Visual Hallucinations in Elderly People: Early Dementia, Psychosis or Charles Bonnet Syndrome? Review and Case Report

Charles Bonnet syndrome (CBS) is a rare clinical condition characterized by complex visual hallucinations in people with loss of vision. So far, the neurobiological mechanisms underlying the hallucinations remain elusive. This case-report study aims at investigating electrical activity changes in a CBS patient during visual hallucinations, as compared to a resting-state period (without hallucinations). Prior to the EEG, the patient underwent neuropsychological, ophthalmologic, and neurological examinations. Spectral and connectivity, graph analyses and signal diversity were applied to high-density EEG data. Visual hallucinations (as compared to resting-state) were characterized by a significant reduction of power in the frontal areas, paralleled by an increase in the midline posterior regions in delta and theta bands and by an increase of alpha power in the occipital and midline posterior regions. We next observed a reduction of theta connectivity in the frontal and right posterior areas, which at a network level was complemented by a disruption of small-worldness (lower local and global efficiency) and by an increase of network modularity. Finally, we found a higher signal complexity especially when considering the frontal areas in the alpha band. The emergence of hallucinations may stem from these changes in the visual cortex and in core cortical regions encompassing both the default mode and the fronto-parietal attentional networks.

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Poster 348: An Unusual Cause of Visual Hallucinations: Embolic Occipital Infarct Causing Charles Bonnet Syndrome: A Case Report

PM&R ◽

10.1016/j.pmrj.2017.08.287 ◽

2017 ◽

Vol 9 ◽

pp. S242-S242

Author(s):

Araj Sidki ◽

Jun Zhang ◽

Nicole Fiorentino

Keyword(s):

Case Report ◽

Visual Hallucinations ◽

Charles Bonnet Syndrome

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Charles Bonnet syndrome and cognitive impairment: a systematic review

International Psychogeriatrics ◽

10.1017/s1041610214000763 ◽

2014 ◽

Vol 26 (9) ◽

pp. 1431-1443 ◽

Cited By ~ 6

Author(s):

Gregor Russell ◽

Alistair Burns

Keyword(s):

Cognitive Impairment ◽

Cognitive Functioning ◽

Diagnostic Criteria ◽

Primary Outcome ◽

Case Reports ◽

Visual Hallucinations ◽

Charles Bonnet Syndrome ◽

Ovid Medline ◽

Early Dementia ◽

Primary Focus

ABSTRACTBackground:Charles Bonnet syndrome (CBS) is defined as complex persistent visual hallucinations in the absence of mental disorder. It is common in conditions causing significant visual impairment. Many authors advise reassurance, considering the condition benign. However, others have suggested that CBS may in some patients represent the early stages of dementia. This review seeks to systematically examine the evidence for any link between CBS and cognitive impairment.Methods:Literature search using OVID Medline, PsychINFO, and Embase.Results:Three studies where cognitive functioning was the primary focus of the research were found. All were small, did not properly apply diagnostic criteria, and reported conflicting results. Eight other studies commented on cognitive functioning, but none used tests sufficiently sensitive to detect changes seen in early dementia. One hundred and thirty four case reports were scrutinized, and reports found of 16 patients with CBS where dementia emerged. High rates of partial insight at diagnosis of CBS were seen in these patients.Conclusions:There have been no adequately powered studies, using accepted diagnostic criteria, where changes in cognitive functioning were the primary outcome. Existing studies are of limited methodological quality and allow no conclusion regarding a relationship between cognitive impairment and CBS to be reached. Numerous case reports of dementia developing in patients with CBS and partial insight raise the possibility of a link between these conditions. There is a clear need for properly constructed studies to investigate this.

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Visual Hallucinations in Elderly People: Early Dementia, Psychosis or Charles Bonnet Syndrome? Review and Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1084 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S650-S650

Author(s):

M. García Moreno ◽

A. De Cos Milas ◽

B. Poza Cano ◽

L. Beatobe Carreño

Keyword(s):

Differential Diagnosis ◽

Cognitive Impairment ◽

Case Report ◽

Psychiatric Illness ◽

Late Onset ◽

Medical Condition ◽

Rare Condition ◽

Disruptive Behaviour ◽

Visual Hallucinations ◽

Charles Bonnet Syndrome

IntroductionCharles Bonnet Syndrome (CBS) is an uncommon disease that involves visual hallucinations in visually impaired individuals, in absence of cognitive impairment or psychiatric illness, although some authors propose CBS as an early maker of dementia.ObjectivesShow the importance of differential diagnosis in individuals with presence of visual hallucinations, with distinction of CBS from others psychiatric or organic disorders such as hypnogogic and hypnopompic hallucinations, epileptic phenomenon, Parkinson disease, dementia, delirum tremens or late-onset psychosis.MethodsLiterature review about visual hallucinations in people with psychiatric illness, dementia or in absence of these status, followed by a case report of a patient who met criteria for CBS.ResultsEighty one-years-old female with no previous psychiatric illness, experience suddenly visual hallucinations (animals, insects) with secondary anxiety, fear and insomnia as well as disruptive behaviour (throw lye to kill the animals) and delusional interpretations of the hallucinations considering them as a divine proof. Clinical exam, neuroimaging tests and SPECT confirmed just a minimal cognitive impairment nor suggestive of dementia. She had personal history of cataracts and macular degeneration, with no other medical condition. Olanzapine was prescribed but it was withdrew because of adverse effects. Later, haloperidol was introduced with well tolerance and symptom's recovery ad integrum.ConclusionsCharles Bonnet syndrome is a rare condition that may sometimes be the beginning of a dementia. Medical evaluation and complementary tests help differential diagnosis in order to reject others psychiatric/somatic disorders. Neuroleptic and anti-epileptic treatment should be useful to control symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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FDG-PET Scanning Shows Distributed Changes in Cortical Activity Associated with Visual Hallucinations in Eye Disease

Endocrine Metabolic & Immune Disorders - Drug Targets ◽

10.2174/1871530318666180830112709 ◽

2019 ◽

Vol 19 (1) ◽

pp. 84-89 ◽

Cited By ~ 3

Author(s):

Lütfü Hanoglu ◽

Sultan Yildiz ◽

Tansel Cakir ◽

Taha Hanoglu ◽

Burak Yulug

Keyword(s):

Visual Cortex ◽

Fdg Pet ◽

Underlying Mechanism ◽

Posterior Cingulate Cortex ◽

Eye Disease ◽

Visual Hallucinations ◽

Charles Bonnet Syndrome ◽

Pet Scanning ◽

Inferior Parietal Cortex ◽

Visual Deafferentation

Background and Objective: Charles Bonnet Syndrome (CBS) has been defined as complex visual hallucinations (CVH) due to visual loss. The underlying mechanism of CBS is not clear and the underlying pathophysiology of the visual hallucinations in CBS patients and pure visually impaired patients is still not clear. </P><P> Methods: In our study, we have scanned three patients with eye disease and CBS (VH+) and three patients with eye disease without CBS (VH-) using FDG-PET. Results: Our results showed underactivity in the pons and overactivity in primary right left visual cortex and inferior parietal cortex in VH- patients and underactivity in left Broca, left inf frontal primary visual cortex and anterior and posterior cingulate cortex in VH+ patients relative to the normative 18FFDG PET data that was taken from the database consisting of 50 age-matched healthy adults without neuropsychiatric disorders. Conclusion: From this distributed pattern of activity changes, we conclude that the generation of visual hallucination in CBS is associated with bottom-up and top-down mechanism rather than the generally accepted visual deafferentation-related hyperexcitability theory.

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Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

BMJ Case Reports ◽

10.1136/bcr-2019-233179 ◽

2020 ◽

Vol 13 (12) ◽

pp. e233179

Author(s):

Eric Garrels ◽

Fawziya Huq ◽

Gavin McKay

Keyword(s):

Cognitive Impairment ◽

Case Report ◽

Potassium Channel ◽

Limbic Encephalitis ◽

Psychiatric Symptoms ◽

Differential Diagnoses ◽

Visual Hallucinations ◽

Voltage Gated ◽

History Of ◽

Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

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An overview of psychological and social factors in Charles Bonnet syndrome

Therapeutic Advances in Ophthalmology ◽

10.1177/25158414211034715 ◽

2021 ◽

Vol 13 ◽

pp. 251584142110347

Author(s):

Lee Jones ◽

Lara Ditzel-Finn ◽

Jamie Enoch ◽

Mariya Moosajee

Keyword(s):

Emotional Response ◽

Causal Mechanism ◽

Visual Hallucinations ◽

Cognitively Normal ◽

Charles Bonnet Syndrome ◽

Raising Awareness ◽

Normal Individuals ◽

The Social ◽

Recent Developments ◽

Insight Into

Charles Bonnet syndrome (CBS) is a condition where cognitively normal individuals with sight impairment experience simple and/or complex visual hallucinations. The exact pathogenesis of CBS is unknown; however, deafferentation is often recognised as a causal mechanism. Studies have provided insight into the multifaceted impact of CBS on wellbeing. Onset of CBS may cause distress among those believing visual hallucinations are indicative of a neurological condition. Hallucinatory content is often congruent with the emotional response. For example, hallucinations of a macabre nature typically result in a fearful response. Visual hallucinations may be highly disruptive, causing everyday tasks to become challenging. Clinical management relies on forewarning and pre-emptive questioning. Yet, knowledge and awareness of CBS is typically low. In this review, we provide a summary of the social and psychological implications of CBS and explore recent developments aimed at raising awareness and improving patient management.

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