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Letter to the Editor

Published online by Cambridge University Press:  24 June 2014

K. Hori ,
T. Inada ,
S. Sengan  and
M. Ikeda
K. Hori*
Affiliation:
National Shimofusa Hospital, Department of Clinical Research, Chiba, Japan
T. Inada
Affiliation:
Nagoya University Graduate School of Medicine, Department of Psychiatry and Psychobiology, Aichi, Japan
S. Sengan
Affiliation:
National Saigata Hospital, Niigata, Japan
M. Ikeda
Affiliation:
National Saigata Hospital, Niigata, Japan
*
National Shimofusa Hospital, 578 Heta, Midoriku, Chiba-shi, Chiba 266–0007, Japan. Tel: + 81 43 291 1221; Fax: + 81 43 291 2602; E-mail: hori@simofusa.hosp.go.jp
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Abstract

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Type
Letter
Information
Acta Neuropsychiatrica , Volume 15 , Issue 2 , April 2003 , pp. 102
Copyright
Copyright © 2003 Blackwell Munksgaard

To the Editor

Charles Bonnet syndrome (CBS) is a condition characterized solely by visual hallucination with insight, and dementia or psychosis is absent (Reference Teunisse, Cruysberg and Hoefnagels1). We report a patient with this syndrome whose visual hallucinations disappeared during treatment with donepezil, an acetylcholine esterase inhibitor.

An 89-year-old woman had been suffering from reading and writing disability since cataracts had developed at the age of 86 years. Nine months before her first visit to our out-patient clinic, she had been complaining of visual hallucinations in which she saw her husband and son, who had already died, a fictitious grandson, and colourful flowers on the ceiling. She recognized these hallucinations to be unreal, and believed they were the result of her missing her husband and son and longing for a grandson. She was not amnesic. Although her MMSE score of 18 indicated mild cognitive impairment, she was not demented or psychotic. Donepezil at 5 mg/day resolved her visual hallucinations almost completely within 2 weeks.

Pliskin et al. suggested that CBS might be an early marker of dementia (Reference Pliskin, Kiolbasa and Towle2), and Terao et al. reported a patient with diffuse Lewy body disease (DLBD) whose visual hallucinations gradually diminished together with recovery of insight after initiation of donepezil (Reference Terao and Collinson3). Cummings suggested that an imbalance between dopaminergic and cholinergic transmission underlies not only cognitive dysfunction but also neuropsychiatric symptoms such as hallucinations and delusions seen in Alzheimer's disease (AD) or DLBD (Reference Cummings4). Because donepezil was effective for treating the visual hallucinations in the present case of CBS, such a dopaminergic/cholinergic imbalance may have been responsible for the pathophysiology, which might be similar to that of the cognitive dysfunctions and neuropsychiatric symptoms seen in AD or DLBD. The present case suggests that CBS might be an early manifestation of these dementias.

References

Teunisse, RJ, Cruysberg, JR, Hoefnagels, WHet al. Visual hallucinations in psychologically normal people: Charles Bonnet's syndrome. Lancet 1996;347: 794–797.CrossRefGoogle ScholarPubMed
Pliskin, NH, Kiolbasa, TA, Towle, VLet al. Charles Bonnet syndrome: an early marker for dementia? J Am Geriatr Soc 1996;44: 1055–1061.CrossRefGoogle ScholarPubMed
Terao, T, Collinson, S. Charles Bonnet syndrome and dementia. Lancet 2000;355: 2168–2168.CrossRefGoogle ScholarPubMed
Cummings, JL. Cholinesterase inhibitors. a new class of psychotropic compounds. Am J Psychiatry 2000; 157: 4–15.CrossRefGoogle ScholarPubMed