Visual signs and symptoms of Parkinson's disease: Review

Vision Sciences, Aston University, Birmingham, UK.
Clinical and Experimental Optometry (Impact Factor: 1.34). 04/2008; 91(2):129-38. DOI: 10.1111/j.1444-0938.2007.00211.x
Source: PubMed


Parkinson's disease (PD) is a common disorder of middle-aged and elderly people, in which there is degeneration of the extra-pyramidal motor system. In some patients, the disease is associated with a range of visual signs and symptoms, including defects in visual acuity, colour vision, the blink reflex, pupil reactivity, saccadic and smooth pursuit movements and visual evoked potentials. In addition, there may be psychophysical changes, disturbances of complex visual functions such as visuospatial orientation and facial recognition, and chronic visual hallucinations. Some of the treatments associated with PD may have adverse ocular reactions. If visual problems are present, they can have an important effect on overall motor function, and quality of life of patients can be improved by accurate diagnosis and correction of such defects. Moreover, visual testing is useful in separating PD from other movement disorders with visual symptoms, such as dementia with Lewy bodies (DLB), multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). Although not central to PD, visual signs and symptoms can be an important though obscure aspect of the disease and should not be overlooked.

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    • "As evidenced in two independent studies [32,33] and the phenomena itself previously described in other studies [56,57], one of the first signs of an affected oculomotor function might be an inability to maintain steady and accurate control of smooth pursuit movements within acceptable velocity boundaries over longer periods of time. Furthermore, Armstrong suggests that this method might prove successful for evaluating PD [58]. In the present study and in previous studies [11,16,40,41], the traditional smooth pursuit gain analysis also provided significant statistical evidence for an altered smooth pursuit function, but not with the same high statistical sensitivity as the velocity accuracy parameter. "
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    ABSTRACT: Background Deep brain stimulation (DBS) in the subthalamic nucleus (STN) significantly reduces symptoms of Parkinson’s disease (PD) such as bradykinesia, tremor and rigidity. It also reduces the need for anti-PD medication, and thereby potential side-effects of L-Dopa. Although DBS in the STN is a highly effective therapeutic intervention in PD, its mechanism and effects on oculomotor eye movement control and particularly smooth pursuit eye movements have to date rarely been investigated. Furthermore, previous reports provide conflicting information. The aim was to investigate how DBS in STN affected oculomotor performance in persons with PD using novel analysis techniques. Methods Twenty-five patients were eligible (22 males, 3 females) according to the clinical inclusion criteria: idiopathic PD responsive to L-Dopa and having had bilateral STN stimulation for at least one year to ensure stable DBS treatment. Fifteen patients were excluded due to the strict inclusion criteria applied to avoid interacting and confounding factors when determining the effects of DBS applied alone without PD medication. One patient declined participation. Nine PD patients (median age 63, range 59–69 years) were assessed after having their PD medications withdrawn overnight. They were examined with DBS ON and OFF, with the ON/OFF order individually randomized. Results DBS ON increased smooth pursuit velocity accuracy (p < 0.001) and smooth pursuit gain (p = 0.005), especially for faster smooth pursuits (p = 0.034). DBS ON generally increased saccade amplitude accuracy (p = 0.007) and tended to increase peak saccade velocity also (p = 0.087), specifically both saccade velocity and amplitude accuracy for the 20 and 40 degree saccades (p < 0.05). Smooth pursuit latency tended to be longer (p = 0.090) approaching normal with DBS ON. Saccade latency was unaffected. Conclusions STN stimulation from DBS alone significantly improved both smooth pursuit and saccade performance in patients with PD. The STN stimulation enhancement found for oculomotor performance suggests clear positive implications for patients’ ability to perform tasks that rely on visual motor control and visual feedback. The new oculomotor analysis methods provide a sensitive vehicle to detect subtle pathological modifications from PD and the functional enhancements produced by STN stimulation from DBS alone.
    Journal of NeuroEngineering and Rehabilitation 04/2013; 10(1):33. DOI:10.1186/1743-0003-10-33 · 2.74 Impact Factor
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    • "Researchers are investigating various possibilities including viruses, environmental factors, aging and genetic causes [11], [12], [1], but no definitive answer can be given at this point in time. "
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    ABSTRACT: Here the research focus of a dissertation is presented. It focuses on evaluation and improvement of algorithms for recognizing Parkinson’s Disease (PD) motor symptoms in time series data. PD is a disorder of the central nervous system resulting in a loss of motor function, increased rigidity and slowness. Through application of artificial intelligence (AI)-based techniques, the occurrence of symptoms such as tremor or bradykinesia can be indicated in time series generated by sensors worn on the patient’s body. Those affected by PD bear a great burden and have to cope with a rather reduced quality of life. Minimizing false negatives and false positives enables a better treatment of people with PD as the applied drug dosage can be set in accordance with currently apparent symptoms (rather than a global dosage as current treatments employ). The paper gives an overview for a doctoral colloquium to discuss the intended research questions.
    ICTMH Workshop, Bremen/Germany; 03/2013
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    • "Numerous studies have shown that individuals with PD demonstrate visual and high-order spatial impairments on laboratory-based assessments that cannot be accounted for by motor or executive dysfunction. Visual impairments and in particular, reduced contrast sensitivity, are well established [3] [4] [5] [6] [7]. In regard to visuospatial abilities, PD patients are impaired on global/local processing [8], a skill independent of executive demands, as well as mental rotation, way finding, visual construction, visuospatial reasoning, and angle size estimation [9] [10] [11] [12]. "
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    ABSTRACT: Visual and visuospatial dysfunction is prevalent in Parkinson's disease (PD). To promote assessment of these often overlooked symptoms, we adapted the PD Vision Questionnaire for Internet administration. The questionnaire evaluates visual and visuospatial symptoms, impairments in activities of daily living (ADLs), and motor symptoms. PD participants of mild to moderate motor severity (n = 24) and healthy control participants (HC, n = 23) completed the questionnaire in paper and web-based formats. Reliability was assessed by comparing responses across formats. Construct validity was evaluated by reference to performance on measures of vision, visuospatial cognition, ADLs, and motor symptoms. The web-based format showed excellent reliability with respect to the paper format for both groups (all P's < 0.001; HC completing the visual and visuospatial section only). Demonstrating the construct validity of the web-based questionnaire, self-rated ADL and visual and visuospatial functioning were significantly associated with performance on objective measures of these abilities (all P's < 0.01). The findings indicate that web-based administration may be a reliable and valid method of assessing visual and visuospatial and ADL functioning in PD.
    03/2012; 2012(1):564812. DOI:10.1155/2012/564812
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