The Pareidolia Test: A Simple Neuropsychological Test Measuring Visual Hallucination-Like Illusions

Yasuyuki Mamiya, Yoshiyuki Nishio, Hiroyuki Watanabe, Kayoko Yokoi, Makoto Uchiyama, Toru Baba, Osamu Iizuka, Shigenori Kanno, Naoto Kamimura, Hiroaki Kazui, Mamoru Hashimoto, Manabu Ikeda, Chieko Takeshita, Tatsuo Shimomura, Etsuro Mori, Yasuyuki Mamiya, Yoshiyuki Nishio, Hiroyuki Watanabe, Kayoko Yokoi, Makoto Uchiyama, Toru Baba, Osamu Iizuka, Shigenori Kanno, Naoto Kamimura, Hiroaki Kazui, Mamoru Hashimoto, Manabu Ikeda, Chieko Takeshita, Tatsuo Shimomura, Etsuro Mori

Abstract

Background: Visual hallucinations are a core clinical feature of dementia with Lewy bodies (DLB), and this symptom is important in the differential diagnosis and prediction of treatment response. The pareidolia test is a tool that evokes visual hallucination-like illusions, and these illusions may be a surrogate marker of visual hallucinations in DLB. We created a simplified version of the pareidolia test and examined its validity and reliability to establish the clinical utility of this test.

Methods: The pareidolia test was administered to 52 patients with DLB, 52 patients with Alzheimer's disease (AD) and 20 healthy controls (HCs). We assessed the test-retest/inter-rater reliability using the intra-class correlation coefficient (ICC) and the concurrent validity using the Neuropsychiatric Inventory (NPI) hallucinations score as a reference. A receiver operating characteristic (ROC) analysis was used to evaluate the sensitivity and specificity of the pareidolia test to differentiate DLB from AD and HCs.

Results: The pareidolia test required approximately 15 minutes to administer, exhibited good test-retest/inter-rater reliability (ICC of 0.82), and moderately correlated with the NPI hallucinations score (rs = 0.42). Using an optimal cut-off score set according to the ROC analysis, and the pareidolia test differentiated DLB from AD with a sensitivity of 81% and a specificity of 92%.

Conclusions: Our study suggests that the simplified version of the pareidolia test is a valid and reliable surrogate marker of visual hallucinations in DLB.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
(A) Numbers of images in which subjects made illusory responses in the scene pareidolia test. (B) Numbers of illusory responses in the noise pareidolia test. (C) The pareidolia score. Significance is denoted by an asterisk (Mann-Whitney U test, p

Fig 2. Receiver Operating Characteristic analysis for…

Fig 2. Receiver Operating Characteristic analysis for the pareidolia test to differentiate DLB from AD.

Fig 2. Receiver Operating Characteristic analysis for the pareidolia test to differentiate DLB from AD.
The areas under the curve (AUCs) were 0.86 for the scene pareidolia test, 0.82 for the noise pareidolia test and 0.92 for the pareidolia score.
Fig 2. Receiver Operating Characteristic analysis for…
Fig 2. Receiver Operating Characteristic analysis for the pareidolia test to differentiate DLB from AD.
The areas under the curve (AUCs) were 0.86 for the scene pareidolia test, 0.82 for the noise pareidolia test and 0.92 for the pareidolia score.

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