International Psychogeriatrics

Aspects of Dementia

A Detailed Phenomenological Comparison of Complex Visual Hallucinations in Dementia With Lewy Bodies and Alzheimer's Disease

Clive Ballard a1, Ian McKeith a2, Richard Harrison a3, John O'Brien a2, Peter Thompson a3, Kath Lowery a4, Robert Perry a2 and Paul Ince a1
a1 MRC Neurochemical Pathology Unit, Newcastle General Hospital, Newcastle Upon Tyne, Newcastle, England
a2 University of Newcastle Upon Tyne, Newcastle, England
a3 Bensham Hospital, Tyne & Wear, England
a4 Newcastle General Hospital, Newcastle Upon Tyne, England.

Article author query
ballard c   [PubMed][Google Scholar] 
mckeith i   [PubMed][Google Scholar] 
harrison r   [PubMed][Google Scholar] 
o'brien j   [PubMed][Google Scholar] 
thompson p   [PubMed][Google Scholar] 
lowery k   [PubMed][Google Scholar] 
perry r   [PubMed][Google Scholar] 
ince p   [PubMed][Google Scholar] 


Visual hallucinations (VH) are a core feature of dementia with Lewy bodies (DLB), but little is known about their phenomenology. A total of 73 dementia patients (42 DLB, 30 Alzheimer's disease [AD], 1 undiagnosed) in contact with clinical services were assessed with a detailed standardized inventory. DLB was diagnosed according to the criteria of McKeith and colleagues, AD was diagnosed using the NINCDS-ADRDA criteria. Autopsy confirmation has been obtained when possible. VH were defined using the definition of Burns and colleagues. Detailed descriptions of hallucinatory experiences were recorded. Annual follow-up interviews were undertaken. The clinical diagnosis has been confirmed in 18 of the 19 cases that have come to autopsy. A total of 93% of DLB patients and 27% of AD patients experienced VH. DLB patients were significantly more likely to experience multiple VH that persisted over follow-up. They were significantly more likely to hear their VH speak but there were no significant differences in the other phenomenological characteristics including whether the hallucinations moved, the time of day that they were experienced, their size, the degree of insight, and whether they were complete. VH may be more likely to be multiple, to speak, and to be persistent in DLB patients. These characteristics could potentially aid accurate diagnosis.