Cited by 32Hallucinations in medical conditionsParkinson's Disease Mechanisms and TreatmentsSchizophrenia research and treatment

Visual hallucinations in Parkinson’s disease: spotlight on central cholinergic dysfunction

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Ignatavicius, Anna, Matar, Elie, Lewis, Simon J G·2025·Brain

Abstract

Visual hallucinations are a common non-motor feature of Parkinson’s disease and have been associated with accelerated cognitive decline, increased mortality and early institutionalization. Despite their prevalence and negative impact on patient outcomes, the repertoire of treatments aimed at addressing this troubling symptom is limited. Over the past two decades, significant contributions have been made in uncovering the pathological and functional mechanisms of visual hallucinations, bringing us closer to the development of a comprehensive neurobiological framework. Convergent evidence now suggests that degeneration within the central cholinergic system may play a significant role in the genesis and progression of visual hallucinations. Here, we outline how cholinergic dysfunction may serve as a potential unifying neurobiological substrate underlying the multifactorial and dynamic nature of visual hallucinations. Drawing upon previous theoretical models, we explore the impact that alterations in cholinergic neurotransmission has on the core cognitive processes pertinent to abnormal perceptual experiences. We conclude by highlighting that a deeper understanding of cholinergic neurobiology and individual pathophysiology may help to improve established and emerging treatment strategies for the management of visual hallucinations and psychotic symptoms in Parkinson’s disease.

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Authors
Ignatavicius, A., Matar, E., & Lewis, S. J. G.
Affiliations
The University of Sydney (AU)
Corresponding author
  • Matar, Elie
  • Lewis, Simon J G
Venue
Brain
Published
2024-09-10
Volume
148
Issue
2
Pages
376-393
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W4402428806
Cited by
32
References
239
Citations by year
2026: 16 · 2025: 16
FWCI
2.07
Type
journal article
Language
en
Open access
Locations
  • Brain (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • National Health and Medical Research Council (2008565)
  • United States Department of Defense (PD220061, 1195830)
  • Australian Research Council
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
visual hallucinations, Parkinson's disease, cholinergic neurotransmission, non-motor symptoms, cognitive decline, perceptual disorders, hallucination treatment, psychotic symptoms
MeSH terms
Acetylcholine, Hallucinations, Humans, Parkinson Disease, Cholinergic Neurons

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