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Suzanne Holroyd, M.D.; Michael L. Shepherd, M.D.; J. Hunter Downs, Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2000;12:517-518. doi:10.1176/appi.neuropsych.12.4.517
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HallucinationsAlzheimer's DiseaseBonnet Syndrome

SIR: We appreciate Dr. Terao's letter regarding our paper. Dr. Terao is of course correct that low visual acuity is associated with visual hallucinations in AD patients. We discussed this in the introduction to our paper, referring to our own work, and it has been confirmed by others, including Chapman et al. as noted by Dr. Terao. The visual acuities of the subjects were within ±10/20 in the "best eye" and thus were quite comparable between groups, and this should have been included in the paper. Dr. Terao notes the Charles Bonnet syndrome as one in which "psychologically normal old people can suffer from visual hallucinations." "Charles Bonnet syndrome" is just a descriptive term and not a diagnosis or an explanation. Research into the causes of this syndrome in fact show that eye disease and, quite possibly, early dementia are associated factors.24 Dr. Terao may be interested in the literature describing visual hallucinations in a variety of eye diseases.47

Dr. Terao notes that if our Alzheimer's patients actually included patients who had dementia with Lewy bodies, "DLB rather than occipital atrophy might have been associated with visual hallucinations." First, our patients met strict research criteria for AD.8,9 Definitive diagnosis can be made only at autopsy. Our patients did not demonstrate parkinsonism or fluctuation, making it unlikely they had DLB.9 Actually, given the high prevalence of visual hallucinations in DLB, we would hypothesize that decreased visual acuity and occipital atrophy may be associated factors of visual hallucinations in DLB.

We thank Dr. Terao for his interest in this relatively unexplored topic.

Holroyd S, Sheldon-Keller A: A study of visual hallucinations in Alzheimer's disease. Am J Geriatr Psychiatry  1995; 3:198— 205
 
Gold K, Rabins PV: Isolated visual hallucinations and the Charles Bonnet Syndrome: a review of literature and presentation of six cases. Compr Psychiatry  1989; 30:90—98
[CrossRef] | [PubMed]
 
McNamara ME, Heros RC, Boller F: Visual hallucinations in blindness: the Charles Bonnet syndrome. Int J Neurosci  1982; 17:13—15
[CrossRef] | [PubMed]
 
Holroyd S, Rabins PV, Finkelstein D, et al: Visual hallucinations in patients with macular degeneration. Am J Psychiatry  1992; 48:29—38
 
Kulmel HW: Complex hallucinations in the hemianopic field. J Neurol Neurosurg Psychiatry  1985; 48:29—38
[CrossRef] | [PubMed]
 
Fitzgerald RG: Visual phenomenology in recently blind adults. Am J Psychiatry 1971; 127:1533—  1539
 
Weinberger LM, Giant FC: Visual hallucinations and their neuro-optical correlates. Arch Ophthalmol  1940; 23:166—199
 
McKhann G, Drachman D, Folstein M, et al: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology  1984; 34:939—944
[PubMed]
 
McKeith IG: Dementia with Lewy bodies: clinical criteria for senile dementia of Lewy body type (SDLT). Psychol Med  1992; 22:911—922
[CrossRef] | [PubMed]
 
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References

Holroyd S, Sheldon-Keller A: A study of visual hallucinations in Alzheimer's disease. Am J Geriatr Psychiatry  1995; 3:198— 205
 
Gold K, Rabins PV: Isolated visual hallucinations and the Charles Bonnet Syndrome: a review of literature and presentation of six cases. Compr Psychiatry  1989; 30:90—98
[CrossRef] | [PubMed]
 
McNamara ME, Heros RC, Boller F: Visual hallucinations in blindness: the Charles Bonnet syndrome. Int J Neurosci  1982; 17:13—15
[CrossRef] | [PubMed]
 
Holroyd S, Rabins PV, Finkelstein D, et al: Visual hallucinations in patients with macular degeneration. Am J Psychiatry  1992; 48:29—38
 
Kulmel HW: Complex hallucinations in the hemianopic field. J Neurol Neurosurg Psychiatry  1985; 48:29—38
[CrossRef] | [PubMed]
 
Fitzgerald RG: Visual phenomenology in recently blind adults. Am J Psychiatry 1971; 127:1533—  1539
 
Weinberger LM, Giant FC: Visual hallucinations and their neuro-optical correlates. Arch Ophthalmol  1940; 23:166—199
 
McKhann G, Drachman D, Folstein M, et al: Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology  1984; 34:939—944
[PubMed]
 
McKeith IG: Dementia with Lewy bodies: clinical criteria for senile dementia of Lewy body type (SDLT). Psychol Med  1992; 22:911—922
[CrossRef] | [PubMed]
 
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