Kakeda Kyosuke, Kanemoto Hideki, Yoshiyama Kenji, Suehiro Takashi, Umeda Sumiyo, Nakatani Yoshitaka, Koizumi Fuyuki, Satake Yuto, Yamakawa Maki, Yamamoto Yuki, Isohashi Kayako, Kato Hiroki, Tomiyama Noriyuki, Hashimoto Mamoru, Ikeda Manabu
Department of Psychiatry, The University of Osaka Graduate School of Medicine, Suita, Osaka, Japan.
Department of Psychiatry, Kyoto Narabigaoka Hospital, Kyoto, Kyoto, Japan.
Psychogeriatrics. 2025 Sep;25(5):e70082. doi: 10.1111/psyg.70082.
We examined the clinical features of tactile hallucinations associated with dementia with Lewy bodies and investigated their neural substrates.
This retrospective observational cross-sectional study enrolled 147 patients with probable dementia with Lewy bodies from the Department of Psychiatry, The University of Osaka Hospital, and collected the data of Clinical Dementia Rating, Mini-Mental State Examination, Neuropsychiatric Inventory-plus, and their demographics. Furthermore, magnetic resonance imaging and cerebral blood flow data from single-photon emission computed tomography were collected when possible.
Ten patients (6.9%) had tactile hallucinations. There were no significant differences in age, sex, or cognitive function between the patients with and without tactile hallucinations. The patients with tactile hallucinations had more severe neuropsychiatric symptoms, although none developed delusional infestations. Magnetic resonance imaging showed lower grey matter volume in the right postcentral gyrus, and single-photon emission computed tomography images showed lower cerebral blood flow in the left postcentral gyrus and relatively higher cerebral blood flow in the left inferior frontal gyrus in patients with tactile hallucinations than in those without. Single-photon emission computed tomography was available for only three patients among those with tactile hallucinations. Cerebral blood flow in the postcentral gyrus was reduced in all three patients compared with the database of age-sex-matched healthy controls.
These findings suggest that tactile hallucinations in patients with dementia with Lewy bodies may be related to damage in the postcentral gyrus and preserved function in the frontal lobe; this could be consistent with the "release phenomena" hypothesis of hallucinations.
我们研究了与路易体痴呆相关的幻触的临床特征，并探究了其神经基础。
这项回顾性观察性横断面研究纳入了大阪大学医院精神科的147例可能患有路易体痴呆的患者，收集了临床痴呆评定量表、简易精神状态检查表、神经精神科问卷升级版的数据以及他们的人口统计学资料。此外，尽可能收集了磁共振成像和单光子发射计算机断层扫描的脑血流数据。
10例患者（6.9%）出现幻触。有幻触和无幻触的患者在年龄、性别或认知功能方面无显著差异。有幻触的患者神经精神症状更严重，尽管均未出现妄想性寄生虫感染。磁共振成像显示右侧中央后回灰质体积较低，单光子发射计算机断层扫描图像显示有幻触的患者左侧中央后回脑血流较低，左侧额下回脑血流相对较高。单光子发射计算机断层扫描仅对3例有幻触的患者可用。与年龄和性别匹配的健康对照数据库相比，这3例患者中央后回的脑血流均减少。
这些发现表明，路易体痴呆患者的幻触可能与中央后回损伤及额叶功能保留有关；这可能与幻觉的“释放现象”假说一致。
