Neurology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
Ophtalmology Department, Université Clermont-Auvergne, EA7280, Clermont-Ferrand University Hospital, Clermont-Ferrand, France.
J Neurol. 2020 Oct;267(10):2829-2841. doi: 10.1007/s00415-020-09925-x. Epub 2020 May 23.
Whether different mechanisms, particularly ocular pathology, could lead to the emergence of visual hallucinations (VH) (defined as false perceptions with no external stimulus) versus visual illusions (VI) (defined as a misperception of a real stimulus) in Parkinson's disease (PD) remains debated. We assessed retinal, clinical and structural brain characteristics depending on the presence of VH or VI in PD.
In this case-control study, we compared retinal thickness using optical coherence tomography (OCT), between PD patients with: VI (PD-I; n = 26), VH (PD-H; n = 28), and without VI or VH (PD-C; n = 28), and assessed demographic data, disease severity, treatment, anatomical and functional visual complaints, cognitive and visuo-perceptive functions and MRI brain volumetry for each group of PD patients.
Parafoveal retina was thinner in PD-H compared to PD-C (p = 0.005) and PD-I (p = 0.009) but did not differ between PD-I and PD-C (p = 0.85). Multivariate analysis showed that 1/retinal parafoveal thinning and total brain gray matter atrophy were independently associated with the presence of VH compared to PD-I; 2/retinal parafoveal thickness, PD duration, sleep quality impairment and total brain gray matter volume were independent factors associated with the presence of VH compared to PD-C; 3/anterior ocular abnormalities were the only factor independently associated with the presence of illusions compared to PD-C.
These findings reinforce the hypothesis that there may be different mechanisms contributing to VH and VI in PD, suggesting that these two entities may also have a different prognosis rather than simply lying along a continuous spectrum.
Clinicaltrials.gov number NCT01114321.
在帕金森病（PD）中，不同的机制，特别是眼部病理学，是否会导致出现视觉幻觉（VH）（定义为没有外部刺激的虚假感知）与视觉错觉（VI）（定义为对真实刺激的错误感知）仍存在争议。我们根据 PD 患者是否存在 VH 或 VI 评估了视网膜、临床和结构脑特征。
在这项病例对照研究中，我们使用光学相干断层扫描（OCT）比较了伴有 VI（PD-I；n=26）、VH（PD-H；n=28）和无 VI 或 VH（PD-C；n=28）的 PD 患者的视网膜厚度，并评估了每组 PD 患者的人口统计学数据、疾病严重程度、治疗、解剖和功能视觉主诉、认知和视知觉功能以及 MRI 脑容积。
与 PD-C（p=0.005）和 PD-I（p=0.009）相比，PD-H 的旁中心视网膜变薄，但 PD-I 和 PD-C 之间无差异（p=0.85）。多变量分析显示，与 PD-I 相比，1/视网膜旁中心变薄和总脑灰质萎缩与 VH 的存在独立相关；2/视网膜旁中心厚度、PD 持续时间、睡眠质量受损和总脑灰质体积是与 VH 存在相关的独立因素，而与 PD-C 相比；3/前眼部异常是与 PD-C 相比与幻觉存在相关的唯一因素。
这些发现进一步支持了这样一种假设，即可能有不同的机制导致 PD 中的 VH 和 VI，这表明这两种病症可能也有不同的预后，而不仅仅是简单地沿着连续谱存在。
Clinicaltrials.gov 编号 NCT01114321。
