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Regional cerebral blood flow in Parkinson disease with nonpsychotic visual hallucinations

From Human Brain Research Center (Drs. Oishi, Sawamoto, Hashikawa, and Fukuyama), Kyoto University Graduate School of Medicine; and Department of Neurology (Drs. Oishi, Udaka, and Kameyama), Sumitomo Hospital, Osaka, Japan.

Address correspondence and reprint requests to Dr. Naoya Oishi, Human Brain Research Center, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; e-mail: noishi{at}kuhp.kyoto-u.ac.jp

Background: Patients with Parkinson disease (PD) often experience visual hallucinations (VH) with retained insight (nonpsychotic) but the precise mechanism remains unclear.

Objective: To clarify which neural substrates participate in nonpsychotic VH in PD, the authors evaluated regional cerebral blood flow (rCBF) changes in patients with PD and VH.

Methods: The authors compared 24 patients with PD who had nonpsychotic VH (hallucinators) and 41 patients with PD who had never experienced VH (non-hallucinators) using SPECT images with N-isopropyl-p-[¹²³I]iodoamphetamine. There were no significant differences in age, sex, duration of disease, doses of PD medications, Hoehn and Yahr scale, or Mini-Mental State Examination (MMSE) scores between the two groups. The rCBF data were analyzed using statistical parametric mapping (SPM).

Results: The rCBF in the right fusiform gyrus was lower in the hallucinators than in the non-hallucinators (corrected p < 0.05 at cluster levels). The hallucinators revealed higher rCBF in the right superior and middle temporal gyri than the non-hallucinators (uncorrected p < 0.001). These significant differences were demonstrated after MMSE scores and duration of disease, which are the relevant factors associated with VH, were covariated out.

Conclusions: Nonpsychotic visual hallucinations in Parkinson disease (PD) may be associated with hypoperfusion in the right fusiform gyrus and hyperperfusion in the right superior and middle temporal gyri. These temporal regions are important for visual object recognition and these regional cerebral blood flow changes are associated with inappropriate visual processing and are responsible for nonpsychotic visual hallucinations in PD.

Supported in part by Grants-in-Aid for Scientific Research (B) 14370205 from the Ministry of Education, Culture, Sports, Science and Technology, and General Research Grant "Science of Mind" and "Aging and Health" from the Ministry of Health, Labor and Welfare.

Disclosure: The authors report no conflicts of interest.

Received January 18, 2005. Accepted in final form August 15, 2005.

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