RT Journal Article
SR Electronic
T1 Visual hallucinations in neurological and ophthalmological disease: pathophysiology and management
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 512
OP 519
DO 10.1136/jnnp-2019-322702
VO 91
IS 5
A1 O'Brien, John
A1 Taylor, John Paul
A1 Ballard, Clive
A1 Barker, Roger A
A1 Bradley, Clare
A1 Burns, Alistair
A1 Collerton, Daniel
A1 Dave, Sonali
A1 Dudley, Rob
A1 Francis, Paul
A1 Gibbons, Andrea
A1 Harris, Kate
A1 Lawrence, Vanessa
A1 Leroi, Iracema
A1 McKeith, Ian
A1 Michaelides, Michel
A1 Naik, Chaitali
A1 O'Callaghan, Claire
A1 Olsen, Kirsty
A1 Onofrj, Marco
A1 Pinto, Rebecca
A1 Russell, Gregor
A1 Swann, Peter
A1 Thomas, Alan
A1 Urwyler, Prabitha
A1 Weil, Rimona Sharon
A1 ffytche, Dominic
YR 2020
UL http://jnnp.bmj.com/content/91/5/512.abstract
AB Visual hallucinations are common in older people and are especially associated with ophthalmological and neurological disorders, including dementia and Parkinson’s disease. Uncertainties remain whether there is a single underlying mechanism for visual hallucinations or they have different disease-dependent causes. However, irrespective of mechanism, visual hallucinations are difficult to treat. The National Institute for Health Research (NIHR) funded a research programme to investigate visual hallucinations in the key and high burden areas of eye disease, dementia and Parkinson’s disease, culminating in a workshop to develop a unified framework for their clinical management. Here we summarise the evidence base, current practice and consensus guidelines that emerged from the workshop.Irrespective of clinical condition, case ascertainment strategies are required to overcome reporting stigma. Once hallucinations are identified, physical, cognitive and ophthalmological health should be reviewed, with education and self-help techniques provided. Not all hallucinations require intervention but for those that are clinically significant, current evidence supports pharmacological modification of cholinergic, GABAergic, serotonergic or dopaminergic systems, or reduction of cortical excitability. A broad treatment perspective is needed, including carer support. Despite their frequency and clinical significance, there is a paucity of randomised, placebo-controlled clinical trial evidence where the primary outcome is an improvement in visual hallucinations. Key areas for future research include the development of valid and reliable assessment tools for use in mechanistic studies and clinical trials, transdiagnostic studies of shared and distinct mechanisms and when and how to treat visual hallucinations.