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Differential progression of brain atrophy in Parkinson's disease with and without visual hallucinations
  1. Naroa Ibarretxe-Bilbao1,2,3,
  2. Blanca Ramirez-Ruiz2,3,
  3. Carme Junque1,2,3,
  4. Maria Jose Marti1,2,4,
  5. Francesc Valldeoriola1,2,4,
  6. Nuria Bargallo2,5,
  7. Silvia Juanes1,
  8. Eduardo Tolosa1,2,4
  1. 1Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Hospital Clínic de Barcelona, Barcelona, Spain
  2. 2Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  3. 3Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
  4. 4Parkinson's Disease and Movement Disorders Unit, Neurology Service, Institut Clínic de Neurociències (ICN), Hospital Clínic de Barcelona, Barcelona, Spain
  5. 5Centre de Diagnòstic per la Imatge Hospital Clínic de Barcelona (CDIC), Hospital Clínic de Barcelona, Barcelona, Spain
  1. Correspondence to Professor Carme Junque, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Casanova 143, Barcelona 08036, Spain; cjunque{at}


Objective To determine the course of cognitive deficits and the regional progression of brain atrophy in patients with Parkinson's disease (PD) with and without visual hallucinations (VH).

Methods The authors performed MRI and neuropsychological assessment at entry to the study and at follow-up (mean±SD=29.91±5.74 months) in a sample of initially non-demented 12 PD patients with VH, 14 PD patients without VH and 12 healthy controls (HC). Grey-matter changes over time were assessed by means of voxel-based morphometry (VBM) and cognitive changes by an extensive neuropsychological battery.

Results At follow-up, 75% of patients with VH developed dementia. The greatest decline was observed in verbal memory, semantic fluency, language comprehension and visuoperceptive functions. None of the patients without VH met criteria for dementia and did not show any worsening in cognitive functions over time. Patients with VH showed widespread limbic, paralimbic and neocortical grey-matter loss, whereas in the PD without VH group, grey-matter loss was restricted to a small region in the frontal cortex and cerebellum. The authors also found significant correlations between the changes in several cognitive functions and grey-matter loss over time in PD patients with VH.

Conclusion The presence of VH in PD determines a different cognitive outcome and a different pattern of progressive brain atrophy. PD patients with VH, unlike PD without VH, frequently develop dementia and show a widespread atrophy involving limbic, paralimbic and neocortical areas.

  • Parkinson's disease
  • dementia
  • MRI
  • hallucinations
  • longitudinal
  • neuropsychology

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  • Funding This work was supported by Generalitat de Catalunya (2005SGR0000836 to ET, 2005SGR00855 to CJ, UNI/2001/2003 to ET, Uni/2001/2004 to CJ); Ministerio de Educación y Ciencia (AP 2005-019 to NI-B) and de Investigación Biomédica en red sobre Enfermedades Neurodegenerativas (CIBERNED).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Hospital Clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.