Hostname: page-component-76fb5796d-qxdb6 Total loading time: 0 Render date: 2024-04-25T21:05:43.690Z Has data issue: false hasContentIssue false
  • English
  • Français

Visual Perceptual Organization Ability in Autopsy-Verified Dementia with Lewy Bodies and Alzheimer’s Disease

Published online by Cambridge University Press:  25 May 2016

Micaela Mitolo ,
Joanne M. Hamilton ,
Kelly M. Landy ,
Lawrence A. Hansen ,
Douglas Galasko ,
Francesca Pazzaglia  and
David P. Salmon
Micaela Mitolo
Affiliation:
Fondazione San Camillo Ospedale - IRCCS, Venice, Italy Department of Neurosciences, University of California San Diego, San Diego, California
Joanne M. Hamilton
Affiliation:
Department of Neurosciences, University of California San Diego, San Diego, California Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, San Diego, California
Kelly M. Landy
Affiliation:
Department of Neurosciences, University of California San Diego, San Diego, California Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, San Diego, California
Lawrence A. Hansen
Affiliation:
Department of Neurosciences, University of California San Diego, San Diego, California Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, San Diego, California Department of Pathology, University of California San Diego, San Diego, California
Douglas Galasko
Affiliation:
Department of Neurosciences, University of California San Diego, San Diego, California Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, San Diego, California Neurology Service, San Diego Veterans Affairs Medical Center, San Diego, California
Francesca Pazzaglia
Affiliation:
Department of Psychology, University of Padua, Padua, Italy
David P. Salmon*
Affiliation:
Department of Neurosciences, University of California San Diego, San Diego, California Shiley-Marcos Alzheimer’s Disease Research Center, University of California, San Diego, San Diego, California
*
Correspondence and reprint requests to: David P. Salmon, Department of Neurosciences, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0948. E-mail: dsalmon@ucsd.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Prominent impairment of visuospatial processing is a feature of dementia with Lewy bodies (DLB), and diagnosis of this impairment may help clinically distinguish DLB from Alzheimer’s disease (AD). The current study compared autopsy-confirmed DLB and AD patients on the Hooper Visual Organization Test (VOT), a test that requires perceptual and mental reorganization of parts of an object into an identifiable whole. The VOT may be particularly sensitive to DLB since it involves integration of visual information processed in separate dorsal and ventral visual “streams”. Methods: Demographically similar DLB (n=28), AD (n=115), and normal control (NC; n=85) participants were compared on the VOT and additional neuropsychological tests. Patient groups did not differ in dementia severity at time of VOT testing. High and Low AD-Braak stage DLB subgroups were compared to examine the influence of concomitant AD pathology on VOT performance. Results: Both patient groups were impaired compared to NC participants. VOT scores of DLB patients were significantly lower than those of AD patients. The diagnostic sensitivity and specificity of the VOT for patients versus controls was good, but marginal for DLB versus AD. High-Braak and low-Braak DLB patients did not differ on the VOT, but High-Braak DLB performed worse than Low-Braak DLB on tests of episodic memory and language. Conclusions: Visual perceptual organization ability is more impaired in DLB than AD but not strongly diagnostic. The disproportionate severity of this visual perceptual deficit in DLB is not related to degree of concomitant AD pathology, which suggests that it might primarily reflect Lewy body pathology. (JINS, 2016, 22, 609–619)

Keywords

Visuoperceptual deficitDementia with Lewy BodiesAlzheimer’s diseaseVisual organizationDementiaVisuospatial deficit
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 22 , Issue 6 , July 2016 , pp. 609 - 619
Copyright
Copyright © The International Neuropsychological Society 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aarsland, D., Litvan, I., Salmon, D., Galasko, D., Wentzel-Larsen, T., & Larsen, J.P. (2003). Performance on the dementia rating scale in Parkinson’s disease with dementia and dementia with Lewy bodies: Comparison with progressive supranuclear palsy and Alzheimer’s disease. Journal of Neurology, Neurosurgery, & Psychiatry, 74(9), 1215–1220.Google Scholar
Ala, T.A., Hughes, L.F., Kyrouac, G.A., Ghobrial, M.W., & Elble, R.J. (2001). Pentagon copying is more impaired in dementia with Lewy bodies than in Alzheimer’s disease. Journal of Neurology, Neurosurgery, & Psychiatry, 70, 483–488.CrossRefGoogle ScholarPubMed
Albin, R.L., Minoshima, S., D’Amato, C.J., Frey, K.A., Kuhl, D.A., & Sima, A.A.F. (1996). Fluoro-deoxyglucose positron emission tomography in diffuse Lewy body disease. Neurology, 47, 462–466.Google Scholar
Bateman, R.J., Xiong, C., Benzinger, T.L., Fagan, A.M., Goate, A., Fox, N.C., … the Dominantly Inherited Alzheimer Network. (2012). Clinical and biomarker changes in dominantly inherited Alzheimer’s disease. New England Journal of Medicine, 367, 795–804.CrossRefGoogle ScholarPubMed
Braak, H., Del Tridici, K., Rub, U., de Vos, R.A.I., Jansen-Steur, E.N.H., & Braak, E. (2003). Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiology of Aging, 24, 197–211.Google Scholar
Braak, H., & Braak, E. (1991). Neuropathological staging of Alzheimer-related changes. Acta Neuropathologica, 82, 239–259.CrossRefGoogle ScholarPubMed
Calderon, J., Perry, R.J., Erzinclioglu, S.W., Berrios, G.E., Dening, T.R., & Hodges, J.R. (2001). Perception, attention, and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 70, 157–164.CrossRefGoogle ScholarPubMed
Colosimo, C., Hughes, A.J., Kilford, L., & Lees, A.J. (2003). Lewy body cortical involvement may not always predict dementia in Parkinson’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 74, 852–856.CrossRefGoogle Scholar
Connor, D.J., Salmon, D.P., Sandy, T., Galasko, D., Hansen, L.A., & Thal, L.J. (1998). Cognitive profiles of autopsy-confirmed Lewy body variant vs “pure” Alzheimer’s disease. Archives of Neurology, 55, 994–1000.CrossRefGoogle Scholar
Cormak, F., Gray, A., Ballard, C., & Tovee, M.J. (2004). A failure of ‘pop-out’ in visual search tasks in dementia with Lewy bodies as compared to Alzheimer’s and Parkinson’s disease. International Journal of Geriatric Psychiatry, 19, 763–772.Google Scholar
Crutch, S.J., Lehmann, M., Schott, J.M., Rabinovici, G.D., Rossor, M.N., & Fox, N.C. (2012). Posterior cortical atrophy. Lancet Neurology, 11, 170–178.Google Scholar
De Haan, E.H.F., & Cowey, A. (2011). On the usefulness of ‘what’ and ‘where’ pathways in vision. Trends in Cognitive Sciences, 15, 460–466.CrossRefGoogle ScholarPubMed
Festa, E., Insler, R.Z., Salmon, D.P., Paxton, J., Hamilton, J.M., & Heindel, W.C. (2005). Neocortical disconnectivity disrupts sensory integration in Alzheimer’s disease. Neuropsychology, 19, 728–738.Google Scholar
Frigerio, R., Fujishioro, H., Ahn, T., Josephs, K., Maraganore, D.M., DelleDonne, A., & Ahlskog, J.E. (2011). Incidental Lewy body disease: Do some cases represent a preclinical stage of dementia with Lewy bodies? Neurobiology of Aging, 32, 857–863.Google Scholar
Galasko, D.R., Gould, R.L., Abramson, I.S., & Salmon, D.P. (2000). Measuring cognitive change in a cohort of patients with Alzheimer’s disease. Statistics in Medicine, 19, 1421–1432.Google Scholar
Galasko, D., Katzman, R., Salmon, D.P., & Hansen, L. (1996). Clinical and neuropathological findings in Lewy body dementias. Brain and Cognition, 31, 166–175.CrossRefGoogle ScholarPubMed
Gnanalingham, K.K., Byrne, E.J., & Thornton, A. (1996). Clock-face drawing to differentiate Lewy body and Alzheimer type dementia syndromes. Lancet, 347, 696–697.CrossRefGoogle ScholarPubMed
Gómez-Tortosa, E., Newell, K., Irizarry, M.C., Albert, M., Growdon, J.H., & Hyman, B.T. (1999). Clinical and quantitative pathologic correlates of dementia with Lewy bodies. Neurology, 53, 1284–1291.Google Scholar
Hamilton, J.M., Salmon, D.P., Galasko, D., Delis, D.C., Hansen, L.A., Masliah, E., & Thal, L.J. (2004). A comparison of episodic memory deficits in neuropathologically-confirmed Dementia with Lewy bodies and Alzheimer’s disease. Journal of the International Neuropsychological Society, 10, 689–697.Google Scholar
Hansen, L.A., Masliah, E., Galasko, D., & Terry, R.D. (1993). Plaque-only Alzheimer’s disease is usually the Lewy body variant, and vice versa. Journal of Neuropathology and Experimental Neurology, 52, 648–654.CrossRefGoogle ScholarPubMed
Hansen, L., Salmon, D., Galasko, D.R., Masliah, E., Katzman, R., DeTeresa, R., & Alford, M. (1990). The Lewy body variant of Alzheimer’s disease: A clinical and pathologic entity. Neurology, 40, 1–8.CrossRefGoogle ScholarPubMed
Hansen, L.A., & Terry, R.D. (1997). Position paper on diagnostic criteria for Alzheimer disease. Neurobiology of Aging, 18, S71–S73.Google Scholar
Harding, A.J., Broe, G.A., & Halliday, G.M. (2002). Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe. Brain, 125, 391–403.CrossRefGoogle ScholarPubMed
Harding, A.J., & Halliday, G.M. (2001). Cortical Lewy body pathology in the diagnosis of dementia. Acta Neuropathologica, 102, 355–363.Google Scholar
Helmes, E., Bowler, J.V., Merskey, H., Munoz, D.G., & Hachinski, V.C. (2003). Rates of cognitive decline in Alzheimer’s disease and dementia with Lewy bodies. Dementia and Geriatric Cognitive Disorders, 15, 67–71.Google Scholar
Heyman, A., Fillenbaum, G.G., Gearing, M., Mirra, S.S., Welsh-Bohmer, K.A., Peterson, B., && Pieper, C. (1999). Comparison of Lewy body variant of Alzheimer’s disease with pure Alzheimer’s disease: Consortium to establish a registry for Alzheimer’s disease, part XIX. Neurology, 52, 1839–1844.CrossRefGoogle ScholarPubMed
Higuchi, M., Tashiro, M., Arai, H., Okamura, N., Hara, S., Higuchi, S.,& Sasaki, H. (2000). Glucose hypometabolism and neuropathological correlates in brains of dementia with Lewy bodies. Experimental Neurology, 162, 247–256.Google Scholar
Hodges, J.R., Salmon, D.P., & Butters, N. (1991). The nature of the naming deficit in Alzheimer’s and Huntington’s disease. Brain, 114, 1547–1558.CrossRefGoogle ScholarPubMed
Hooper, H.E. (1983). Hooper Visual Organization Test (VOT) Manual. Los Angeles, CA: Western Psychological Services.Google Scholar
Horimoto, Y., Matsumoto, M., Nakazawa, H., Yuasa, H., Morishita, M., Akatsu, H., & Kosaka, K. (2003). Cognitive conditions of pathologically confirmed dementia with Lewy bodies and Parkinson’s disease with dementia. Journal of Neurological Science, 216, 105–108.Google Scholar
Imamura, T., Ishii, K., Hirono, N., Hashimoto, M., Tanimukai, S., Kazuai, H., & Mori, E. (1999). Visual hallucinations and regional cerebral metabolism in dementia with Lewy bodies (DLB). Neuroreport, 10, 1903–1907.Google Scholar
Imamura, T., Ishii, K., Hirono, N., Hashimoto, M., Tanimukai, S., Kazui, H., & Mori, E. (2001). Occipital glucose metabolism in dementia with Lewy bodies with and without Parkinsonism: A study using positron emission tomography. Dementia and Geriatric Cognitive Disorders, 12, 194–197.CrossRefGoogle ScholarPubMed
Ishii, K., Imamura, T., Sasaki, M., Yamaji, S., Sakamoto, S., Kitagaki, H., & Mori, E. (1998). Regional cerebral glucose metabolism in dementia with Lewy bodies and Alzheimer’s disease. Neurology, 51, 125–130.Google Scholar
Johnson, D.K., Morris, J.C., & Galvin, J.E. (2005). Verbal and visuospatial deficits in dementia with Lewy bodies. Neurology, 65, 1232–1238.Google Scholar
Kosaka, K., Yoshimura, M., Ikeda, K., & Budka, H. (1984). Diffuse type of Lewy body disease: Progressive dementia with abundant cortical Lewy bodies and senile changes of varying degree: A new disease? Clinical Neuropathology, 3, 185–192.Google Scholar
Kraybill, M.L., Larson, E.B., Tsuang, D.W., Teri, L., McCormick, W.C., Bowen, J.D., & Cherrier, M.M. (2005). Cognitive differences in dementia patients with autopsy-verified AD, Lewy body pathology, or both. Neurology, 64, 2069–2073.Google Scholar
Lambon Ralph, M.A., Powell, J., Howard, D., Whitworth, A.B., Garrard, P., & Hodges, J.R. (2001). Semantic memory is impaired in both dementia with Lewy bodies and dementia of Alzheimer’s type: A comparative neuropsychological study and literature review. Journal of Neurology, Neurosurgery, and Psychiatry, 70, 149–156.Google Scholar
Landy, K.M., Salmon, D.P., Galasko, D., Filoteo, J.V., Festa, E., Heindel, W.C., & Hamilton, J.M. (2015). Motion discrimination in dementia with Lewy bodies and Alzheimer’s disease. Neurology, 85, 1376–1382.CrossRefGoogle Scholar
Lobotesis, K., Fenwick, J.D., Phipps, A., Ryman, A., Swann, A., Ballard, C., & O’Brien, J.T. (2001). Occipital hypoperfusion on SPECT in dementia with Lewy bodies but not AD. Neurology, 56, 643–649.Google Scholar
McKeith, I.G., Dickson, D.W., Lowe, J., Emre, M., O’Brien, J.T., Feldman, H., & Yamada, M. (2005). Diagnosis and management of dementia with Lewy bodies: Third report of the DLB Consortium. Neurology, 65, 1863–1872.Google Scholar
McKeith, I.G., Galasko, D., Kosaka, K., Perry, E., Dickson, D., Hansen, L.A., & Perry, R.H. (1996). Clinical and pathological diagnosis of dementia with Lewy bodies (DLB): Report of the Consortium on Dementia with Lewy Bodies (CDLB) International Workgroup. Neurology, 47, 1113–1124.Google Scholar
Merdes, A.R., Hansen, L.A., Jeste, D.V., Galasko, D., Hofstetter, C.R., Ho, G.J., & Corey-Bloom, J. (2003). Influence of Alzheimer pathology on clinical diagnostic accuracy in dementia with Lewy bodies. Neurology, 60, 1586–1590.Google Scholar
Merten, T. (2005). Factor structure of the Hooper Visual Organization Test: A cross-cultural replication and extension. Archives of Clinical Neuropsychology, 20, 123–128.Google Scholar
Metzler-Baddeley, C. (2007). A review of cognitive impairments in dementia with Lewy bodies relative to Alzheimer’s disease and Parkinson’s disease with dementia. Cortex, 43, 583–600.CrossRefGoogle ScholarPubMed
Metzler-Baddeley, C., Baddeley, R.J., Lovell, P.G., Laffan, A., & Jones, R.W. (2010). Visual impairments in dementia with Lewy bodies and posterior cortical atrophy. Neuropsychology, 24, 35–48.CrossRefGoogle ScholarPubMed
Milner, A.D., & Goodale, M.A. (1995). The visual brain in action. Oxford, UK: Oxford University press.Google Scholar
Minoshima, S., Foster, N.L., Sima, A., Frey, K.A., Albin, R.L., & Kuhl, D.E. (2001). Alzheimer’s disease versus dementia with Lewy bodies: Cerebral metabolic distinction with autopsy confirmation. Annals of Neurology, 50, 358–365.CrossRefGoogle ScholarPubMed
Mori, E., Shimomura, T., Fujimori, M., Hirono, N., Imamura, T., Hashimoto, M., & Hanihara, T. (2000). Visuoperceptual impairment in dementia with Lewy bodies. Archives of Neurology, 57, 489–493.CrossRefGoogle ScholarPubMed
Moritz, C.H., Johnson, S.C., McMillan, K.M., Haughton, V.M., & Meyerand, M.E. (2004). Functional MRI neuroanatomic correlates of the Hooper Visual Organization Test. Journal of the International Neuropsychological Society, 10, 939–947.Google Scholar
Mosimann, U.P., Mather, G., Wesnes, K.A., O’Brien, J.T., Burn, D.J., & McKeith, I.G. (2004). Visual perception in Parkinson disease dementia and dementia with Lewy bodies. Neurology, 63, 2091–2096.CrossRefGoogle ScholarPubMed
Noe, E., Marder, K., Bell, K.L., Jacobs, D.M., Manly, J.J., & Stern, Y. (2004). Comparison of dementia with Lewy bodies to Alzheimer’s disease and Parkinson’s disease with dementia. Movement Disorders, 19, 60–67.Google Scholar
Olichney, J.M., Galasko, D., Salmon, D.P., Hofstetter, C.R., Hansen, L.A., Katzman, R., && Thal, L.J. (1998). Cognitive decline is faster in Lewy body variant than in Alzheimer’s disease. Neurology, 51, 351–357.Google Scholar
Paolo, A.M., Cluff, R.B., & Ryan, J.J. (1996). Influence of perceptual organization and naming abilities on the Hooper Visual Organization Test, A replication and extension. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 9, 254–257.Google Scholar
Paul, R., Cohen, R., Moser, D., Ott, B., Zawacki, T., & Gordon, N. (2001). Performance on the Hooper Visual Organization Test in patients diagnosed with subcortical vascular dementia: Relation to naming performance. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 14, 93–97.Google Scholar
Paxton, J.L., Peavy, G.M., Jenkins, C., Rice, V.A., Heindel, W.C., & Salmon, D.P. (2007). Deterioration of visual-perceptual organization ability in Alzheimer’s disease. Cortex, 43, 967–975.CrossRefGoogle ScholarPubMed
Pellise, A., Roig, C., Barraquer-Bordas, L., & Ferrer, I. (1996). Abnormal, ubiquinated cortical neurites in patients with diffuse Lewy body disease. Neuroscience Letters, 206, 85–88.CrossRefGoogle Scholar
Rezaie, P., Cairns, N.J., Chadwick, A., & Lantos, P.L. (1996). Lewy bodies are located preferentially in limbic areas in diffuse Lewy body disease. Neuroscience Letters, 212, 111–114.Google Scholar
Ricker, J.H., & Axelrod, B.N. (1995). Hooper Visual Organization Test: Effects of object naming ability. The Clinical Neuropsychologist, 9, 57–62.Google Scholar
Salmon, D., & Butters, N. (1992). Neuropsychologic assessment of dementia in the elderly. In: Principles of geriatric neurology (pp. 144–163). New York: FA Davis.Google Scholar
Salmon, D.P., Galasko, D., Hansen, L.A., Masliah, E., Butters, N., Thal, L.J., && Katzman, R. (1996). Neuropsychological deficits associated with diffuse Lewy body disease. Brain and Cognition, 31, 148–165.Google Scholar
Salmon, D.P., & Hamilton, J.M. (2006). Neuropsychological features of dementia with Lewy bodies. In: J. O’Brien, I. McKeith, D. Ames, & E. Chiu (Eds.), Dementia with Lewy Bodies. (pp. 49–72). London: Taylor & Francis Press.Google Scholar
Salmon, D.P., Thomas, R.G., Pay, M.M., Booth, A., Hofstetter, C.R., Thal, L.J., && Katzman, R. (2002). Alzheimer’s disease can be accurately diagnosed in very mildly impaired individuals. Neurology, 59, 1022–1028.Google Scholar
Schenk, T., & McIntosh, R.D. (2010). Do we have independent visual streams for perception and action? Cognitive Neuroscience, 1, 52–78.Google Scholar
Schulteis, M.T., Caplan, B., Ricker, J.H., & Woessner, R. (2000). Fractioning the Hooper: A multiple-choice response format. The Clinical Neuropsychologist, 14, 196–201.Google Scholar
Shimomura, T., Mori, E., Yamashita, H., Imamura, T., Hirono, N., Hashimoto, M., & Hanihara, T. (1998). Cognitive loss in dementia with Lewy bodies and Alzheimer disease. Archives of Neurology, 55, 1547–1552.CrossRefGoogle ScholarPubMed
Stern, Y., Jacobs, D., Goldman, J., Gomez-Tortosa, E., Hyman, B.T., Liu, Y., & Albert, M. (2001). An investigation of clinical correlates of Lewy bodies in autopsy-proven Alzheimer disease. Archives of Neurology, 58, 460–465.Google Scholar
Taylor, J.-P., Firbank, M.J., He, J., Barnett, N., Pearce, S., Livingstone, A., & O’Brien, J.T. (2012). Visual cortex in dementia with Lewy bodies: Magnetic resonance imaging study. British Journal of Psychiatry, 200, 491–498.Google Scholar
Terry, R.D., Peck, A., DeTeresa, R., Schechter, R., & Horoupian, D.S. (1981). Some morphometric aspects of the brain in senile dementia of the Alzheimer type. Annals of Neurology, 10, 184–192.Google Scholar
Tiraboschi, P., Salmon, D.P., Hansen, L.A., Hofstetter, R.C., Thal, L.J., & Corey-Bloom, J. (2006). What best differentiates Lewy body from Alzheimer’s disease in early-stage dementia? Brain, 129, 729–735.Google Scholar
Troster, A.I. (2008). Neuropsychological characteristics of dementia with Lewy bodies and Parkinson’s disease with dementia: Differentiation, early detection, and implications for “mild cognitive impairment” and biomarkers. Neuropsychology Review, 18, 103–119.Google Scholar
Tsuboi, Y., & Dickson, D.W. (2005). Dementia with Lewy bodies and Parkinson’s disease with dementia: Are they different? Parkinsonism and Related Disorders, 11(Suppl. 1), S47–S51.Google Scholar
Ungerleider, L.G., & Mishkin, M. (1982). Two cortical visual systems. In D.J. Ingle, R.J.W. Mansfield, & M.S. Goodale (Eds.), The analysis of visual behavior. Cambridge: MIT.Google Scholar
Villemagne, V.L., Burnham, S., Bourgeat, P., Brown, B., Ellis, K.A., Salvado, O., … the Australian Imaging Biomarkers and Lifestyle (AIBL) Research Group. (2013). Amyloid B deposition, neurodegeneration, and cognitive decline in sporadic Alzheimer’s disease: A prospective cohort study. Lancet Neurology, 12, 357–367.Google Scholar
Walker, Z., Allen, R.L., Shergill, S., & Katona, C.L. (1997). Neuropsychological performance in Lewy body dementia and Alzheimer’s disease. British Journal of Psychiatry, 170, 156–158.Google Scholar
Wood, J.S., Firbank, M.J., Mosimann, U.P., Watson, R., Barber, R., Blamire, A.M., && O’Brien, J.T. (2013). Testing visual perception in dementia with Lewy bodies and Alzheimer’s disease. American Journal of Geriatric Psychiatry, 21, 501–508.Google Scholar
Wood, J.S., Watson, R., Firbank, M.J., Mosimann, U.P., Barber, R., Blamire, A.M., && O’Brien, J.T. (2013). Longitudinal testing of visual perception in dementia with Lewy bodies and Alzheimer’s disease. International Journal of Geriatric Psychiatry, 28, 567–572.Google Scholar
Yamamoto, R., Iseki, E., Murayama, N., Minegishi, M., Marui, W., Togo, T., & Arai, H. (2006). Investigation of Lewy pathology in the visual pathway of brains of dementia with Lewy bodies. Journal of the Neurological Sciences, 246, 95–101.Google Scholar