Cholinergic deficiency in Parkinson’s disease patients with visual hallucinations
Open accessAbstract
Visual hallucinations can increase the burden of disease for both patients with Parkinson’s disease and their caregivers. Multiple neurotransmitters have been implicated in the neuropathology of visual hallucinations, which provide targets for treatment and prevention. In this study, we assessed the association between cholinergic denervation and visual hallucinations in Parkinson’s disease in vivo, using PET imaging of the cholinergic system. A total of 38 patients with Parkinson’s disease participated in this study. A group of 10 healthy subjects, matched for age, sex and education, was included for comparison. None of the participants used cholinergic drugs. Thirteen patients who had experienced visual hallucinations in the past month (VH+) were compared with 20 patients who had never experienced visual hallucinations in their lives (VH−). Cholinergic system integrity was assessed with PET imaging using 18F-fluoroethoxybenzovesamicol as the tracer. We assessed the differences in tracer uptake between groups by cluster-based analysis and by analysis of predefined regions of interest consisting of the ventral visual stream, the dorsal attentional network, the ventral attentional network and the lateral geniculate nucleus and mediodorsal nucleus of the thalamus. The Parkinson’s disease group (n = 38) showed an extensive pattern of decreased tracer uptake throughout the brain compared with the controls (n = 10). Within the Parkinson’s disease group, the VH+ group (n = 13) showed a cluster of decreased tracer uptake compared with the VH− group (n = 20), which covered most of the left ventral visual stream and extended towards superior temporal areas. These results were mirrored in the regions of interest-based analysis, in which the VH+ group showed the strongest deficits in the left inferior temporal gyrus and the left superior temporal gyrus compared with the VH− group. Visual hallucinations in Parkinson’s disease are associated with a marked cholinergic deficiency in the left ventral visual stream and the left superior temporal lobe, in addition to an extensive global cholinergic denervation in the general Parkinson’s disease population.
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A recent PET study in PD-VH showed marked cholinergic deficiency in the left ventral visual stream.
“A recent PET study in PD-VH showed a marked cholinergic deficiency in the left ventral visual stream57.”
From Deviations in effective connectivity explain different hallucination subtypes in Parkinson's disease psychosis (2026) · cites this paper as [57]
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“A recent PET study in PD-VH showed a marked cholinergic deficiency in the left ventral visual stream 57 .”
- Authors
- d’Angremont, E., van der Zee, S., Slingerland, S., Slomp, A. C., de Vries, E. F. J., van Laar, T., & Sommer, I. E.
- Affiliations
- University Medical Center Groningen (NL)
- Department of Neurology, University Medical Center Groningen, University of Groningen , 9713 GZ Groningen ,
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen , 9713 GZ Groningen ,
- Corresponding author
- d’Angremont, Emile
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-06-12
- Volume
- 147
- Issue
- 10
- Pages
- 3370-3378
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC11449127
- OpenAlex
- W4399597282
- Cited by
- 22
- References
- 48
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 1
- FWCI
- 5.33
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
- Funders
- ZonMW (636310010)
- 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 › Schizophrenia research and treatment
- Keywords
- Parkinson's disease, visual hallucinations, cholinergic denervation, cholinergic deficit, ventral stream, superior temporal gyrus, inferior temporal gyrus, mediodorsal thalamus, lateral geniculate nucleus, attentional networks
- MeSH terms
- Aged, Brain, Female, Hallucinations, Humans, Male, Middle Aged, Parkinson Disease, Piperidines, Positron-Emission Tomography
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