Visual hallucinations in neurological and ophthalmological disease: Pathophysiology and management

John O'Brien, John Paul Taylor, Clive Ballard, Roger A. Barker, Clare Bradley, Alistair Burns, Daniel Collerton, Sonali Dave, Rob Dudley, Paul Francis, Andrea Gibbons, Kate Harris, Vanessa Lawrence, Iracema Leroi, Ian McKeith, Michel Michaelides, Chaitali Naik, Claire O'Callaghan, Kirsty Olsen, Marco OnofrjRebecca Pinto, Gregor Russell, Peter Swann, Alan Thomas, Prabitha Urwyler, Rimona Sharon Weil, Dominic Ffytche

Research output: Contribution to journalReview articlepeer-review

71 Citations (Scopus)
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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.

Original languageEnglish
Article number322702
Pages (from-to)512-519
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Issue number5
Early online date25 Mar 2020
Publication statusPublished - 1 May 2020


  • dementia
  • hallucinations
  • parkinson's disease


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