnosia emerged on the finger localization test [40].


Preclinical polymodal hallucinations for 13 years before dementia with Lewy bodies.

Abbate C, Trimarchi PD, Inglese S, Viti N, Cantatore A, De Agostini L, Pirri F, Marino L, Bagarolo R, Mari D - Behav Neurol (2014)

BG's copy of the Rey-Osterrieth complex figure.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4020531&req=5

fig2: BG's copy of the Rey-Osterrieth complex figure.
Mentions: As shown in Table 3, global cognitive functioning and general intellectual functions were preserved. A slight impairment of prefrontal executive functions emerged. In particular, BG had some difficulty on the WCST [38] and her performance was impaired on the switching task (TMT, part B) [39], on the categorical thinking task (Weigl test) [40], and on the CET [41]. Her performance on the other prefrontal tests, the semantic and phonologic verbal fluency tasks and the working memory task, was normal. A slight psychomotor slowness was evident, as measured by the tracking task (TMT, part A). Short-term, anterograde, and semantic memory were all preserved. No impairments of selective visual attention, visual spatial attention (neglect), language, ideomotor, and orofacial praxis emerged. A significant impairment resulted on the object decision task from the BORB [53], suggesting an isolated mild disruption at the structural description stage of visual processing [60]. No other impairments of visual perception from the early (discrimination of scribbles test and minimal feature view task from BORB) to late (picture naming test and associative match task from BORB) stages of visual processing emerged. A significant deficit, suggesting simultanagnosia, appeared on Navon's letters task (BG's performance = 30/60; mean control performance = 52.5, SD = 6.5; t = −3.205, P = .024, two-tailed). A mild visuoconstructional impairment resulted from the copy of Rey-Osterrieth complex figure test [44] (see Figure 2). The copy of geometrical figures test was globally unimpaired; nevertheless, BG made two errors while drawing the two most complex figures included in this test. No impairments of other visuospatial abilities emerged (dot counting task). Finally, no signs of finger agnosia emerged on the finger localization test [40].

Bottom Line: The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS).The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB.It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker.

View Article: PubMed Central - PubMed

Affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Unità Operativa Complessa di Geriatria, Via Pace 9, 20122 Milan, Italy.

ABSTRACT

Objective: We describe a case of dementia with Lewy bodies (DLB) that presented long-lasting preclinical complex polymodal hallucinations.

Background: Few studies have deeply investigated the characteristics of hallucinations in DLB, especially in the preclinical phase. Moreover, the clinical phenotype of mild cognitive impairment-(MCI-) DLB is poorly understood.

Methods: The patient was followed for 4 years and a selective phenomenological and cognitive study was performed at the predementia stage.

Results: The phenomenological study showed the presence of hypnagogic and hypnopompic hallucinations that allowed us to make a differential diagnosis between DLB and Charles Bonnet syndrome (CBS). The neuropsychological evaluation showed a multiple domain without amnesia MCI subtype with prefrontal dysexecutive, visuoperceptual, and visuospatial impairments and simultanagnosia, which has not previously been reported in MCI-DLB.

Conclusions: This study extends the prognostic value of hallucinations for DLB to the preclinical phases. It supports and refines the MCI-DLB concept and identifies simultanagnosia as a possible early cognitive marker. Finally, it confirms an association between hallucinations and visuoperceptual impairments at an intermediate stage of the disease course and strongly supports the hypothesis that hallucinations in the earliest stages of DLB may reflect a narcolepsy-like REM-sleep disorder.

Show MeSH
Related in: MedlinePlus