Abbott Emily J, Connor Gillian B, Artes Paul H, Abadi Richard V
University of Manchester, Faculty of Life Sciences, Manchester, England, United Kingdom.
Invest Ophthalmol Vis Sci. 2007 Mar;48(3):1416-23. doi: 10.1167/iovs.06-0942.
The condition in which visual hallucinations (VHs) are solely associated with a visual impairment is termed Charles Bonnet Syndrome (CBS). The study was undertaken to investigate whether the extent of visual acuity (VA) loss and central visual field loss predisposes a patient with age-related macular degeneration (AMD) to develop a CBS VH and, in addition, whether the progression in loss is mirrored in the complexity of the VHs reported. VH phenomenology and CBS prevalence were also examined.
Sixty-six patients (age range, 63-96 years, mean +/- SD 81.2 +/- 7.1 years) with bilateral AMD were questioned as to whether they had experienced any hallucinatory episodes exclusive to vision. The four-point primary inclusion criterion ensured that all patients had bilateral AMD, a bilateral central scotoma, best monocular VA poorer than or equal to 0.6 logMAR (logarithm of the minimum angle of resolution) and intact cognition (using the Mini Mental State Examination for the Blind and the Telephone Interview for Cognitive Status). The patients who did not report VH were classified into the non-VH group, with the remainder in the VH group. An extended Institute of Psychiatry Structural Interview characterized the phenomenology of the VH. A secondary inclusion criterion subdivided the VH group into the apparent CBS group, in which personal medical history may have contributed to VH generation, and the manifest CBS group, where VHs were solely as a result of the visual loss.
Fifty-three patients met the primary inclusion criterion: 32 were classified into the non-VH group and 21 into the VH group. The VH group were slightly younger (median difference, 4 years, P = 0.03) and appeared to have a lower VA (median difference, 0.20 logMAR, P = 0.08) and a more extensive visual field loss (P = 0.06) than did the non-VH group. However, when these variables were evaluated simultaneously by logistic regression, only age emerged as a statistically significant predictor of VH (odds ratio 0.88, 95% confidence interval [CI] 0.8-0.99, P = 0.03). The prevalence of apparent CBS and manifest CBS in the AMD population was found to be 25% and 15%, respectively. With no clinical and phenomenological differences between the two CBS groups, the secondary inclusion criterion was withdrawn, the VH group was renamed the CBS group, and a prevalence of 40% was recalculated. Of the 82 visual phenomena experienced by the CBS group, 21 were classified as simple VHs and 39 as complex VHs, with the remainder classified as either entopic phenomena or visual inference. Patients who experienced both simple and complex VHs appeared to have a greater visual field loss (P = 0.06) compared with those patients who reported either solely simple or solely complex VHs.
The extent of visual loss did not appear to be a predictor for the likelihood of a patient with AMD experiencing a CBS VH, nor was the progression of loss reflected in the complexity of the VHs reported.
视幻觉（VHs）仅与视力损害相关的情况被称为查尔斯·博内综合征（CBS）。本研究旨在调查视力（VA）丧失程度和中心视野丧失是否会使年龄相关性黄斑变性（AMD）患者易患CBS视幻觉，此外，丧失的进展是否反映在所报告的视幻觉的复杂性中。还对视幻觉现象学和CBS患病率进行了研究。
对66例双侧AMD患者（年龄范围63 - 96岁，平均±标准差81.2±7.1岁）询问他们是否经历过仅视觉方面的幻觉发作。四点主要纳入标准确保所有患者患有双侧AMD、双侧中心暗点、最佳单眼视力低于或等于0.6 logMAR（最小分辨角的对数）且认知完整（使用盲人简易精神状态检查表和认知状态电话访谈）。未报告视幻觉的患者被分类为非视幻觉组，其余患者为视幻觉组。扩展的精神病学研究所结构化访谈对视幻觉的现象学进行了描述。次要纳入标准将视幻觉组细分为明显CBS组（个人病史可能导致视幻觉产生）和明显CBS组（视幻觉完全是视力丧失的结果）。
53例患者符合主要纳入标准：32例被分类为非视幻觉组，21例被分类为视幻觉组。视幻觉组患者年龄稍小（中位数差异4岁，P = 0.03），与非视幻觉组相比，似乎视力更低（中位数差异0.20 logMAR，P = 0.08）且视野丧失更广泛（P = 0.06）。然而，当通过逻辑回归同时评估这些变量时，只有年龄成为视幻觉的统计学显著预测因素（优势比0.88，95%置信区间[CI] 0.8 - 0.99，P = 0.03）。在AMD人群中，明显CBS和明显CBS的患病率分别为25%和15%。由于两个CBS组之间在临床和现象学上没有差异，次要纳入标准被取消，视幻觉组重新命名为CBS组，并重新计算患病率为40%。在CBS组经历的82种视觉现象中，21种被分类为简单视幻觉，39种为复杂视幻觉，其余分类为内视现象或视觉推理。与仅报告简单或仅报告复杂视幻觉的患者相比，经历简单和复杂视幻觉的患者似乎视野丧失更大（P = 0.06）。
视力丧失程度似乎不是AMD患者发生CBS视幻觉可能性的预测因素，丧失的进展也未反映在所报告的视幻觉的复杂性中。
