Cognition, hallucination severity and hallucination-specific insight in neurodegenerative disorders and eye disease

Montagnese, Marcella; Vignando, Miriam; Collerton, Daniel; ffytche, Dominic; Mosimann, Urs Peter; Taylor, John-Paul; daSilva Morgan, Katrina; Urwyler, Prabitha (2021). Cognition, hallucination severity and hallucination-specific insight in neurodegenerative disorders and eye disease. Cognitive neuropsychiatry, 27(2-3), pp. 105-121. Taylor & Francis 10.1080/13546805.2021.1960812

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Introduction
Hallucinations occur across neurodegenerative disorders, with increasing severity, poorer cognition and impaired hallucination-specific insight associated with worse outcomes and faster disease progression. It remains unclear how changes in cognition, temporal aspects of hallucinations, hallucination-specific insight and distress relate to each other.

Methods
Extant samples of patients experiencing visual hallucinations were included in the analyses: Parkinson’s Disease (n = 103), Parkinson’s Disease Dementia (n = 41), Dementia with Lewy Bodies (n = 27) and Eye Disease (n = 113). We explored the relationship between factors of interest with Spearman’s correlations and random-effect linear models.

Results
Spearman’s correlation analyses at the whole-group level showed that higher hallucination-specific insight was related to higher MMSE score (rs = 0.39, p < 0.001) and less severe hallucinations (rs = −0.28, p < .01). Linear mixed-models controlling for diagnostic group showed that insight was related to higher MMSE (p < .001), to hallucination severity (p = 0.003), and to VH duration (p = 0.04). Interestingly, insight was linked to the distress component but not the frequency component of severity. No significant relationship was found between MMSE and hallucination severity in these analyses.

Conclusion
Our findings highlight the importance of hallucination-specific insight, distress and duration across groups. A better understanding of the role these factors play in VH may help with the development of future therapeutic interventions trans-diagnostically.

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