Visual hallucinations are a common non-motor feature of Parkinson’s disease and have been associated with accelerated cognitive decline, increased mortality and early institutionalization. Despite their prevalence and negative impact on patient outcomes, the repertoire of treatments aimed at addressing this troubling symptom is limited. Over the past two decades, significant contributions have been made in uncovering the pathological and functional mechanisms of visual hallucinations, bringing us closer to the development of a comprehensive neurobiological framework. Convergent evidence now suggests that degeneration within the central cholinergic system may play a significant role in the genesis and progression of visual hallucinations. Here, we outline how cholinergic dysfunction may serve as a potential unifying neurobiological substrate underlying the multifactorial and dynamic nature of visual hallucinations. Drawing upon previous theoretical models, we explore the impact that alterations in cholinergic neurotransmission has on the core cognitive processes pertinent to abnormal perceptual experiences. We conclude by highlighting that a deeper understanding of cholinergic neurobiology and individual pathophysiology may help to improve established and emerging treatment strategies for the management of visual hallucinations and psychotic symptoms in Parkinson’s disease.

中文翻译：

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帕金森病中的幻视：聚焦中枢胆碱能功能障碍


幻视是帕金森病常见的非运动特征，与认知能力加速下降、死亡率增加和早期入院有关。尽管它们普遍存在并对患者预后产生负面影响，但旨在解决这种令人不安的症状的治疗方法是有限的。在过去的二十年里，在揭示幻视的病理和功能机制方面做出了重大贡献，使我们更接近于开发全面的神经生物学框架。现在的趋同证据表明，中枢胆碱能系统内的退化可能在幻视的发生和发展中起重要作用。在这里，我们概述了胆碱能功能障碍如何成为幻视多因素和动态性质的潜在统一神经生物学基础。借鉴以前的理论模型，我们探讨了胆碱能神经传递的改变对与异常感知体验相关的核心认知过程的影响。我们最后强调，更深入地了解胆碱能神经生物学和个体病理生理学可能有助于改进已建立和新兴的治疗策略，以管理帕金森病的幻视和精神病症状。