Structural and functional neuroimaging in patients with Parkinson's disease and visual hallucinations: A critical review
Abstract
Patients with Parkinson's disease (PD) may develop various non-motor symptoms (NMS) during the course of the illness and psychosis is one of the common NMS of PD. Visual hallucinations (VH) are the most common manifestation of psychosis in PD. The exact pathogenesis of VH in patients with PD is not clearly understood. Presence of VH has been described to be associated with rapid cognitive decline and increased nursing home placements in PD patients. A large number of structural and functional neuroimaging studies have been conducted to understand the cerebral basis of VH in PD. Structural imaging studies (Voxel Based Morphometry) have reported grey matter atrophy in multiple regions of the brain such as primary visual cortex, visual association cortex, limbic regions, cholinergic structures such as pedunculopontine nucleus and substantia innominata, which conclude possible alterations of brain regions associated with functions such as visuospatial-perception, attention control and memory. Most functional neuroimaging studies (functional MRI, positron emission tomography and single photon emission computerized tomography) have reported altered activation, blood flow, or reduced metabolism in both dorsal and ventral visual pathways, which probably indicates an alteration in the normal bottom-top visual processing and the presence of an aberrant top-down visual processing. This review critically analyzes the published studies on the structural and functional neuroimaging in PD patients with VH.
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Morphological and functional alterations differentiate patients with PD with VH from those without VH.
“Although morphological5–7 and functional7–9 alterations differentiate patients with PD with VH (PD-VH) from those without VH”
From Deviations in effective connectivity explain different hallucination subtypes in Parkinson's disease psychosis (2026) · cites this paper as [7]
Cites
Voxel-Based Morphometry—The Methods
Ashburner, J., & Friston, K. J. (2000) · NeuroImage · doi:10.1006/nimg.2000.0582 · Cited by 8,676 · see citing works
Parkinson's disease: clinical features and diagnosis
Jankovic, J. (2008) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp.2007.131045 · Cited by 5,720 · cited 1× · see citing works
“Though tremor at rest, rigidity, bradykinesia and postural instability are the key motor symptoms of PD [2], various non-motor symptoms (NMS) such as psychosis, depression, cognitive decline, autonomic disturbances, sleep disturbances may be observed during the course of illness [3,4].”
Epidemiology of Parkinson's disease
de Lau, L. M., & Breteler, M. M. (2006) · The Lancet Neurology · doi:10.1016/s1474-4422(06)70471-9 · Cited by 4,110 · cited 1× · see citing works
“3% among people aged<60 years and 1% among those older than 60 years [1].”
BackgroundJ Neuropsychiatry Clin Neurosci
Yudofsky, S. C., & Hales, R. E. (1992) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.4.4.359 · Cited by 3,818 · see citing works
Kastner, S., Pinsk, M. A., De Weerd, P., Desimone, R., & Ungerleider, L. G. (1999) · Neuron · doi:10.1016/s0896-6273(00)80734-5 · Cited by 1,622 · see citing works
Chaudhuri, K. R., Martinez‐Martin, P., Schapira, A. H. V., Stocchi, F., Sethi, K., Odin, P., Brown, R. G., Koller, W., Barone, P., MacPhee, G., et al. (2006) · Movement Disorders · doi:10.1002/mds.20844 · Cited by 1,100 · see citing works
Hallucinations in Parkinson's disease: Prevalence, phenomenology and risk factors
Fénelon, G. (2000) · Brain · doi:10.1093/brain/123.4.733 · Cited by 1,035 · see citing works
The role of the limbic system in experiential phenomena of temporal lobe epilepsy
GLOOR, P., Olivier, A., QUESNEY, L. F., Andermann, F., & Horowitz, S. L. (1982) · Annals of Neurology · doi:10.1002/ana.410120203 · Cited by 849 · see citing works
Predictors of Nursing Home Placement in Parkinson's Disease: A Population‐Based, Prospective Study
Aarsland, D., Larsen, J. P., Tandberg, E., & Laake, K. (2000) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2000.tb06891.x · Cited by 811 · see citing works
Top-down signal from prefrontal cortex in executive control of memory retrieval
Tomita, H., Ohbayashi, M., Nakahara, K., Hasegawa, I., & Miyashita, Y. (1999) · Nature · doi:10.1038/44372 · Cited by 615 · see citing works
Martínez‐Martín, P., Schapira, A. H. V., Stocchi, F., Sethi, K. D., Odin, P., Macphee, G. J. A., Brown, R. G., Naidu, Y., Clayton, L. M. S., Abe, K., et al. (2007) · Movement Disorders · doi:10.1002/mds.21586 · Cited by 556 · see citing works
Clinical correlates of selective pathology in the amygdala of patients with Parkinson’s disease
Harding, A. J., Stimson, E., Henderson, J. M., & Halliday, G. M. (2002) · Brain · doi:10.1093/brain/awf251 · Cited by 445 · see citing works
The pedunculopontine nucleus in Parkinson's disease
Zweig, R. M., Jankel, W. R., Hedreen, J. C., Mayeux, R. P., & Price, D. L. (1989) · Annals of Neurology · doi:10.1002/ana.410260106 · Cited by 388 · see citing works
Functional Characterization of the Cingulo-Opercular Network in the Maintenance of Tonic Alertness
Sadaghiani, S., & D’Esposito, M. (2014) · Cerebral Cortex · doi:10.1093/cercor/bhu072 · Cited by 375 · see citing works
Epidemiology of psychosis in Parkinson's disease
Fénelon, G., & Alves, G. (2010) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2009.08.014 · Cited by 330 · see citing works
Levodopa-induced psychosis: a kindling phenomenon
Moskovitz, C., Moses, H., & Klawans, H. L. (1978) · American Journal of Psychiatry · doi:10.1176/ajp.135.6.669 · Cited by 325 · see citing works
Hallucinations in Parkinson disease
Diederich, N. J., Fénelon, G., Stebbins, G., & Goetz, C. G. (2009) · Nature Reviews Neurology · doi:10.1038/nrneurol.2009.62 · Cited by 312 · see citing works
What predicts mortality in Parkinson disease?
Forsaa, E. B., Larsen, J. O., Wentzel‐Larsen, T., & Alves, G. W. (2010) · Neurology · doi:10.1212/wnl.0b013e3181f61311 · Cited by 304 · see citing works
Covariation of activity in visual and prefrontal cortex associated with subjective visual perception
Lumer, E. D., & Rees, G. E. (1999) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.96.4.1669 · Cited by 275 · see citing works
Psychiatric comorbidities in patients with Parkinson disease and psychosis
Marsh, L., Williams, J. R., Rocco, M., Grill, S. E., Munro, C. A., & Dawson, T. M. (2004) · Neurology · doi:10.1212/01.wnl.0000129843.15756.a3 · Cited by 229 · see citing works
Cholinergic Transmitter and Neurotrophic Activities in Lewy Body Dementia
Perry, E. K., Irving, D., Kerwin, J. M., McKeith, I. G., Thompson, P., Collerton, D., FAIRBAIRN, A. F., Ince, P. G., Morris, C. M., Cheng, A. V., et al. (1993) · Alzheimer Disease & Associated Disorders · doi:10.1097/00002093-199307020-00002 · Cited by 213 · see citing works
Shine, J. M., Halliday, G. M., Naismith, S. L., & Lewis, S. J. G. (2011) · Movement Disorders · doi:10.1002/mds.23896 · Cited by 205 · see citing works
Anatomy, physiology, and pathophysiology of the pedunculopontine nucleus
Jenkinson, N., Nandi, D., Muthusamy, K. A., Ray, N. J., Gregory, R. P., Stein, J. F., & Aziz, T. Z. (2008) · Movement Disorders · doi:10.1002/mds.22189 · Cited by 195 · see citing works
Altered cortical visual processing in PD with hallucinations
Stebbins, G. T., Goetz, C. G., Carrillo, M. C., Bangen, K. J., Turner, D. A., Glover, G. H., & Gabrieli, J. D. E. (2004) · Neurology · doi:10.1212/01.wnl.0000141853.27081.bd · Cited by 189 · see citing works
Neuronal Hypertrophy in Asymptomatic Alzheimer Disease
Iacono, D., O'Brien, R., Resnick, S. M., Zonderman, A. B., Pletnikova, O., Rudow, G., An, Y., West, M. J., Crain, B., & Troncoso, J. C. (2008) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181772794 · Cited by 188 · see citing works
Mapping of functional organization in human visual cortex: Electrical cortical stimulation
Lee, H. W., Hong, S. B., Seo, D. W., Tae, W. S., & Hong, S. C. (2000) · Neurology · doi:10.1212/wnl.54.4.849 · Cited by 184 · see citing works
Control of Visuotemporal Attention by Inferior Parietal and Superior Temporal Cortex
Shapiro, K. L., Hillstrom, A. P., & Masud Husain, B. (2002) · Current Biology · doi:10.1016/s0960-9822(02)01040-0 · Cited by 172 · see citing works
Hallucinosis in idiopathic Parkinson's disease
Graham, J., Grünewald, R. A., & SAGAR, H. J. (1997) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.63.4.434 · Cited by 167 · see citing works
Cerebral atrophy in Parkinson's disease patients with visual hallucinations
Ramírez‐Ruiz, B., Martí, M., TOLOSA, E. S., Giménez, M., Bargalló, N., Valldeoriola, F., & Junqué, C. (2007) · European Journal of Neurology · doi:10.1111/j.1468-1331.2007.01768.x · Cited by 154 · see citing works
Goldman, J. G., Stebbins, G. T., Dinh, V., Bernard, B. A., Merkitch, D., deToledo‐Morrell, L., & Goetz, C. G. (2014) · Brain · doi:10.1093/brain/awt360 · Cited by 152 · see citing works
The default mode network is disrupted in parkinson's disease with visual hallucinations
Yao, N., Chang, R. S., Cheung, C., Pang, S. Y.-Y., Lau, K. K., John Suckling, A., Rowe, J. B., Yu, K., Mak, H. K., Chua, S.-E., et al. (2014) · Human Brain Mapping · doi:10.1002/hbm.22577 · Cited by 151 · see citing works
fMRI Study of Face Perception and Memory Using Random Stimulus Sequences
Clark, V. P., Maisog, J. M., & Haxby, J. V. (1998) · Journal of Neurophysiology · doi:10.1152/jn.1998.79.6.3257 · Cited by 144 · see citing works
Regional cerebral blood flow in Parkinson disease with nonpsychotic visual hallucinations
Oishi, N., Udaka, F., Kameyama, M., Sawamoto, N., Hashikawa, K., & Fukuyama, H. (2005) · Neurology · doi:10.1212/01.wnl.0000187116.13370.e0 · Cited by 137 · see citing works
Hippocampal head atrophy predominance in Parkinson’s disease with hallucinations and with dementia
Ibarretxe‐Bilbao, N., Ramírez‐Ruiz, B., Tolosa, E., Martı́, M. J., Valldeoriola, F., Bargalló, N., & Junqué, C. (2008) · Journal of Neurology · doi:10.1007/s00415-008-0885-8 · Cited by 134 · see citing works
Ibarretxe‐Bilbao, N., Ramírez‐Ruiz, B., Junqué, C., Martí, M. J., Valldeoriola, F., Bargalló, N., Juanes, S., & Tolosa, E. (2009) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2009.179655 · Cited by 133 · see citing works
Dopamine transporter imaging is associated with long‐term outcomes in Parkinson's disease
Ravina, B. M., MAREK, K. L., Eberly, S. W., Oakes, D., Kurlan, R., Ascherio, A., Beal, F. M., Beck, J. C., Flagg, E., Galpern, W. R., et al. (2012) · Movement Disorders · doi:10.1002/mds.25157 · Cited by 133 · see citing works
Metabolic Alterations in Patients With Parkinson Disease and Visual Hallucinations
Boecker, H., Ceballos-Baumann, A., Volk, D., Conrad, B., Förstl, H., & Häussermann, P. (2007) · Archives of Neurology · doi:10.1001/archneur.64.7.984 · Cited by 123 · see citing works
Manganelli, F., Vitale, C., Santangelo, G., Pisciotta, C., Iodice, R., Cozzolino, A., Dubbioso, R., Picillo, M., Barone, P., & Santoro, L. (2009) · Brain · doi:10.1093/brain/awp166 · Cited by 122 · see citing works
Janzen, J., Ent, D. V. ‘., Lemstra, A. W., Berendse, H. W., Barkhof, F., & Foncke, E. M. J. (2011) · Journal of Neurology · doi:10.1007/s00415-011-6149-z · Cited by 120 · see citing works
Dementia with Lewy bodies: choline acetyltransferase parallels nucleus basalis pathology
Lippa, C. F., Smith, T. W., & Perry, E. K. (1999) · Journal of Neural Transmission · doi:10.1007/s007020050176 · Cited by 114 · see citing works
Visual hallucination in Parkinson's disease with FDG PET
Nagano‐Saito, A., Washimi, Y., Arahata, Y., Iwai, K., Kawatsu, S., Ito, K., Nakamura, A., Abe, Y., Yamada, T., Kato, T., et al. (2004) · Movement Disorders · doi:10.1002/mds.20129 · Cited by 105 · see citing works
Resting State Functional Connectivity in Patients with Chronic Hallucinations
Sommer, I. E., Clos, M., Meijering, A. L., Diederen, K. M. J., & Eickhoff, S. B. (2012) · PLoS ONE · doi:10.1371/journal.pone.0043516 · Cited by 103 · see citing works
Neural correlates of minor hallucinations in non-demented patients with Parkinson's disease
Pagonabarraga, J., Soriano‐Mas, C., Llebaria, G., López‐Solà, M., Pujol, J., & Kulisevsky, J. (2013) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2013.11.017 · Cited by 103 · see citing works
Cortical and subcortical brain atrophy in Parkinson's disease with visual hallucination
Watanabe, H., Senda, J., Kato, S., Ito, M., Atsuta, N., Hara, K., Tsuboi, T., Katsuno, M., Nakamura, T., Hirayama, M., et al. (2013) · Movement Disorders · doi:10.1002/mds.25641 · Cited by 92 · see citing works
Ondansetron for hallucinosis in advanced Parkinson's disease
Zoldan, J., Friedberg, G., Goldberg‐Stern, H., et al. (1993) · The Lancet · doi:10.1016/0140-6736(93)90327-d · Cited by 91 · see citing works
Ramírez‐Ruiz, B., Martı́, M. J., TOLOSA, E. S., Falcón, C., Bargalló, N., Valldeoriola, F., & Junqué, C. (2008) · Movement Disorders · doi:10.1002/mds.22258 · Cited by 89 · see citing works
Blindness and brain plasticity: contribution of mental imagery?
Lambert, S., Sampaio, E., Mauss, Y., & Scheiber, C. (2004) · Cognitive Brain Research · doi:10.1016/j.cogbrainres.2003.12.012 · Cited by 84 · see citing works
Shin, S., Lee, J. E., Hong, J. Y., Sunwoo, M.-K., Sohn, Y. H., & Lee, P. H. (2012) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2012-303391 · Cited by 83 · see citing works
Choi, S. H., Jung, T.-M., Lee, J. E., Lee, S., Sohn, Y. H., & Lee, P. H. (2011) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2010.11.015 · Cited by 83 · see citing works
Hypoperfusion of the visual pathway in parkinsonian patients with visual hallucinations
Matsui, H., Nishinaka, K., Oda, M., Hara, N., Komatsu, K., Kubori, T., & Udaka, F. (2006) · Movement Disorders · doi:10.1002/mds.21140 · Cited by 73 · see citing works
Holroyd, S., & Wooten, G. F. (2006) · Journal of Neuropsychiatry · doi:10.1176/jnp.2006.18.3.402 · Cited by 72 · see citing works
Medication-induced hallucination and cerebral blood flow in Parkinson's disease
Okada, K., D, N. S. M., Kobayashi, S., Oguro, H., & Yamaguchi, S. (1999) · Journal of Neurology · doi:10.1007/s004150050364 · Cited by 64 · see citing works
Goetz, C. G., Fan, W., & Leurgans, S. E. (2008) · Movement Disorders · doi:10.1002/mds.22132 · Cited by 61 · see citing works
Meppelink, A. M., de Jong, B. M., Teune, L. K., & van Laar, T. (2010) · Movement Disorders · doi:10.1002/mds.23375 · Cited by 52 · see citing works
Caudate dopaminergic denervation and visual hallucinations: Evidence from a 123I-FP-CIT SPECT study
Kiferle, L., Ceravolo, R., Giuntini, M., Linsalata, G., Puccini, G., Volterrani, D., & Bonuccelli, U. (2014) · Parkinsonism & Related Disorders · doi:10.1016/j.parkreldis.2014.04.006 · Cited by 41 · see citing works
Gama, R. L., de Bruin, V. M. S., Távora, D. G. F., Duran, F., Bittencourt, L., & Tufik, S. B. (2014) · Brain and Cognition · doi:10.1016/j.bandc.2014.03.011 · Cited by 39 · see citing works
Visual Hallucinations and Cognitive Impairment in Parkinson's Disease
Park, H. K., Kim, J. S., Im, K. C., Kim, M. J., Lee, J., Lee, M. C., Kim, J., & Chung, S. J. (2013) · Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques · doi:10.1017/s0317167100014888 · Cited by 36 · see citing works
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ffytche, D. H., Creese, B., Politis, M., Chaudhuri, K. R., Weintraub, D., Ballard, C., & Aarsland, D. (2017) · Nature Reviews Neurology · doi:10.1038/nrneurol.2016.200 · Cited by 355 · see citing works
Reduced occipital GABA in Parkinson disease with visual hallucinations
Firbank, M. J., Parikh, J., Murphy, N., Killen, A., Allan, C. L., Collerton, D., Blamire, A. M., & Taylor, J.-P. (2018) · Neurology · doi:10.1212/wnl.0000000000006007 · Cited by 103 · see citing works
Vignando, M., ffytche, D., Lewis, S. J. G., Lee, P. H., Chung, S. J., Weil, R. S., Hu, M. T., Mackay, C. E., Griffanti, L., Pins, D., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-28087-0 · Cited by 42 · see citing works
Thomas, G. E. C., Zeidman, P., Sultana, T., Zarkali, A., Razi, A., & Weil, R. S. (2022) · Brain Communications · doi:10.1093/braincomms/fcac329 · Cited by 38 · see citing works
Zarkali, A., McColgan, P., Leyland, L. A., Lees, A. J., & Weil, R. S. (2022) · Journal of Neurology, Neurosurgery & Psychiatry · doi:10.1136/jnnp-2021-326630 · Cited by 32 · see citing works
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Cholinergic deficiency in Parkinson’s disease patients with visual hallucinations
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Visual mismatch negativity in Parkinson's psychosis and potential for testing treatment mechanisms
Vignando, M., ffytche, D., Mazibuko, N., Palma, G., Montagnese, M., Dave, S., Nutt, D. J., Gabay, A. S., Tai, Y. F., Batzu, L., et al. (2024) · Brain Communications · doi:10.1093/braincomms/fcae291 · Cited by 6 · see citing works
Stampacchia, S., Bernasconi, F., Van De Ville, D., Amico, E., Pagonabarraga, J., Kulisevsky, J., & Blanke, O. (2025) · doi:10.1101/2025.04.17.649310 · Cited by 5 · see citing works
Vignando, M., Ffytche, D., Mazibuko, N., Palma, G., Bhat, A., Montagnese, M., Dave, S., Tai, Y. F., Batzu, L., Leta, V., et al. (2026) · Nature Mental Health · doi:10.1038/s44220-026-00669-7
“Multimodal hallucinations were best predicted by a model using four of the latent matrix A connections found to be altered (details in Supplementary Information 7).”
Influential
- Authors
- Lenka, A., Jhunjhunwala, K. R., Saini, J., & Pal, P. K.
- Affiliations
- National Institute of Mental Health and Neurosciences (IN)
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2015-07
- Volume
- 21
- Issue
- 7
- Pages
- 683-691
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W2055870666
- Cited by
- 106
- References
- 57
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 7 · 2023: 13 · 2022: 10 · 2021: 10 · 2020: 7 · 2019: 13 · 2018: 5 · 2017: 12 · 2016: 9 · 2015: 6
- FWCI
- 1.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Parkinsonism & Related Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hallucinations in medical conditions
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Parkinson's disease, visual hallucinations
- MeSH terms
- Hallucinations, Humans, Parkinson Disease, Positron-Emission Tomography, Functional Neuroimaging
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