Visual hallucinations in Parkinson's disease: The critical role of intermediate nucleus basalis of Meynert

Patients with Parkinson's disease (PD) often experience visual hallucinations (VH) and delusions. PD patients with VH reportedly have a higher incidence of dementia than PD patients without VH. The nucleus basalis of Meynert (nbM) comprises acetylcholine-releasing neurons that are critical for memory, attention, and arousal. Notably, the nbM also exhibits pathological α-synuclein accumulation, which is a hallmark of Lewy body diseases, including PD. In the present study, we investigated the distribution of abnormal α-synuclein accumulation in the nbM.

nbM sections of PD 28 autopsy patients were prepared and analyzed via immunohistochemistry using antibodies against phosphorylated α-synuclein and Choline acetyltransferase. The analysis included quantitative assessments of Choline acetyltransferase or α-synuclein positive neurons.

Immunohistochemical analyses of the nbM sections revealed significant cholinergic neuron loss in the intermediate nbM of patients with VH compared with those without VH (137 vs. 191, p = 0.04). Moreover, the ratio of α-synuclein-positive cells to choline acetyltransferase-positive cells was significantly higher in patients with VH than in those without VH (p = 0.03).

Pathological changes in nbM-particularly cholinergic deficits in the intermediate part-were therefore identified as potential contributors to VH in PD. These findings add to our understanding of the neuropathological basis of VH in PD and may inform future therapeutic strategies.