Visual hallucinations in neurological and ophthalmological disease: pathophysiology and management

O'Brien, John; Taylor, John Paul; Ballard, Clive; Barker, Roger A; Bradley, Clare; Burns, Alistair; Collerton, Daniel; Dave, Sonali; Dudley, Rob; Francis, Paul; Gibbons, Andrea; Harris, Kate; Lawrence, Vanessa; Leroi, Iracema; McKeith, Ian; Michaelides, Michel; Naik, Chaitali; O'Callaghan, Claire; Olsen, Kirsty; Onofrj, Marco; ... (2020). Visual hallucinations in neurological and ophthalmological disease: pathophysiology and management. Journal of Neurology, Neurosurgery & Psychiatry, 91(5), pp. 512-519. BMJ Journals 10.1136/jnnp-2019-322702

jnnp-2019-322702.full.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (681kB) | Preview

Visual hallucinations are common in older people and are especially associated with ophthalmological and neurological disorders, including dementia and Parkinson’s disease. Uncertainties remain whether there is a single underlying mechanism for visual hallucinations or they have different disease-dependent causes. However, irrespective of mechanism, visual hallucinations are difficult to treat. The National Institute for Health Research (NIHR) funded a research programme to investigate visual hallucinations in the key and high burden areas of eye disease, dementia and Parkinson’s disease, culminating in a workshop to develop a unified framework for their clinical management. Here we summarise the evidence base, current practice and consensus guidelines that emerged from the workshop.

Irrespective of clinical condition, case ascertainment strategies are required to overcome reporting stigma. Once hallucinations are identified, physical, cognitive and ophthalmological health should be reviewed, with education and self-help techniques provided. Not all hallucinations require intervention but for those that are clinically significant, current evidence supports pharmacological modification of cholinergic, GABAergic, serotonergic or dopaminergic systems, or reduction of cortical excitability. A broad treatment perspective is needed, including carer support. Despite their frequency and clinical significance, there is a paucity of randomised, placebo-controlled clinical trial evidence where the primary outcome is an improvement in visual hallucinations. Key areas for future research include the development of valid and reliable assessment tools for use in mechanistic studies and clinical trials, transdiagnostic studies of shared and distinct mechanisms and when and how to treat visual hallucinations.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
10 Strategic Research Centers > ARTORG Center for Biomedical Engineering Research > ARTORG Center - Gerontechnology and Rehabilitation

UniBE Contributor:

Urwyler-Harischandra, Prabitha


600 Technology > 610 Medicine & health




BMJ Journals




Angela Amira Botros

Date Deposited:

28 Apr 2020 11:41

Last Modified:

24 Feb 2021 05:53

Publisher DOI:


PubMed ID:





Actions (login required)

Edit item Edit item
Provide Feedback