title: Preclinical polymodal hallucinations for 13 years before dementia with Lewy bodies.
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.
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Unità Operativa Complessa di Geriatria, Via Pace 9, 20122 Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Abbate
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Pietro Davide
authors.initials: PD
authors.lastname: Trimarchi
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Unità Operativa Complessa di Geriatria, Via Pace 9, 20122 Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Inglese
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Viti
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Cantatore
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Lisa
authors.initials: L
authors.lastname: De Agostini
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pirri
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Lorenza
authors.initials: L
authors.lastname: Marino
authors.affiliation: Fondazione IRCCS Don Carlo Gnocchi, ONLUS, S. Maria Nascente, Via Capecelatro 66, 20148 Milan, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Bagarolo
authors.affiliation: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Unità Operativa Complessa di Geriatria, Via Pace 9, 20122 Milan, Italy ; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Via Della Commenda 9/12, 20122 Milan, Italy.
authors.forename: Daniela
authors.identifier: 0000-0002-6950-0789
authors.initials: D
authors.lastname: Mari
mesh_terms: D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D006212:Hallucinations / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D020961:Lewy Body Disease / Q000175:diagnosis* / Q000523:psychology; D009483:Neuropsychological Tests; D062706:Prodromal Symptoms