Visual hallucinations in Lewy body disease: pathophysiological insights from phenomenology
Fabrizia D'Antonio, M. Boccia, A. di Vita, Antonio Suppa, A. Fabbrini, M. Canevelli, Francesca Caramia, Marco Fiorelli, Cecilia Guariglia, S. Ferracuti, C. de Lena, D. Aarsland, D. Ffytche
Journal of Neurology January 31, 2022 DOI: 10.1007/s00415-022-10983-6 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cross-sectional observational study Peer reviewed |
|---|---|
| Sample size | 35 |
| Population | Patients with Lewy body disease who experience visual hallucinations |
| Measures | North-East-Visual-Hallucinations-Interview, resting-state fMRI, neuropsychological evaluation |
| Topics | Philosophy of mind |
| Key findings | Minor hallucinations were not associated with cognitive impairment, whereas complex hallucinations were associated with impairments in visuoperceptual processes, attention, and visual abstract reasoning. Hallucination severity, duration, and frequency were each associated with distinct patterns of resting-state functional connectivity; the authors argue these results support the "hodotopic" hypothesis, in which increased connectivity may prolong hallucinations and decreased connectivity may increase their frequency. |
Abstract
Visual hallucinations (VH) in Lewy body disease (LBD) have a heterogenous phenomenology classified into minor phenomena (MVH) and complex hallucinations (CVH). Mechanisms underpinning VH and their temporal aspects are largely unknown. According to the hodotopic model, we investigated whether changes in distinct cognitive domains and neural networks in the hallucination trait underpin temporal aspects of MVH and CVH in the hallucination state. 35 LBD patients with VH underwent a complete neuropsychological evaluation and resting-state fMRI. North-East-Visual-Hallucinations-Interview was used to assess their typical VH content, duration, and frequency. We found that MVH was not associated with cognitive impairment, while CVH was associated with impairments in visuoperceptual processes, attention and visual abstract reasoning. In seed-to-seed functional connectivity (FC) analysis we identified functional couplings associated with MVH and CVH temporal severity (duration x frequency), duration and frequency. MVH severity was negatively associated with FC between early visual areas (EVA) and ventral-visual-stream regions, and negatively associated with FC between brainstem and EVA, which may be linked to LBD brainstem neuropathology. CVH duration was positively associated with FC between ventral-visual stream and salience network (SN). CVH frequency was negatively associated with FC between DMN and SN. Functional alterations in distinct visual and attentional networks and their dynamic interaction in trait LBD hallucinators are linked to both the phenomenology of state content and its temporal characteristics. Within a network, VH frequency and duration may be linked to different types of functional alterations: increased connectivity leading to sustained activity prolonging VH (duration) and decreased connectivity increasing dysregulated, spontaneous activity (frequency). These findings support the hodotopic hypothesis of VH and may reflect a link between VH phenomenology, LBD neuropathological progression and the involvement of specific neurotransmitter systems.
Comparable studies
Other cross-sectional and survey studies on philosophy of mind, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Survey of entity encounter experiences occasioned by inhaled N,N-dimethyltryptamine: Phenomenology, interpretation, and enduring effects. People who had a memorable entity encounter after taking N,N-dimethyltryptamine | 2020 | Survey | n = 2,561 |
| Future directions in meditation research: Recommendations for expanding the field of contemplative science Meditators | 2018 | Cross-sectional online survey | n = 1,120 |
| The Phenomenology of Lucid Dreaming: An Online Survey Respondents to an online survey about lucid dreams | 2014 | Online survey | n = 684 |
| The neurophenomenology of early psychosis: An integrative empirical study. Ultra-high risk for psychosis patients, first episode psychosis patients, and healthy... | 2019 | Cross-sectional | n = 123 |
| Spontaneous Spiritual Awakenings: Phenomenology, Altered States, Individual Differences, and Well-Being People reporting their most powerful Spontaneous Spiritual or Kundalini Awakening | 2021 | Mixed within and between-participants self-report survey design | n = 152 |
Citations in the library
Cited by 4
- Visual mismatch negativity in Parkinson's psychosis and potential for testing treatment mechanisms Brain Communications 2024
- Visual Hallucinations in Serotonergic Psychedelics and Lewy Body Diseases Schizophrenia Bulletin April 17, 2025
- Hallucinations and Related Perceptual Phenomena in Systemic Lupus Erythematosus and Inflammatory Arthritis: A Cross-sectional Mixed-Methods Study Journal of the Academy of Consultation-Liaison Psychiatry May 19, 2025
- Compensatory hallucinogenesis across three neuropsychiatric disorders: a Bayesian account. Brain Communications 2026
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