Functional involvement of central cholinergic circuits and visual hallucinations in Parkinson's disease
Identifieur interne : 000329 ( Main/Corpus ); précédent : 000328; suivant : 000330Functional involvement of central cholinergic circuits and visual hallucinations in Parkinson's disease
Auteurs : Fiore Manganelli ; Carmine Vitale ; Gabriella Santangelo ; Chiara Pisciotta ; Rosa Iodice ; Autilia Cozzolino ; Raffaele Dubbioso ; Marina Picillo ; Paolo Barone ; Lucio SantoroSource :
- Brain [ 0006-8950 ] ; 2009-09.
Abstract
Visual hallucinations (VHs) represent a frequent and disturbing complication of Parkinson's disease. Evidence suggests that VH can be related to central cholinergic dysfunction. Short-latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. This inhibition of motor-evoked potentials can be observed when transcranial magnetic stimulation is delivered with a delay ranging from 2 to 8 ms, after a peripheral nerve afferent input has reached the somatosensory cortex. We applied SAI technique in 10 non-demented patients with Parkinson's disease with VHs, in 12 non-demented patients with Parkinson's disease without VHs (NVH-pts) and in 11 age-matched normal controls. All patients with Parkinson's disease underwent a battery of neuropsychological tests to assess frontal and visuospatial functions, memory and attention. SAI was significantly reduced in patients with VHs compared with controls and patients without VHs. Neuropsychological examination showed a mild cognitive impairment in 16 out of 22 patients with Parkinson's disease. In addition, we found that in our patients with VHs, performance of some tasks evaluating visuospatial functions and attentional/frontal lobe functions was significantly more impaired than in patients without VHs. SAI abnormalities, presence of VH and neuropsychological results strongly support the hypothesis of cholinergic dysfunction in some patients with Parkinson's disease, who will probably develop a dementia. A follow-up study of our patients is required to verify whether SAI abnormalities can predict a future severe cognitive decline. Moreover, SAI can also be very useful to follow-up the efficacy of anti-cholinesterase therapies.
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DOI: 10.1093/brain/awp166
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Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: lusantor@unina.it</mods:affiliation></affiliation></author><author><name sortKey="Vitale, Carmine" sort="Vitale, Carmine" uniqKey="Vitale C" first="Carmine" last="Vitale">Carmine Vitale</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>2 University Parthenope of Naples, Naples, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: lusantor@unina.it</mods:affiliation></affiliation></author><author><name sortKey="Santangelo, Gabriella" sort="Santangelo, Gabriella" uniqKey="Santangelo G" first="Gabriella" last="Santangelo">Gabriella Santangelo</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University 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Italy</mods:affiliation></affiliation></author><author><name sortKey="Cozzolino, Autilia" sort="Cozzolino, Autilia" uniqKey="Cozzolino A" first="Autilia" last="Cozzolino">Autilia Cozzolino</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</mods:affiliation></affiliation></author><author><name sortKey="Dubbioso, Raffaele" sort="Dubbioso, Raffaele" uniqKey="Dubbioso R" first="Raffaele" last="Dubbioso">Raffaele Dubbioso</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</mods:affiliation></affiliation></author><author><name sortKey="Picillo, Marina" sort="Picillo, Marina" uniqKey="Picillo M" first="Marina" last="Picillo">Marina Picillo</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</mods:affiliation></affiliation></author><author><name sortKey="Barone, Paolo" sort="Barone, Paolo" uniqKey="Barone P" first="Paolo" last="Barone">Paolo Barone</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</mods:affiliation></affiliation></author><author><name sortKey="Santoro, Lucio" sort="Santoro, Lucio" uniqKey="Santoro L" first="Lucio" last="Santoro">Lucio Santoro</name><affiliation><mods:affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: lusantor@unina.it</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009-09">2009-09</date><biblScope unit="volume">132</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="2350">2350</biblScope><biblScope unit="page" to="2355">2355</biblScope></imprint><idno type="ISSN">0006-8950</idno></series><idno type="istex">90846F904B4D02E6B4943E4A838DF18DEFA46506</idno><idno type="DOI">10.1093/brain/awp166</idno><idno type="ArticleID">awp166</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Visual hallucinations (VHs) represent a frequent and disturbing complication of Parkinson's disease. Evidence suggests that VH can be related to central cholinergic dysfunction. Short-latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. This inhibition of motor-evoked potentials can be observed when transcranial magnetic stimulation is delivered with a delay ranging from 2 to 8 ms, after a peripheral nerve afferent input has reached the somatosensory cortex. We applied SAI technique in 10 non-demented patients with Parkinson's disease with VHs, in 12 non-demented patients with Parkinson's disease without VHs (NVH-pts) and in 11 age-matched normal controls. All patients with Parkinson's disease underwent a battery of neuropsychological tests to assess frontal and visuospatial functions, memory and attention. SAI was significantly reduced in patients with VHs compared with controls and patients without VHs. Neuropsychological examination showed a mild cognitive impairment in 16 out of 22 patients with Parkinson's disease. In addition, we found that in our patients with VHs, performance of some tasks evaluating visuospatial functions and attentional/frontal lobe functions was significantly more impaired than in patients without VHs. SAI abnormalities, presence of VH and neuropsychological results strongly support the hypothesis of cholinergic dysfunction in some patients with Parkinson's disease, who will probably develop a dementia. A follow-up study of our patients is required to verify whether SAI abnormalities can predict a future severe cognitive decline. Moreover, SAI can also be very useful to follow-up the efficacy of anti-cholinesterase therapies.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Fiore Manganelli</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string><json:string>E-mail: lusantor@unina.it</json:string></affiliations></json:item><json:item><name>Carmine Vitale</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string><json:string>2 University Parthenope of Naples, Naples, Italy</json:string><json:string>3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</json:string><json:string>E-mail: lusantor@unina.it</json:string></affiliations></json:item><json:item><name>Gabriella Santangelo</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string><json:string>3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</json:string><json:string>4 Second University of Naples, Neuropsychology Laboratory, Department of Psychology, Naples, Italy</json:string><json:string>E-mail: lusantor@unina.it</json:string></affiliations></json:item><json:item><name>Chiara Pisciotta</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string></affiliations></json:item><json:item><name>Rosa Iodice</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string></affiliations></json:item><json:item><name>Autilia Cozzolino</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string></affiliations></json:item><json:item><name>Raffaele Dubbioso</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string></affiliations></json:item><json:item><name>Marina Picillo</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string></affiliations></json:item><json:item><name>Paolo Barone</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string></affiliations></json:item><json:item><name>Lucio Santoro</name><affiliations><json:string>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</json:string><json:string>E-mail: lusantor@unina.it</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Original Articles</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Parkinson's disease</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>TMS</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>short-latency afferent inhibition</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>cognitive deficits</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>visual hallucinations</value></json:item></subject><language><json:string>eng</json:string></language><abstract>Visual hallucinations (VHs) represent a frequent and disturbing complication of Parkinson's disease. Evidence suggests that VH can be related to central cholinergic dysfunction. Short-latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. This inhibition of motor-evoked potentials can be observed when transcranial magnetic stimulation is delivered with a delay ranging from 2 to 8 ms, after a peripheral nerve afferent input has reached the somatosensory cortex. We applied SAI technique in 10 non-demented patients with Parkinson's disease with VHs, in 12 non-demented patients with Parkinson's disease without VHs (NVH-pts) and in 11 age-matched normal controls. All patients with Parkinson's disease underwent a battery of neuropsychological tests to assess frontal and visuospatial functions, memory and attention. SAI was significantly reduced in patients with VHs compared with controls and patients without VHs. Neuropsychological examination showed a mild cognitive impairment in 16 out of 22 patients with Parkinson's disease. In addition, we found that in our patients with VHs, performance of some tasks evaluating visuospatial functions and attentional/frontal lobe functions was significantly more impaired than in patients without VHs. SAI abnormalities, presence of VH and neuropsychological results strongly support the hypothesis of cholinergic dysfunction in some patients with Parkinson's disease, who will probably develop a dementia. A follow-up study of our patients is required to verify whether SAI abnormalities can predict a future severe cognitive decline. Moreover, SAI can also be very useful to follow-up the efficacy of anti-cholinesterase therapies.</abstract><qualityIndicators><score>7.519</score><pdfVersion>1.4</pdfVersion><pdfPageSize>612.68 x 790.866 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>6</keywordCount><abstractCharCount>1772</abstractCharCount><pdfWordCount>4043</pdfWordCount><pdfCharCount>26766</pdfCharCount><pdfPageCount>6</pdfPageCount><abstractWordCount>248</abstractWordCount></qualityIndicators><title>Functional involvement of central cholinergic circuits and visual hallucinations in Parkinson's disease</title><genre><json:string>research-article</json:string></genre><host><volume>132</volume><pages><last>2355</last><first>2350</first></pages><issn><json:string>0006-8950</json:string></issn><issue>9</issue><genre></genre><language><json:string>unknown</json:string></language><eissn><json:string>1460-2156</json:string></eissn><title>Brain</title></host><categories><wos><json:string>CLINICAL 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Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</affiliation></author><author corresp="yes"><persName><forename type="first">Gabriella</forename><surname>Santangelo</surname></persName><email>lusantor@unina.it</email><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><affiliation>3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</affiliation><affiliation>4 Second University of Naples, Neuropsychology Laboratory, Department of Psychology, Naples, Italy</affiliation></author><author><persName><forename type="first">Chiara</forename><surname>Pisciotta</surname></persName><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author><author><persName><forename type="first">Rosa</forename><surname>Iodice</surname></persName><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author><author><persName><forename type="first">Autilia</forename><surname>Cozzolino</surname></persName><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author><author><persName><forename type="first">Raffaele</forename><surname>Dubbioso</surname></persName><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author><author><persName><forename type="first">Marina</forename><surname>Picillo</surname></persName><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author><author><persName><forename type="first">Paolo</forename><surname>Barone</surname></persName><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author><author corresp="yes"><persName><forename type="first">Lucio</forename><surname>Santoro</surname></persName><email>lusantor@unina.it</email><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation></author></analytic><monogr><title level="j">Brain</title><idno type="pISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009-09"></date><biblScope unit="volume">132</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="2350">2350</biblScope><biblScope unit="page" to="2355">2355</biblScope></imprint></monogr><idno type="istex">90846F904B4D02E6B4943E4A838DF18DEFA46506</idno><idno type="DOI">10.1093/brain/awp166</idno><idno type="ArticleID">awp166</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2009-07-07</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Visual hallucinations (VHs) represent a frequent and disturbing complication of Parkinson's disease. Evidence suggests that VH can be related to central cholinergic dysfunction. Short-latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. This inhibition of motor-evoked potentials can be observed when transcranial magnetic stimulation is delivered with a delay ranging from 2 to 8 ms, after a peripheral nerve afferent input has reached the somatosensory cortex. We applied SAI technique in 10 non-demented patients with Parkinson's disease with VHs, in 12 non-demented patients with Parkinson's disease without VHs (NVH-pts) and in 11 age-matched normal controls. All patients with Parkinson's disease underwent a battery of neuropsychological tests to assess frontal and visuospatial functions, memory and attention. SAI was significantly reduced in patients with VHs compared with controls and patients without VHs. Neuropsychological examination showed a mild cognitive impairment in 16 out of 22 patients with Parkinson's disease. In addition, we found that in our patients with VHs, performance of some tasks evaluating visuospatial functions and attentional/frontal lobe functions was significantly more impaired than in patients without VHs. SAI abnormalities, presence of VH and neuropsychological results strongly support the hypothesis of cholinergic dysfunction in some patients with Parkinson's disease, who will probably develop a dementia. A follow-up study of our patients is required to verify whether SAI abnormalities can predict a future severe cognitive decline. Moreover, SAI can also be very useful to follow-up the efficacy of anti-cholinesterase therapies.</p></abstract><textClass><keywords scheme="keyword"><list><item><term>Original Articles</term></item></list></keywords></textClass><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Parkinson's disease</term></item><item><term>TMS</term></item><item><term>short-latency afferent inhibition</term></item><item><term>cognitive deficits</term></item><item><term>visual hallucinations</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2009-07-07">Created</change><change when="2009-09">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/90846F904B4D02E6B4943E4A838DF18DEFA46506/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">brain</journal-id><journal-id journal-id-type="publisher-id">brainj</journal-id><journal-title>Brain</journal-title><issn pub-type="ppub">0006-8950</issn><issn pub-type="epub">1460-2156</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/brain/awp166</article-id><article-id pub-id-type="publisher-id">awp166</article-id><article-categories><subj-group><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Functional involvement of central cholinergic circuits and visual hallucinations in Parkinson's disease</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Manganelli</surname><given-names>Fiore</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Vitale</surname><given-names>Carmine</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF2"><sup>2</sup></xref><xref ref-type="aff" rid="AFF3"><sup>3</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Santangelo</surname><given-names>Gabriella</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref><xref ref-type="aff" rid="AFF3"><sup>3</sup></xref><xref ref-type="aff" rid="AFF4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Pisciotta</surname><given-names>Chiara</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Iodice</surname><given-names>Rosa</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cozzolino</surname><given-names>Autilia</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Dubbioso</surname><given-names>Raffaele</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Picillo</surname><given-names>Marina</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Barone</surname><given-names>Paolo</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib><contrib contrib-type="author" corresp="yes"><name><surname>Santoro</surname><given-names>Lucio</given-names></name><xref ref-type="aff" rid="AFF1"><sup>1</sup></xref></contrib></contrib-group><aff id="AFF1">1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</aff><aff id="AFF2">2 University Parthenope of Naples, Naples, Italy</aff><aff id="AFF3">3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</aff><aff id="AFF4">4 Second University of Naples, Neuropsychology Laboratory, Department of Psychology, Naples, Italy</aff><author-notes><corresp>Correspondence to: Lucio Santoro, MD, Department of Neurological Sciences, University Federico II of Naples, Via Sergio Pansini 5, 80131 Naples, Italy E-mail: <email>lusantor@unina.it</email></corresp></author-notes><pub-date pub-type="ppub"><month>9</month><year>2009</year></pub-date><pub-date pub-type="epub"><day>7</day><month>7</month><year>2009</year></pub-date><volume>132</volume><issue>9</issue><fpage>2350</fpage><lpage>2355</lpage><history><date date-type="received"><day>27</day><month>2</month><year>2009</year></date><date date-type="rev-recd"><day>16</day><month>4</month><year>2009</year></date><date date-type="accepted"><day>15</day><month>5</month><year>2009</year></date></history><permissions><copyright-statement>© The Author (2009). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org</copyright-statement><copyright-year>2009</copyright-year></permissions><abstract><p>Visual hallucinations (VHs) represent a frequent and disturbing complication of Parkinson's disease. Evidence suggests that VH can be related to central cholinergic dysfunction. Short-latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. This inhibition of motor-evoked potentials can be observed when transcranial magnetic stimulation is delivered with a delay ranging from 2 to 8 ms, after a peripheral nerve afferent input has reached the somatosensory cortex. We applied SAI technique in 10 non-demented patients with Parkinson's disease with VHs, in 12 non-demented patients with Parkinson's disease without VHs (NVH-pts) and in 11 age-matched normal controls. All patients with Parkinson's disease underwent a battery of neuropsychological tests to assess frontal and visuospatial functions, memory and attention. SAI was significantly reduced in patients with VHs compared with controls and patients without VHs. Neuropsychological examination showed a mild cognitive impairment in 16 out of 22 patients with Parkinson's disease. In addition, we found that in our patients with VHs, performance of some tasks evaluating visuospatial functions and attentional/frontal lobe functions was significantly more impaired than in patients without VHs. SAI abnormalities, presence of VH and neuropsychological results strongly support the hypothesis of cholinergic dysfunction in some patients with Parkinson's disease, who will probably develop a dementia. A follow-up study of our patients is required to verify whether SAI abnormalities can predict a future severe cognitive decline. Moreover, SAI can also be very useful to follow-up the efficacy of anti-cholinesterase therapies.</p></abstract><kwd-group><kwd>Parkinson's disease</kwd><kwd>TMS</kwd><kwd>short-latency afferent inhibition</kwd><kwd>cognitive deficits</kwd><kwd>visual hallucinations</kwd></kwd-group></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Functional involvement of central cholinergic circuits and visual hallucinations in Parkinson's disease</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Functional involvement of central cholinergic circuits and visual hallucinations in Parkinson's disease</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Fiore</namePart><namePart type="family">Manganelli</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><affiliation>E-mail: lusantor@unina.it</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Carmine</namePart><namePart type="family">Vitale</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><affiliation>2 University Parthenope of Naples, Naples, Italy</affiliation><affiliation>3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</affiliation><affiliation>E-mail: lusantor@unina.it</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Gabriella</namePart><namePart type="family">Santangelo</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><affiliation>3 Istituto di Diagnosi e Cura Hermitage Capodimonte, Naples, Italy</affiliation><affiliation>4 Second University of Naples, Neuropsychology Laboratory, Department of Psychology, Naples, Italy</affiliation><affiliation>E-mail: lusantor@unina.it</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Chiara</namePart><namePart type="family">Pisciotta</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rosa</namePart><namePart type="family">Iodice</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Autilia</namePart><namePart type="family">Cozzolino</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Raffaele</namePart><namePart type="family">Dubbioso</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Marina</namePart><namePart type="family">Picillo</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Paolo</namePart><namePart type="family">Barone</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Lucio</namePart><namePart type="family">Santoro</namePart><affiliation>1 Department of Neurological Sciences, University Federico II of Naples, Naples, Italy</affiliation><affiliation>E-mail: lusantor@unina.it</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><topic>Original Articles</topic></subject><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2009-09</dateIssued><dateCreated encoding="w3cdtf">2009-07-07</dateCreated><copyrightDate encoding="w3cdtf">2009</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Visual hallucinations (VHs) represent a frequent and disturbing complication of Parkinson's disease. Evidence suggests that VH can be related to central cholinergic dysfunction. Short-latency afferent inhibition (SAI) technique gives the opportunity to test an inhibitory cholinergic circuit in the human cerebral motor cortex. This inhibition of motor-evoked potentials can be observed when transcranial magnetic stimulation is delivered with a delay ranging from 2 to 8 ms, after a peripheral nerve afferent input has reached the somatosensory cortex. We applied SAI technique in 10 non-demented patients with Parkinson's disease with VHs, in 12 non-demented patients with Parkinson's disease without VHs (NVH-pts) and in 11 age-matched normal controls. All patients with Parkinson's disease underwent a battery of neuropsychological tests to assess frontal and visuospatial functions, memory and attention. SAI was significantly reduced in patients with VHs compared with controls and patients without VHs. Neuropsychological examination showed a mild cognitive impairment in 16 out of 22 patients with Parkinson's disease. In addition, we found that in our patients with VHs, performance of some tasks evaluating visuospatial functions and attentional/frontal lobe functions was significantly more impaired than in patients without VHs. SAI abnormalities, presence of VH and neuropsychological results strongly support the hypothesis of cholinergic dysfunction in some patients with Parkinson's disease, who will probably develop a dementia. A follow-up study of our patients is required to verify whether SAI abnormalities can predict a future severe cognitive decline. Moreover, SAI can also be very useful to follow-up the efficacy of anti-cholinesterase therapies.</abstract><subject><genre>Keywords</genre><topic>Parkinson's disease</topic><topic>TMS</topic><topic>short-latency afferent inhibition</topic><topic>cognitive deficits</topic><topic>visual hallucinations</topic></subject><relatedItem type="host"><titleInfo><title>Brain</title></titleInfo><genre type="Journal">journal</genre><identifier type="ISSN">0006-8950</identifier><identifier type="eISSN">1460-2156</identifier><identifier type="PublisherID">brainj</identifier><identifier type="PublisherID-hwp">brain</identifier><part><date>2009</date><detail type="volume"><caption>vol.</caption><number>132</number></detail><detail type="issue"><caption>no.</caption><number>9</number></detail><extent unit="pages"><start>2350</start><end>2355</end></extent></part></relatedItem><identifier type="istex">90846F904B4D02E6B4943E4A838DF18DEFA46506</identifier><identifier type="DOI">10.1093/brain/awp166</identifier><identifier type="ArticleID">awp166</identifier><accessCondition type="use and reproduction" contentType="copyright">© The Author (2009). 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