Visual hallucinations in posterior cortical atrophy.
BACKGROUND
Visual hallucinations have been reported to occur in up to 25% of patients who meet the criteria for posterior cortical atrophy (PCA). It is not known, however, whether patients who meet the criteria for PCA and have hallucinations are different from those who meet the criteria and do not have hallucinations.


OBJECTIVE
To compare the clinical and imaging features of patients with PCA with and without well-formed visual hallucinations.


METHODS
Case-control study.


METHODS
Tertiary care medical center.


METHODS
Fifty-nine patients fulfilling the criteria for PCA were retrospectively identified and divided into 2 groups based on the presence (n = 13) or absence (n = 46) of visual hallucinations.


METHODS
Statistically significant clinical differences and imaging differences using voxel-based morphometry between the 2 groups.


RESULTS
In patients with PCA and hallucinations, parkinsonism and rapid eye movement sleep behavior disorder occurred more frequently, as did myoclonic jerks (P<.001 for both). Voxel-based morphometry showed greater atrophy in a network of structures, including the primary visual cortex, lentiform nuclei, thalamus, basal forebrain, and midbrain, in patients with hallucinations.


CONCLUSIONS
Hallucinations in patients with PCA are associated with parkinsonism, rapid eye movement sleep behavior disorder, and myoclonic jerks. The voxel-based morphometry results suggest that hallucinations in PCA cannot be exclusively attributed to atrophy of the posterior association cortices and may involve a circuit of thalamocortical connections.
Josephs
Keith A
KA
Divisions of Movement Disorders and Behavioral Neurology, Department of Neurology, Mayo Clinic, Rochester, Minn, USA. josephs.keith@mayo.edu
Whitwell
Jennifer L
JL
Boeve
Bradley F
BF
Knopman
David S
DS
Tang-Wai
David F
DF
Drubach
Daniel A
DA
Jack
Clifford R
CR
Petersen
Ronald C
RC
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000150:complications / Q000503:physiopathology*; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D006212:Hallucinations / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D009778:Occipital Lobe / Q000473:pathology / Q000503:physiopathology*; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D020187:REM Sleep Behavior Disorder / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies