title: Neuronal Loss and Α-Synuclein Pathology in the Superior Colliculus and Its Relationship to Visual Hallucinations in Dementia with Lewy Bodies.
abstract: OBJECTIVE
  Patients with dementia with Lewy bodies (DLB) often experience visual hallucinations, which are related to decreased quality of life for patients and increased caregiver distress. The pathologic changes that contribute to visual hallucinations are not known, but several hypotheses implicate deficient attentional processing. The superior colliculus has a role in visual attention and planning eye movements and has been directly implicated in several models of visual hallucinations. Therefore, the present study sought to identify neurodegenerative changes that may contribute to hallucinations in DLB.
  
  
  METHODS
  Postmortem superior colliculus tissue from 13 comparison, 10 DLB, and 10 Alzheimer disease (AD) cases was evaluated using quantitative neuropathologic methods.
  
  
  RESULTS
  α-Synuclein and tau deposition were more severe in deeper layers of the superior colliculus. DLB cases had neuronal density reductions in the stratum griseum intermedium, an important structure in directing attention toward visual targets. In contrast, neuronal density was reduced in all laminae of the superior colliculus in AD.
  
  
  CONCLUSIONS
  These findings suggest that regions involved in directing attention toward visual targets are subject to neurodegenerative changes in DLB. Considering several hypotheses of visual hallucinations implicating dysfunctional attention toward external stimuli, these findings may provide evidence of pathologic changes that contribute to the manifestation of visual hallucinations in DLB.
authors.affiliation: Ageing Research Laboratories, Newcastle University, Newcastle upon Tyne, United Kingdom; Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Erskine
authors.affiliation: Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Thomas
authors.affiliation: Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Taylor
authors.affiliation: Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Savage
authors.affiliation: Ageing Research Laboratories, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Johannes
authors.initials: J
authors.lastname: Attems
authors.affiliation: Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Ian G
authors.initials: IG
authors.lastname: McKeith
authors.affiliation: Ageing Research Laboratories, Newcastle University, Newcastle upon Tyne, United Kingdom; Medical Toxicology Centre, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Morris
authors.affiliation: Ageing Research Laboratories, Newcastle University, Newcastle upon Tyne, United Kingdom. Electronic address: ahmad.khundakar@newcastle.ac.uk.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Khundakar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications / Q000378:metabolism / Q000473:pathology; D016022:Case-Control Studies; D002452:Cell Count; D005260:Female; D006212:Hallucinations / Q000150:complications / Q000473:pathology*; D006801:Humans; D020961:Lewy Body Disease / Q000150:complications / Q000378:metabolism* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009410:Nerve Degeneration / Q000473:pathology*; D013477:Superior Colliculi / Q000378:metabolism* / Q000473:pathology*; D024801:Tauopathies / Q000150:complications / Q000378:metabolism / Q000473:pathology; D051844:alpha-Synuclein / Q000378:metabolism*
chemical_list: D051844:alpha-Synuclein
keywords: Dementia; Lewy; neuropathology; neuropsychiatry; superior colliculus; visual