Visual hallucinations, thalamocortical physiology and Lewy body disease: A review

Shooka Esmaeeli, Kathleen Murphy, Gabriel M. Swords, Baher A. Ibrahim, Jeffrey William Brown, Daniel A. Llano

Research output: Contribution to journalReview articlepeer-review


One of the core diagnostic criteria for Dementia with Lewy Bodies (DLB) is the presence of visual hallucinations. The presence of hallucinations, along with fluctuations in the level of arousal and sleep disturbance, point to potential pathological mechanisms at the level of the thalamus. However, the potential role of thalamic dysfunction in DLB, particularly as it relates to the presence of formed visual hallucinations is not known. Here, we review the literature on the pathophysiology of DLB with respect to modern theories of thalamocortical function and attempt to derive an understanding of how such hallucinations arise. Based on the available literature, we propose that combined thalamic-thalamic reticular nucleus and thalamocortical pathology may explain the phenomenology of visual hallucinations in DLB. In particular, diminished α7 cholinergic activity in the thalamic reticular nucleus may critically disinhibit thalamocortical activity. Further, concentrated pathological changes within the posterior regions of the thalamus may explain the predilection for the hallucinations to be visual in nature.

Original languageEnglish (US)
Pages (from-to)337-351
Number of pages15
JournalNeuroscience and Biobehavioral Reviews
StatePublished - Aug 2019


  • Acetylcholine
  • Dementia
  • Hallucination
  • Lewy body
  • Thalamic reticular nucleus
  • Thalamus

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


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