{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T12:20:50Z","timestamp":1770898850708,"version":"3.50.1"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Visual hallucinations are a core feature of dementia with Lewy bodies and primary psychiatric disease, yet identification of a hallucination vs normal spiritual experience depends on cultural context. Almost no information exists in the medical literature regarding normal spiritual experiences in American Indian participants in the context of a neurocognitive evaluation.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess the characteristics of a normal spiritual experience in an Ojibwe Tribal Nation.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This prospective, cross-sectional study was conducted between August 1, 2021, and August 31, 2022, among an Ojibwe Tribal Nation in northern Minnesota. Participants were evaluated at their tribal nation clinic. Cognitively unimpaired tribal Elders who were enrolled members of the tribal nation and aged 55 years or older were invited to participate via fliers, radio advertisements, and health fair presentations. Thirty-seven tribal Elders volunteered.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Each participant was asked whether they experienced hallucinations or visions of people, animals, or objects that are not part of the physical world. This was an a priori formulated question and part of a comprehensive neurocognitive evaluation consisting of history and physical examination (including cognitive screening with a subspecialty-trained behavioral neurologist); blood tests for metabolic, nutritional, and thyroid conditions; and noncontrast magnetic resonance imaging brain scan. Four patients were excluded from the present analysis due to having mild cognitive impairment or dementia.<\/jats:p><\/jats:sec>Results<\/jats:title>Thirty-three cognitively unimpaired tribal Elders (mean [SD] age, 66.0 [7.5] years; 22 women [67%]) were included. Sixteen (48%) answered affirmatively, reporting recurrent visions of the nonphysical world. Generally, these visions were well formed, benevolent in nature, and transient; started in preadolescence; involved spirits or ancestors; and were congruent with cultural and spiritual beliefs of the Ojibwe people. No patients had accompanying dream enactment behavior, dysautonomia, parkinsonism, sleep transition\u2013related hallucinations, or moderate to severe depression to suggest a prodrome of an \u03b1-synucleinopathy, hypnopompic or hypnagogic hallucinations, or psychosis.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Although based on only 1 Ojibwe Tribal Nation, this study suggests that formed visions of the nonphysical world are common among cognitively healthy Ojibwe individuals and can represent normal spiritual experiences. Clinicians would benefit from careful consideration of cultural or spiritual context to avoid misdiagnosis of neuropsychiatric disease.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.38221","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T15:04:38Z","timestamp":1697641478000},"page":"e2338221","source":"Crossref","is-referenced-by-count":1,"title":["Characteristics of Recurrent Visions of the Nonphysical World Among Cognitively Unimpaired Elders of an Ojibwe Tribal Nation"],"prefix":"10.1001","volume":"6","author":[{"given":"William G.","family":"Mantyh","sequence":"first","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam D.","family":"Block","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madelyn R.","family":"Castro","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis"},{"name":"Department of Psychological Sciences, Rice University, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Hansen","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matti J.","family":"Matheson","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Minnesota, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"Jr","given":"Corey","family":"Strong","sequence":"additional","affiliation":[{"name":"Bois Forte Health Services, Bois Forte Band of Chippewa, Nett Lake, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annamarie","family":"Hill","sequence":"additional","affiliation":[{"name":"Memory Keepers Medical Discovery Team, University of Minnesota Duluth, Duluth"},{"name":"Community Outreach, Strategy, External Relations, University of Minnesota Duluth, Duluth"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zuzan","family":"Cayci","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Minnesota, Minneapolis"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Neil","family":"Henderson","sequence":"additional","affiliation":[{"name":"Memory Keepers Medical Discovery Team, University of Minnesota Duluth, Duluth"},{"name":"Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth, Duluth"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"issue":"1","key":"zoi231123r2","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1212\/WNL.0000000000004058","article-title":"Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB Consortium.","volume":"89","author":"McKeith","year":"2017","journal-title":"Neurology"},{"issue":"3","key":"zoi231123r3","doi-asserted-by":"publisher","first-page":"362","DOI":"10.14283\/jpad.2023.30","article-title":"Lecanemab: appropriate use recommendations.","volume":"10","author":"Cummings","year":"2023","journal-title":"J Prev Alzheimers Dis"},{"key":"zoi231123r6","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igaa038","author":"Jacklin","year":"2020","journal-title":"Innov Aging"},{"issue":"3","key":"zoi231123r7","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d: a practical method for grading the cognitive state of patients for the clinician.","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"issue":"3","key":"zoi231123r8","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.jalz.2011.03.008","article-title":"The diagnosis of mild cognitive impairment due to Alzheimer\u2019s disease: recommendations from the National Institute on Aging\u2013Alzheimer\u2019s Association workgroups on diagnostic guidelines for Alzheimer\u2019s disease.","volume":"7","author":"Albert","year":"2011","journal-title":"Alzheimers Dement"},{"issue":"2","key":"zoi231123r9","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1212\/WNL.43.2.250","article-title":"Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop.","volume":"43","author":"Rom\u00e1n","year":"1993","journal-title":"Neurology"},{"issue":"3","key":"zoi231123r10","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1093\/brain\/awaa413","article-title":"Psychosis in neurodegenerative disease: differential patterns of hallucination and delusion symptoms.","volume":"144","author":"Naasan","year":"2021","journal-title":"Brain"},{"issue":"3","key":"zoi231123r14","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/S1474-4422(18)30028-0","article-title":"Spatial patterns of neuroimaging biomarker change in individuals from families with autosomal dominant Alzheimer\u2019s disease: a longitudinal study.","volume":"17","author":"Gordon","year":"2018","journal-title":"Lancet Neurol"},{"issue":"1","key":"zoi231123r15","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1212\/WNL.0000000000001096","article-title":"Factors associated with cognitive evaluations in the United States.","volume":"84","author":"Kotagal","year":"2015","journal-title":"Neurology"},{"issue":"11","key":"zoi231123r16","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1007\/s11606-007-0317-y","article-title":"Practice constraints, behavioral problems, and dementia care: primary care physicians\u2019 perspectives.","volume":"22","author":"Hinton","year":"2007","journal-title":"J Gen Intern Med"},{"issue":"2","key":"zoi231123r17","doi-asserted-by":"publisher","first-page":"91","DOI":"10.22454\/FamMed.2018.184803","article-title":"A time-motion study of primary care physicians\u2019 work in the electronic health record era.","volume":"50","author":"Young","year":"2018","journal-title":"Fam Med"},{"issue":"6","key":"zoi231123r18","first-page":"34","article-title":"Putting pre-visit planning into practice.","volume":"22","author":"Sinsky","year":"2015","journal-title":"Fam Pract Manag"},{"key":"zoi231123r19","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.jpsychires.2015.08.005","article-title":"The exclusion of people with psychiatric disorders from medical research.","volume":"70","author":"Humphreys","year":"2015","journal-title":"J Psychiatr Res"},{"issue":"1","key":"zoi231123r20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40478-021-01282-8","article-title":"High diagnostic performance of independent alpha-synuclein seed amplification assays for detection of early Parkinson\u2019s disease.","volume":"9","author":"Russo","year":"2021","journal-title":"Acta Neuropathol Commun"},{"issue":"5","key":"zoi231123r21","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1212\/WNL.0000000000200878","article-title":"a-Synuclein seed amplification assays for diagnosing synucleinopathies: the way forward.","volume":"99","author":"Bellomo","year":"2022","journal-title":"Neurology"},{"issue":"5","key":"zoi231123r22","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1001\/jamaneurol.2016.6117","article-title":"Association of plasma neurofilament light with neurodegeneration in patients with Alzheimer disease.","volume":"74","author":"Mattsson","year":"2017","journal-title":"JAMA Neurol"},{"issue":"5","key":"zoi231123r23","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1016\/S1474-4422(20)30071-5","article-title":"Blood phosphorylated tau 181 as a biomarker for Alzheimer\u2019s disease: a diagnostic performance and prediction modelling study using data from four prospective cohorts.","volume":"19","author":"Karikari","year":"2020","journal-title":"Lancet Neurol"},{"key":"zoi231123r1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th ed"},{"key":"zoi231123r4","unstructured":"National Endowment for the Humanities. Anishinabe\/Ojibwe\/Chippewa: culture of an Indian Nation. Accessed August 28, 2023. https:\/\/edsitement.neh.gov\/lesson-plans\/anishinabeojibwechippewa-culture-indian-nation"},{"key":"zoi231123r5","unstructured":"United States Census Bureau. American Community Survey: American Indian and Alaska Native alone for selected tribal groupings. 2021. Accessed March 20, 2023. https:\/\/data.census.gov\/table?q=American+Indian+and+Alaska+Native&tid=ACSDT1Y2021.B02014"},{"key":"zoi231123r11","unstructured":"Ondich? J. World Religions: The Spirit Searching. Creative Commons; 2021. Accessed August 28, 2023. https:\/\/mlpp.pressbooks.pub\/worldreligionsthespiritsearching\/"},{"key":"zoi231123r12","unstructured":"Federal Register. Indian entities recognized by and eligible to receive services from the United States Bureau of Indian Affairs. January 29, 2021. Accessed May 2, 2023. https:\/\/www.federalregister.gov\/documents\/2021\/01\/29\/2021-01606\/indian-entities-recognized-by-and-eligible-to-receive-services-from-the-united-states-bureau-of"},{"key":"zoi231123r13","unstructured":"Forbes? JD. Indigenous Americans: spirituality and ecos.? Daedalus. 2001;130(4):283-300. Accessed September 14, 2023. https:\/\/www.jstor.org\/stable\/20027728"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2810823\/mantyh_2023_oi_231123_1700243237.94383.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T16:06:25Z","timestamp":1701187585000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2810823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":23,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.38221","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,18]]}}}