Associations between visual hallucinations and impaired visuo-spatial abilities in dementia with Lewy bodies.

Yevgenia Rosenblum, Noa Bregman, Nir Giladi, Anat Mirelman*, Tamara Shiner

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: In dementia with Lewy bodies (DLB) recurrent visual hallucinations (VH) often coexist or occur consecutively to impaired visual perception. Since in-depth neuropsychological testing is time-consuming, and therefore, not routinely performed in clinical settings, we aimed to explore whether standard cognitive screening tests may be helpful to alert a clinician to the presence of VH in DLB by exploring association between visuo-spatial dysfunction and VH. Method: The clock drawing, cube, and pentagons copying items from Montreal Cognitive Assessment and Mini-Mental State Exam and nonmotor Hooper visual organization test (HVOT) have been scored in DLB patients with and without VH using traditional and extended scoring methods. Results: Forty-five of 69 (65%) DLB patients were VH-positive (VH+). VH+ patients performed worse on the clock drawing (8.8/16 vs. 11.9/16, p = .016) with a higher rate of misrepresentation of time (69% vs. 29%, p = .002) and numbers (53% vs. 25%, p = .024). Likewise, VH+ patients performed worse on the HVOT (13.3/30 vs. 15.7/30, p = .009) having more isolated (6.2/30 vs. 4.4/30, p = .012) types of responses compared to VH− patients. Both groups had similar copying ability (p > .05). The VH discriminative accuracy of the clock drawing was comparable to that of the more elaborate test of visual perception, the HVOT. Conclusions: In DLB impaired drawing and visual organization, but not copying ability is associated with the presence of VH. The simple clock drawing test can be helpful to alert a clinician to the possibility of VH in DLB. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Key points—Question: Whether the visuo-spatial items of the standard cognitive screening tests may be helpful to alert a clinician to the presence of visual hallucinations in dementia with Lewy bodies? Finding: The presence of visual hallucinations is related to poorer clock drawing and visual organization, but not to copying ability of the patients. The standard simple clock drawing test and more elaborate visual perception test showed similar discriminative accuracy. Importance: Dementia with Lewy bodies (DLB) is a syndrome with prominent visuo-spatial dysfunction and visual hallucinations, both of which require clinical attention. The MMSE is the most widely used clinical cognitive screening test in DLB, but does not include clock drawing task. Therefore, a clinician should consider adding the clock drawing task to the MMSE, to help alert to the possibility of the presence of visual dysfunction, which is associated with visual hallucinations. Next steps: To explore which deficit (visual hallucinations or visuo-spatial impairment) comes first and shed light on the origin and mechanism of the reported association, using neuroimaging in combination with neuropsychological tests.

Original languageEnglish
Pages (from-to)276-284
Number of pages9
JournalNeuropsychology
Volume35
Issue number3
DOIs
StatePublished - 2021
Externally publishedYes

Keywords

  • Hooper visual organization test
  • clock drawing test
  • dementia with Lewy bodies
  • visual hallucinations
  • visuo-spatial dysfunction

Fingerprint

Dive into the research topics of 'Associations between visual hallucinations and impaired visuo-spatial abilities in dementia with Lewy bodies.'. Together they form a unique fingerprint.

Cite this