Lucy Honeycutt1, Jean-François Gagnon2, Amélie Pelletier3, Jessie De Roy2, Jacques Y Montplaisir4, Ronald B Postuma5. 1. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada. 2. Centre d'Études Avancées en Médecine du Sommeil, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada. 3. Centre d'Études Avancées en Médecine du Sommeil, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Department of Neurology, The Research Institute of the McGill University Health Centre, Montreal, Canada. 4. Centre d'Études Avancées en Médecine du Sommeil, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Department of Psychiatry, Université de Montréal, Montreal, QC, Canada. 5. Department of Neurology, McGill University, Montreal General Hospital, Montreal, Canada; Centre d'Études Avancées en Médecine du Sommeil, CIUSSS-NÎM-Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada; Department of Neurology, The Research Institute of the McGill University Health Centre, Montreal, Canada. Electronic address: ron.postuma@mcgill.ca.
Abstract
BACKGROUND: Though visual illusions and hallucinations are common in dementia with Lewy bodies (DLB) and Parkinson's disease (PD), they are not typically observed clinically in prodromal stages, including isolated REM sleep behavior disorder (iRBD). False-noise errors on the pareidolia test (seeing faces when none are present) may be an effective measure of susceptibility to future hallucinations in iRBD. METHODS: One hundred patients with iRBD underwent the 20-image pareidolia test. Clinical markers were assessed and a neuropsychological battery was administered. An exploratory analysis on the impact of pareidolic errors on phenoconversion was also performed. RESULTS: In our cohort, 17 patients (17%) made false-noise pareidolic errors. These patients had significantly lower total Montreal Cognitive Assesment (MoCA) scores (26.7 ± 2.3 vs. 24.4 ± 2.6, B = -1.88, 95% CI: [-3.17, -0.59]), with lower subcomponent MoCA scores on memory and visuospatial-executive sections. Pareidolic errors were also associated with lower visuospatial, attention/executive, and memory scores on the neuropsychological tests. Furthermore, after 1.6 years follow-up, 3/16 (19%) patients making pareidolic errors had phenoconverted at time of publication compared to 6/71 (8%) patients who did not make errors. CONCLUSION: Pareidolic errors in patients with iRBD are associated with poorer overall cognition and may indicate higher risk of DLB.
BACKGROUND: Though visual illusions and hallucinations are common in dementia with Lewy bodies (DLB) and Parkinson's disease (PD), they are not typically observed clinically in prodromal stages, including isolated REM sleep behavior disorder (iRBD). False-noise errors on the pareidolia test (seeing faces when none are present) may be an effective measure of susceptibility to future hallucinations in iRBD. METHODS: One hundred patients with iRBD underwent the 20-image pareidolia test. Clinical markers were assessed and a neuropsychological battery was administered. An exploratory analysis on the impact of pareidolic errors on phenoconversion was also performed. RESULTS: In our cohort, 17 patients (17%) made false-noise pareidolic errors. These patients had significantly lower total Montreal Cognitive Assesment (MoCA) scores (26.7 ± 2.3 vs. 24.4 ± 2.6, B = -1.88, 95% CI: [-3.17, -0.59]), with lower subcomponent MoCA scores on memory and visuospatial-executive sections. Pareidolic errors were also associated with lower visuospatial, attention/executive, and memory scores on the neuropsychological tests. Furthermore, after 1.6 years follow-up, 3/16 (19%) patients making pareidolic errors had phenoconverted at time of publication compared to 6/71 (8%) patients who did not make errors. CONCLUSION: Pareidolic errors in patients with iRBD are associated with poorer overall cognition and may indicate higher risk of DLB.
Authors: Mitchell G Miglis; Charles H Adler; Elena Antelmi; Dario Arnaldi; Luca Baldelli; Bradley F Boeve; Matteo Cesari; Irene Dall'Antonia; Nico J Diederich; Kathrin Doppler; Petr Dušek; Raffaele Ferri; Jean-François Gagnon; Ziv Gan-Or; Wiebke Hermann; Birgit Högl; Michele T Hu; Alex Iranzo; Annette Janzen; Anastasia Kuzkina; Jee-Young Lee; Klaus L Leenders; Simon J G Lewis; Claudio Liguori; Jun Liu; Christine Lo; Kaylena A Ehgoetz Martens; Jiri Nepozitek; Giuseppe Plazzi; Federica Provini; Monica Puligheddu; Michal Rolinski; Jan Rusz; Ambra Stefani; Rebekah L S Summers; Dallah Yoo; Jennifer Zitser; Wolfgang H Oertel Journal: Lancet Neurol Date: 2021-08 Impact factor: 44.182