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Department of Neurology, Division of Behavioural Neurology, Mayo Clinic, Rochester, Minnesota, USA
Correspondence to: Keith A. Josephs, MD, MST, MSc
Professor of Neurology
Mayo Clinic
200 1st Street S.W.
Rochester, MN, 55905, USA
E-mail: Josephs.keith@mayo.edu
Received May 14, 2015. Revised July 27, 2015. Accepted August 9, 2015. Advance Access publication October 7, 2015
ß The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.
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3794 | BRAIN 2015: 138; 3793–3802 E. C. Golden and K. A. Josephs
to capture all medical records in which the terms ‘musical If significance was found, the Tukey-Kramer post hoc test
hallucinations’, ‘music AND hallucinations’, and ‘hear music’ was then used to compare all pairs of groups.
including all tenses of ‘hear’ appeared. The medical records of We did not adjust for multiple comparisons in our study
all subjects identified were then reviewed to determine whether given that we had an a priori hypothesis for testing for these
they met criteria for musical hallucinations defined as the per- associations. In addition, adjusting for multiple comparisons
ception of music not perceived by others present. Subjects were would have increased the likelihood of type II errors for asso-
only included if they were at least 18 years old and the symp- ciations that were not null. Not adjusting for multiple com-
tom of musical hallucinations was documented in a clinical parisons has been advocated since it will result in fewer errors
encounter with a Mayo Clinic provider including physician, in interpretation when the data are not random numbers but
nurse practitioner, or psychologist. Subjects who only experi- actual observations in nature (Rothman, 1990). Therefore,
enced isolated hypnagogic or hypnopompic hallucinations adjusting our data could have resulted in missing important
were excluded. Clinical data were abstracted in all subjects findings.
that met the inclusion criteria, including age at onset of
musical hallucinations, the presence of visual or other auditory
Structural group
Thirty-seven subjects (9%) had structural lesions associated
with the musical hallucinations. Of the 37, all had MRI
completed except for two who had a head CT and one
who did not have imaging available for review but had a
50.0001a,b,c,d,g,i,j
50.0001a,b,d,f,g,i,j
50.0001a,b,d,e,h
50.0173b,c,e,f
50.0001a,e,f,g
Category Description
P-values*
Neuro versus Psych; bNeuro versus Structural; cNeuro versus Drug; dNeuro versus NOC; ePsych versus Structural; fPsych versus Drug; gPsych versus NOC; hStructural versus Drug; iStructural versus NOC; jDrug versus NOC.
Neurologic
Neurodegenerative ‘church choral music’
39 (67.2%)
39 (67.2%)
17 (29.3%)
‘echo of last music he heard’
7 (12.1%)
73 (12.9)
‘big band’ (n = 2 subjects)
Structural NOC
‘single tune with the words “where were
58 you when the Lord was crucified” or
18 (48.9%)
10 (27.0%)
5 (13.5%)
44 (19.2)
1 (2.7%)
“where were you when your Lord was
placed in the grave, 24 hours a day”
37
‘church hymns’
23 (51.1%)
11 (24.4%)
12 (26.7%)
7 (15.6%)
Structural
54 (19.0)
‘rock music’
‘Fraggle rock’
109 (70.3%)
18 (11.6%)
74 (47.8%)
33 (21.3%)
‘Queen’
Dementia NOS All Neurodegenerative Psych
155
‘string instruments’
1 (50%)
1 (50%)
0 (0%)
59 (3)
FTD
14 (77.8%)
Neurodegenerative
*All of the results except for the gender association would have survived Bonferroni correction.
classifiable
8 (44.4%)
7 (38.9%)
7 (38.9%)
17 (73.9%)
4 (17.4%)
Low-Sweet Chariot’
other auditory hallucinations
‘Japanese’
‘Polish’
visual hallucinations
hearing impairment
‘Star-Spangled banner’
n
a
3798 | BRAIN 2015: 138; 3793–3802 E. C. Golden and K. A. Josephs
Table 3 All neurological diagnoses associated with Table 4 All psychiatric disorders associated with mu-
musical hallucinations sical hallucinations
Table 5 All structural lesions associated with musical musical imagery and perception, the primary auditory
hallucinations cortex is not necessarily activated in musical imagery
(Cope and Baguley, 2009). In a model proposed by
Structural Location n
Griffiths (2000), hearing impairment decreases auditory
Tumour Left temporal Total = 14 input to the primary auditory cortex, releasing basal inhib-
Left frontotemporal 8
ition on the auditory association cortex allowing for spon-
Left temporoparietal 3
taneous activity and potentially augmenting connections
Right parietotemporal 1
Right pons, midbrain, 1
with areas that encode and recognize patterned sounds
cerebellum 1 such as music. It is suggested that the threshold for spon-
Post-surgical lesion Total = 7 taneous activity varies between people and may be lowered
Right temporal 4 by disease or toxicity affecting the auditory pathway
Right frontotemporal 1 (Griffiths, 2000; Kumar et al., 2014). This study character-
left temporoparietal 1 izes a variety of conditions associated with musical hallu-
musical hallucinations than other neurodegenerative dis- provider, sometimes unsolicited and sometimes as part of
orders is due to a greater cholinergic deficit and possibly screening in neurologic or psychiatric review of symptoms,
due to early brainstem involvement, affecting the proximal which may have slightly shifted the population. Certainly,
auditory pathways. there were patients seen at Mayo Clinic during the study
Subjects who had musical hallucinations in association time period outside of neurology and psychiatry practices
with a neurodegenerative disease or with isolated hearing who were not screened for hallucinations. Detail concern-
impairment tended to hear music, which was more persistent ing hallucination characteristics and temporal profile was
over a longer time period. Several of these individuals experi- often lacking. Hearing impairment was not always screened
enced an interesting phenomenon where the music disinte- for or documented so its prevalence in this population was
grated over time into increasingly shorter melodies and tunes certainly falsely low.
and sometimes terminating in repetitive single notes well This study reviewed cases seen at Mayo Clinic across
described by one subject who reported that she ‘noted a specialties, including primary care, neurology, psychiatry,
change in the phenomena. . .such as hearing a certain otorhinolaryngology, and audiology, a design which
in Alzheimer’s disease: randomised double blind placebo controlled McKeith IG, Perry RH, Fairbairn AF, Jabeen S, Perry EK. Operational
trial. BMJ 2005; 330: 874. criteria for senile dementia of Lewy body type (SDLT). Psychol Med
Berger J The necessity of musical hallucinations. Nautilus Online blog. 1992; 22: 911–22.
January 29, 2015. Issue 20. Chapter 4. “Creativity” http://nautil. Mori T, Ikeda M, Fukuhara R, Sugawara Y, Nakata S, Matsumoto N,
us/issue/20/creativity/the-necessity-of-musical-hallucinations. et al. Regional cerebral blood flow change in a case of Alzheimer’s
Berrios GE. Musical hallucinations. A historical and clinical study. Br J disease with musical hallucinations. Eur Arch Psychiatry Clin
Psychiatry 1990; 156: 188–94. Neurosci 2006; 256: 236–9.
Burke W. The neural basis of Charles Bonnet hallucinations: a hypoth- Nagaratnam N, Virk S, Brdarevic O. Musical hallucinations associated
esis. J Neurol Neurosurg Psychiatry 2002; 73: 535–41. with recurrence of a right occipital meningioma. Br J Clin Pract
Calabro RS, Baglieri A, Ferlazzo E, Passari S, Marino S, Bramanti P. 1996; 50: 56–7.
Neurofunctional assessment in a stroke patient with musical hallu- Nikolajsen L, Jensen TS. Phantom limb pain. Br J Anaesth 2001; 87:
cinations. Neurocase 2012; 18: 514–20. 107–16.
Cole MG, Dowson L, Dendukuri N, Belzile E. The prevalence and Ozsarac M, Aksay E, Kiyan S, Unek O, Gulec FF. De novo cerebral
phenomenology of auditory hallucinations among elderly subjects arteriovenous malformation: Pink Floyd’s song “Brick in the Wall”
attending an audiology clinic. Int J Geriatr Psychiatry 2002; 17: as a warning sign. J Emerg Med 2012; 43: e17–20.